The Centers for Medicare & Medicaid Services mandated that nursing homes detail all COVID-19 cases directly to the Centers for Disease Control and Prevention, along with residents and families. The fine for failing to do so within 12 hours of learning about them will be “at least” $1,000 per week, CMS Administrator Seema Verma said. An initial grace period to test the system was to start around the final week of April. 

The COVID-19 rates would be posted publicly, she added. Previously, providers only had to report cases to local health authorities. 

The orders came as providers faced increasing criticism for failing to notify residents and families about the COVID-19 situation in their buildings. Total deaths at long-term care facilities — including nursing homes and assisted living facilities — reached 5,670 as of mid-April, according to NBC News, which compiled data from states that made it available. 

“We feel like we’ve been forgotten,” Mark Parkinson, the president and CEO of the American Health Care Association and National Center for Assisted Living, said in a widely publicized CNN interview. “It’s great the way we’ve rallied around the hospitals … [B]ut the front lines are nursing homes. If we don’t stop it in nursing homes, we’re not going to stop it in hospitals. So far, the country just hasn’t figured that out.”

Parkinson said it felt like providers were “fighting this incredible battle with two hands tied behind our back[s].” One “hand” was a lack of masks, while the other was a lack of complete testing. Regulators moved quickly to improve reimbursement and availability for tests not long after Parkinson’s impassioned plea. 

It was a month earlier that Parkinson first grabbed the nation’s attention, near the onset of the U.S. novel coronavirus outbreak, when he told the same CNN host, Kate Bolduan, that “COVID-19 is almost a perfect killing machine” for the elderly. 

The call led to a flurry of individuals creating homemade masks from cloth and other materials. Usually cloth is not deemed sufficient, but a persistent shortage of medical-grade face masks at nursing homes and other healthcare settings helped push the administration in this direction. Nursing homes repeatedly have appealed to health agencies for more proper  personal protective equipment.

The administration also made it clear that it wants all nursing home personnel to wear face masks “for the duration of the state of emergency in their state” and for every person in a facility to be screened for signs of the coronavirus.

Judge Michael P. Shea ruled in March that as a matter of constitutional due process, patients who are initially admitted as inpatients by a physician but whose status is later changed to observation by their hospital have the right to appeal to Medicare to be certified fully as hospital inpatients.

The government could still appeal the ruling. n

California launched its Skilled Nursing Facility Hero Awards in April. It was funded by a $25 million donation from Facebook. 

The awards will provide 50,000 licensed vocational nurses and certified nurse assistants who work in SNFs a one-time, $500 stipend.

“We’re grateful for all the incredible work California’s critical staff in nursing facilities are doing to save lives and help combat COVID-19,” Facebook founder and CEO Mark Zuckerberg said. 

A:It’s a multiyear campaign. Our first phase is to raise awareness of long-term care and post-acute care (PAC) nursing opportunities. The video (at http://www.aapacn.org/nurseheroes) is a great presentation of leadership and career opportunities available to LTC and PAC nurses.

Q: How big a problem is nurse retention and recruitment?

A:When we ask our members what keeps them awake at night, workforce retention and recruitment are their biggest challenges. We need to shine more attention on this segment to recruit additional healthcare providers. Looking forward, in 30 years, over 20% of our population will be over age 65, with more than 23 million adults requiring specialized care. However, 60% of our current LTPAC nurses retire before then. We don’t have a sufficient workforce to replace them as they retire, so we need to rebuild this workforce.

Q: How do you know the campaign will be successful?

A:We will track the number of nurses in LTPAC roles. Our members will tell us that this is no longer their biggest challenge, and long term we’ll see a greater number of nurses in LTPAC. 

Centers for Medicare & Medicaid Services Administrator Seema Verma said the new, “unprecedented” reporting requirement — which is in addition to the traditionally expected local health department reporting — was being implemented because providers weren’t doing enough on their own.

“The nursing home association even a week ago put out recommendations that nursing homes inform patients and their families, but we understood that that wasn’t happening so we went a step further to make that a requirement,” she said at a press briefing held on April 20. 

Both the American Health Care Association and Leading-
Age on April 11 urged nursing homes to inform residents and families about cases.

“This nationwide reporting system will create a crucial element of the surveillance and monitoring system in communities so we can quickly identify outbreaks, conduct contact tracing and stem outbreaks at the community level” for numerous kinds of infections, Verma added.

“If we are very focused on nursing homes and we can see early outbreaks in nursing homes, that can be an early predictor for the entire community.”

But LeadingAge’s top lawyer warned that duplicative reporting (to different health authorities, with possibly different criteria) is “a recipe for unfortunate disaster.” 

“Documentation is critical,” said Christy Tosh Crider, chair of Baker Donelson’s Health Care Litigation Group and the Women’s Initiative. “Document, document, document your efforts.”

She issued the warning during an April webinar hosted by the Society for Healthcare Organization Purchasing Professionals (SHOPP). 

Many providers may be subject to lawsuits in coming months due to unfortunate patient outcomes from the new coronavirus, she warned. She added that procurement officers may become “critical witnesses” in such litigation. The first known lawsuit against the site of the first known U.S. outbreak, a nursing home in Kirkland, WA, recently was filed. 

Tosh Crider said the focus of future lawsuits against nursing homes may involve staff members who have tested positive for the disease returning to work; struggles to get personal protective equipment; and staff training on how to effectively use PPE. 

“What’s unfortunate is that you’re going to be judged against a standard six months from now that is not the standard today and wasn’t the standard yesterday, or last week,” she said.

Operators found themselves being pushed as never before to deliver care while underequipped, understaffed and pressed to admit infected patients, a pair of McKnight’s Flash Surveys in late March and mid-April revealed.

An initial McKnight’s survey was released March 30, painting a picture of an industry at the precipice of disaster in many locations, and a general state of heightened anxiety amid shortages of personal protective equipment.

A second McKnight’s survey  two weeks later found that the percentage of provider respondents with COVID-19 detected in their buildings had nearly doubled (to 34%).

In addition, the latter survey, released on April 16, found that nearly 1 in 6 (16%) had had a resident or worker die due to COVID-19, while more than 1 in 5 (21%) had had residents move out due to COVID-19 fears.

Extrapolating the statistics to a nationwide total of about 16,000 skilled nursing facilities, the numbers indicated that more than 5,400 nursing homes could have had COVID-19 detected in their buildings at that point. In addition, 2,600 facilities might already have experienced at least one coronavirus-related death and more than 3,300 might have had at least one resident leave due to COVID-19 or fears of the virus.

There was no national strategy or mandate for reporting nursing-home related COVID-19 infections or deaths at the time of either survey. On April 19, federal health officials announced a nursing home infection surveillance strategy involving direct reporting to the Centers for Disease Control and Prevention.

McKnight’s collected survey results from respondents following emails sent to the publication’s readers. As an incentive for each survey, McKnight’s offered participants the chance of being entered in a drawing for a $50 gift card. There were 350 respondents in the first round and 631 in the second.

Staff frailties

Results of the latter survey showed a profession facing far more workforce challenges than usual. Two-thirds of respondents (67.4%) said they had staff call in sick or quit due to COVID-19 concerns, up from 45% in the survey two weeks earlier.

More than 83% said they were using homemade or reused personal protective equipment, significantly up from 55% in the first survey. 

Also in the mid-April survey, a total of 19.8% of respondents said they felt pressure from hospitals to admit patients who had been treated for the coronavirus, up by nearly half from 14% two weeks earlier. This was shortly after providers started experimenting with COVID-only units and buildings.

Toughness growing 

The trait of resilience, however, also revealed itself in the second survey’s responses. Just under 65% of participants said they were equipped to handle COVID-19 patients, up nearly 15 percentage points from two weeks previous.

The percentage of those reporting PPE shortages actually fell slightly (to 71% from 75%), perhaps a reflection of the huge rise in the use of homemade or reused equipment.

Overall facility mood 

The general attitude levels among respondents at nursing facilities seemed to remain steady from survey to survey, a period when the number of cases and deaths climbed sharply in the U.S., and in the long-term care population in particular. 

As of April 16, COVID-19 deaths connected with long-term care facilities reportedly totaled around 5,500, which didn’t include statistics from many states that said they didn’t keep them.

Given the option of checking as many choices as applied at their facilities, the vast majority of respondents described the mood in their facilities as “Coping day to day” (63%) or “A little shaky but confident overall” (55%). That tracked closely with two weeks earlier, when the numbers were 59% and 46%, respectively.

Third in line for both surveys was “Fingers crossed” (24% in the second survey, down from 26%), while the more confident choices of “A model of efficiency and pride” (18%) and “Almost business as usual” (17%) grew from 14% for each two weeks earlier.

Respondents on the least confident end of the spectrum lessened with time. “Panicked” fell to 6% from 13%, while “Chaos/Near chaos dropped to 2% from 3%.

All of this was measured just before the toughest weeks of the pandemic were forecast to hit in numerous geographic areas, according to many experts. 

It was also a time when protests against stay-at-home orders started to occur in various states where infection and death rates may have been below average and some members of the public were calling for the loosening of restrictions and the ability to start gathering in public again.

Yes. And as a disclaimer, I am not paid by, nor do I own any part of this or any of, the companies mentioned here.

A new product on the market for pushing two wheelchairs at once is called Easy Pushbar. You install this bar over the two wheelchair handles. The bar is padded and enables a caregiver to push a wheelchair with one hand, allowing caregivers to push two wheelchairs simultaneously.   

The standard model slips on easily and attaches quickly, with no tools required. You can quickly remove the item to fold and store the chair when needed. The security bar model needs a control key to install and remove the bar. This prevents wheelchairs from folding and leaving the premises too easily. Another benefit of the Pushbar is that tall workers will not need to bend over to touch the wheelchair.

Another product is the Gyenno Steady Spoon. It counters tremors to assist Parkinson’s residents with feeding themselves. There are many similar products on the market, but this spoon is automatically activated by movement. 

I also am excited to see the UV Box, which disinfects hand-held items in just 55 seconds. It is for mobile devices, staff badges, TV remotes, call cords, eyeglasses and other small items. It can be placed on a cart or wall-mounted. You can find it online.

And taking temperatures has never been easier and safer than with the non-contact thermometer. The Protekt ProTemp provides convenience, accuracy and a precise reading when taking a temperature. A number of infrared thermometers on the market, in fact, are now being sold by your local corner pharmacy, or supplier, or online.