Since June, CMS has required states to perform on-site infection control-focused surveys by the end of July at nursing homes with previous COVID-19 outbreaks, or within three to five days of any nursing home with three or more new confirmed cases since their last report to the National Health Care Safety Network.

The agency added five other factors that would trigger a survey. In addition to the presence of multiple new cases and consistently low staffing, new factors are: facilities selected for Special Focus Facility designation; facilities causing concerns related to conducting outbreak testing; and facilities that have had “Immediate Jeopardy” allegations or complaints lodged against them.

CMS said it will work with state surveyors to identify facilities meeting the new criteria.  

“Facilities that meet the criteria above to trigger a FIC (focused infection control) survey do not need to be resurveyed if a FIC survey was conducted (as a stand-alone FIC survey or as part of a recertification survey) within the previous three weeks,” the agency explained.  

“For example, if a facility is surveyed with a FIC survey within three to five days after meeting the criteria, and the same facility meets the criteria for being surveyed within three to five days in any of the next three weeks, the survey team does not need to conduct another survey within those three weeks. However, if the facility meets the criteria for a survey in the fourth week after a FIC survey was conducted, an additional FIC survey must be conducted within three to five days.”

The Department of Health and Human Services announced in December it was immediately distributing $523 million to the providers.

The payments represented the second round of payments to facilities under the performance-based payment program that aims to keep nursing home COVID-19 rates lower than the surrounding communities they serve. 

The incentive program was initially announced in August and gauges providers on two measured outcomes: COVID-19 infection rates and mortality rates. HHS distributed $333 million to more than 10,000 nursing homes during the first round of performance payments. 

Two more monthly rounds, plus an overall rewards period, were still on tap at press time.

HHS found that 69% of eligible facilities met infection control criteria for the second round of the incentive program, while 68% met the mortality criteria during this round. The agency added that the collective efforts of these nursing homes resulted in about 3,900 fewer infections relative to the rates seen in the communities where they exist. 

The authorization to resume the survey and certification process has been given by the Centers for Medicare & Medicaid Services. States may be resuming, or making plans to resume surveys other than FICS or complaints.  

Health inspections and quality measures will be added into the Five Star Quality Rating System calculations beginning Jan. 27, 2021. In QSO 21-06-NH released on Dec. 4, CMS addresses the temporary waivers that impacted the information used to calculate the Five Star rating as well as the nursing home compare website. Of significant interest is that the focused infection control inspections will be used to calculate the rating and incorporated the same way complaint surveys are used. 

Quality measures will be updated using data based on the collection period ending June 30, 2020.  While waivers have been in place for the time frames to submit MDS data, they are still receiving enough data to calculate the QMs, “analyze for significant changes and take any actions needed to improve and protect resident health and safety.”

If you have not been monitoring your data, or acting on it, now is a good time to start. With the isolation of our residents from COVID-19 over the last nine months, we have all noticed the changes: increased depression, weight loss, and changes in cognitive or functional status.

These can and will be hot spots for surveyors. For those residents who have had significant changes, review the documentation and timeline as to what occurred and what the facility did to attempt to mitigate decline (was it avoidable?). 

Also, ensure that all data needed to be submitted for QRP and VBP have been captured. 

The survey showed that 39.4% were “more optimistic” while 37.4% were “less optimistic.” Nearly 24% said they thought prospects “are about the same” under a Biden administration as under the Trump administration.

Results reflect answers from 313 McKnight’s Long-Term Care News readers, including owners, administrators and nurse managers, who responded to solicitations emailed from Dec. 7–12 — about a month before a riot broke out at the U.S. Capitol, to which five deaths and dozens of arrests had been attributed, as of press time.

Survey participants said that keeping sufficient staff and rebuilding census levels were their top two concerns for 2021, with the availability of personal protective equipment a distant third.

Meanwhile, fewer than 15% of respondents said their organizations would mandate COVID-19 vaccinations for staff members and more than 70% gave favorable reviews to the point-of-care test kits being heavily pushed by federal officials.

Results also pointed to top strategies being employed to recruit and retain staff and favored ways to help employees’ well-being, among other areas.

Administrators, as a subgrouping of respondents, were the most pessimistic about potential Biden administration policies, while LTC execs were most favorable.

Democrats, in general, are considered more likely to add to the regulatory burden for providers, and Biden has shown signs of upholding that trend. 

“I wouldn’t be more surprised to see more regulations coming,” said Bill McGinley, CEO of the American College of Health Care Administrators. 

Old worries worsen

“Having enough staff” was the nearly unanimous top worry for 2021, with 88% of survey respondents picking it as one of their four biggest concerns. “Rebuilding or keeping enough census” (82%), “Having enough PPE” (44%) and “COVID-related legal/liability claims” (40%) were next in the 10-choice field.

PPE, which would not have been in anybody’s top 10 a year ago, was the No. 3-rated concern for all groups except owners. The top execs elevated legal/liability concerns into the third slot with a 58% vote, relegating PPE to its seventh-most popular pick (27%).

POC tests a surprise

Although well below 20% of respondents said they would mandate that employees get vaccinated against COVID-19, the percentage shot up to 38% when asked whether employees should be required to get vaccinated.

Nearly three-fourths (72%) said that government-supplied point-of-care tests are either great and being used “as much as possible” or “not great, but we’re going to do the best we can with them.” This was in stark contrast to recent government and academic findings that showed a huge percentage of operators were making sparse use of the units, if at all.

How to recruit, keep staff

Offering bonuses to staff for referrals (54%), as well as sign-on bonuses (41%) and bonus pay at the six-month employment mark (18%) turned up as three of the top strategies for improving recruitment and retention.

The next most popular approaches were offering flexible scheduling (38%) and creating part-time positions (33%) to allow workers more family time.

The survey also found that the No. 1 tactic for trying to help staff weather the pandemic has been providing small gifts (such as pizza parties and cookies at nursing stations). A total of 75.1% of respondents said that has been effective.

For the question, “How do you rate your job satisfaction right now?” respondents averaged 6.8 overall on a scale of 1 to 10. 

The Pennsylvania Health Care Association, LeadingAge Pennsylvania and the Pennsylvania Coalition of Affiliated Healthcare & Living Communities filed a lawsuit against the state in December, demanding that state officials reallocate the funding to providers.

The Families First Coronavirus Response Act, the first federal stimulus package for the pandemic, provided increased Medicaid funding, which resulted in an increase to the Federal Medical Assistance Percentage (FMAP) of about $153 million, according to the suit. “At a time when they need assistance the most, the Department is unlawfully withholding over $153 million in additional payments from certain nursing facilities,” the suit stated. 

 Instead of providing the supplemental payments to nursing homes, the state has used the money to fill budget holes for other programs. It has used the funding “as its own piggybank,” the suit said.

“The department’s refusal to distribute the federal funds is particularly egregious here because the funds were only received as a result of assessments paid by the nursing facilities,” the lawsuit stated.  

Zach Shamberg, PHCA’s president and CEO, added that providers know Pennsylvania officials want the best for long-term care residents; the best way to achieve the shared goal is for the state to immediately distribute the funds. 

“Despite our best efforts during months of negotiations, the commonwealth has refused to distribute this funding to our long-term care providers on the front lines of the COVID-19 pandemic, jeopardizing mitigation efforts and the safety of the residents in our care,” Shamberg said.

New Jersey’s Department of Health missed the Dec. 7 date that required the state to submit information on all of its registered long-term care facilities in order for the state to begin the federal vaccination program. 

Officials missed that deadline by a day because of the “volume of information that had to be inputted,” according to State Health Commissioner Judy Persichilli. 

“We asked to start on the 21st and they said, no, you will start on the 28th,” Persichilli said during a press conference. 

Following the state’s missed deadline, the interim CEO of the Health Care Association of New Jersey told local media that “nursing home residents and staff are looking forward to the start of this important immunization program, and are coordinating with CVS and Walgreens to maximize success.” 

New Jersey Senate minority leader Tom Kean Jr. (R) called the delay “unbelievable and totally unacceptable.”

“After more than 7,100 lives were lost in New Jersey’s nursing homes and veterans homes, you would think the [Gov. Phil] Murphy (D) administration would waste no effort to ensure that the remaining residents would be vaccinated as quickly as possible,” Kean said. 

“Instead, those vulnerable seniors, our parents and grandparents, will remain at risk even longer over the administration’s failure to file simple paperwork on time,” he added.

Torrington Health & Rehabilitation Center, a closed nursing home that reopened this year, was scheduled to begin receiving sick residents the first week of December. Recovery centers allow nursing homes to transfer their COVID-19 residents there for treatment while they manage the rest of their residents, the CT Mirror reported. They also accept COVID-positive discharges from hospitals, and residents from assisted living facilities who contract the coronavirus.

Connecticut providers have previously stressed the need for creating COVID-only recovery centers since early in the pandemic. The goal is to help create additional bed space and prevent the disease from spreading throughout facilities.

“The trick is to keep it from getting into the building,” Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, told the Mirror. “When you find people in the building that have it, try to get those people out of the facility, or get the well people out. So we’re looking at the concept of COVID-19-specific nursing facilities, at least for the time being during the pandemic,” he added. 

The Oklahoma State Department of Health on Nov. 19 issued a notice to providers allowing the practice as a mitigation tactic against staffing shortages. It said providers should first “carefully consider all other alternatives and only take such measures as a last resort.” The state added that “this practice should be used to the minimal extent possible.”

The department later issued a revised notice on Nov. 23, clarifying that nursing home providers must first notify the OSDH Long-Term Care Department prior to engaging in the strategy. 

“At the end of the day, our utmost concern is for the health and safety of our residents and the staff,” Mary Brinkley, LeadingAge Oklahoma executive director, told McKnight’s Long-Term Care News.

“The health department has not issued any guidance for the requirements to use the asymptomatic staff. All they require is that you request approval,” she added. 

In addition to the lack of guidance, Brinkley noted that there are concerns among nursing homes about the risk the measure could pose for other non-infected residents and staff in those facilities. She added that COVID-positive workers also may not feel comfortable working under those conditions. 

“It has to be done in a very carefully controlled environment,” Brinkley explained. 

Iowa also has issued updated emergency staffing guidance that allows for workers with confirmed COVID-19 to care for residents who are also positive or suspected of having the disease. The measure also allows workers with COVID-19 to care for residents without the disease but only in “last resort emergency staffing situations.”

Officials with Los Angeles County added that the change would “support both quicker vaccination and higher vaccination coverage” than the federal government’s partnership program with pharmacy chains CVS Health and Walgreens, according to a report in the Wall Street Journal. 

They added that the move will allow facilities to vaccinate people without having to wait to schedule a visit from the pharmacy retailers and to alternate when shots are given, according to the report. 

The move was a surprise to providers, according to the California Association of Health Facilities. The group said that there are both pros and cons to the decision. 

There are concerns about operational issues, as facilities will now have to take over documentation and other requirements, instead of outsourcing the process, according to re authors.

 On the flip side, the change “will allow facilities to stagger the delivery of the vaccine, avoiding a scenario where everyone is experiencing side effects at one time,” the spokeswoman told the news agency.