Practicing social distancing, mask wearing and handwashing — all of which help mitigate the spread of COVID-19 — “are not only going to affect COVID, but other respiratory viruses,” as well, Robert Redfield, M.D., director of the Centers for Disease Control and Prevention, told McKnight’s in July.

Similarly, the flu shot must play a bigger role this year in long-term care facilities, where staff vaccination rates have remained below 70%, he said.  

Nancy Losben, a consultant pharmacist for Omnicare, a CVS Health company, agreed. 

“Everybody on the nursing home staff needs to receive their vaccination,” she said during a McKnight’s webinar in August.

Many myths persist with the flu vaccine, she noted, including the misconceptions that it can cause the flu and Alzheimer’s disease. 

At the head of the class was Wendy Simpson, chairman and CEO of LTC Properties. Mc-
Knight’s honored her with a Lifetime Achievement Award during the 90-minute event, which went online due to the pandemic.

The second annual event, which recognizes women leaders in skilled nursing and senior living, presented video montages featuring of all the honorees. Key leaders in the field, along with the chairman and ranking member of the Senate Special Committee on Aging, also provided video testimonials.

“Your dedication to provide a full and enriched life to our older relatives and friends makes such a positive difference,” Committee Chairman Sen. Susan Collins (R-ME) said during the program.

Register at the following link to see the ceremony: https://bit.ly/3gqDnjr.

Read more about the 2020 McKnight’s Women of Distinction observations on page 24.

New quadrivalent formulations of high-dose and adjuvanted influenza vaccines are in production for older adults. Fluzone High-Dose Quadrivalent (HD-IIV4) is intended to replace the trivalent formulation of Fluzone High-Dose (HD-IIV3). In contrast, the new Fluad Quadrivalent (aIIV4) also will be made available. Fluad Quadrivalent contains an adjuvant intended to strengthen the immune response. 

There was no meaningful improvement in shortages overall from May to July 2020, investigators from the University of Rochester, New York, and Harvard  University reported in late August. Equipment shortages — most often of masks and gowns — were noted nationwide. 

A quarter of U.S. counties had at least 44% of nursing homes reporting staff shortages, most often of nurses and aides.

A day prior to the announcement, CMS Administrator Seema Verma had said on a stakeholder conference call with nursing home stakeholders, “We are here to help you and support you. This isn’t a time of fines and being punitive.” 

More than 3,400 nursing homes overall had been cited for noncompliance with infection control requirements or failure to report COVID-19 data to federal authorities.

Verma attributed an alarming rise in coronavirus infections to nearby communities bringing in more infections, but also to a troubling degree of infection control lapses by providers.

Providers also will be required to test residents and staff in the event of a new case or if someone shows symptoms, the new regulations say.

The Centers for Medicare & Medicaid Services disclosed the new regulatory changes in late August. The move is part of an overall effort by the federal government to identify asymptomatic staff and residents who may be infected and could transmit the virus in facilities, CMS Administrator Seema Verma explained.

Surveyors can cite facilities for noncompliance with the new regulations. Cited providers would be required to implement a plan of correction and follow other regulatory instructions. 

Fines for noncompliance will start at $400 per day and can range up to $8,000, with termination from the Medicare and Medicaid programs the ultimate punishment. 

Providers also could face denial of payment for new admissions.

“These new rules represent a dramatic acceleration of our efforts to track and control the spread of COVID-19, especially in nursing homes,” Verma said. “Reporting of test results and other data … give providers on the front lines what they need to fight [the virus].” 

The Centers for Medicare & Medicaid Services released details about the program in late August. The program, which is available to all Medicare- and Medicaid-certified nursing homes, is a tailored course that incorporates the most recent lessons learned by nursing homes during the ongoing pandemic. It also features best practices that frontline workers can implement to fight COVID-19 in their facilities.

There are five training modules for staff members and 10 modules for management. The training program for staff members covers multiple concerns found by surveyors and strike teams. Topics include: hand hygiene and personal protective equipment, screening and surveillance, cleaning, cohorting, and caring for residents with dementia during the pandemic. 

Training for management  targets such issues as implementation of telehealth, emergency preparedness and vaccine delivery.

The program was originally announced in late July.

A:If the American public fully embraces the mitigation strategies that we continue to advocate [social distancing, mask wearing and handwashing] … we’ll have a very mild flu season. Or we could end up with two serious pathogens coming through at the same time and, as a consequence, have a very difficult time in terms of our response.

Q: What can long-term care operators do specifically on the flu front? 

A:I need healthcare workers … to embrace the flu vaccine. 

Q: How can operators improve the flu vaccination rate in facilities?

A:Make it a requirement, like it had been made for me to work in my hospital when I practiced medicine.

Q: How is the National Healthcare Safety Network using nursing home data to fight COVID-19?

A:It’s a very important tool for us to understand the extent of COVID. It’s also a tool that we can use to begin to have real-time data on the parameters of COVID infection within long-term care facilities, particularly as new therapies are developed, which may have unique benefits under specific circumstances of COVID infection. 

Larger facilities and operations that provide on-site ventilator or hemodialysis services should employ a full-time, trained staff member in that position, the Centers for Disease Control and Prevention said in a recently updated guidance.

 This position is necessary to cover all needed aspects of COVID-19 infection control. Those include developing policies and procedures, offering competency-based staff training and auditing protocol adherence, it said. 

Also in late June, the CDC expanded upon its list of chronic health conditions that put people at risk for notably severe outcomes from COVID-19.

While risk increases with age, people of any age are more likely to be hospitalized, admitted to an intensive care unit or face health complications and death when they have certain conditions.

Those include the following: obesity with a body mass index of 30 or higher; chronic obstructive pulmonary disease; chronic kidney disease; serious heart conditions, such as heart failure and coronary artery disease; sickle cell disease; type 2 diabetes; and immunocompromised state from solid organ transplant. 

The retrospective study analyzed data from 2,777 facilities operating in urban areas across 41 states between 2011 and 2014. Beyond a link between ratings and admissions, the researchers assessed the influence of market-level wages for certified nursing assistants and state Medicaid behavioral and mental health add-on policies. 

Quality measures were based on Nursing Home Compare ratings published by the Centers for Disease Control and Prevention. Highly rated operations had 3% fewer newly admitted residents with Alzheimer’s than low-quality facilities, first author Di Yan, of the University of Rochester reported.

CNA pay was also a factor. A $1 increase in hourly wage was linked to a 0.9% decrease in the prevalence of these adults among newly admitted residents. In contrast, a state Medicaid behavioral and mental health add-on policy conferred a 2.5% increase in the prevalence of Alzheimer’s in high-quality, but not low-quality, facilities.

Study results were published in JAMDA.