Snow and ice are a mainstay of Missouri winter weather. Because of the variety of weather conditions as well as other events, facilities must have an emergency preparedness plan and be ready to act in an emergency to ensure they are to adequately prepared to meet the needs of patients, clients, residents, and participants during disasters and emergency situations.

If your facility experiences a loss of a necessary service (electricity, water, gas, phone, etc.), contact SLCR via the Regional Office emergency phone line and keep them informed of their status. If, for some reason, the facility cannot contact SLCR staff through the regional office phone number, you should contact the hotline. The emergency protocol is located here.

When you call, be prepared to answer to the following:

Facility name

  • Census, including staff assessment of current needs of the residents and monitoring of the ill.
  • Contact person and emergency contact number that is not the facility main line.
  • Has the facility called the fire department and central monitoring company if phones, alarm systems are down?
  • Generator: Y/N
    • If yes, what equipment does the generator serve (fire alarm, HVAC systems)?
    • If yes, amount of fuel onsite and/or system for delivery? How long will fuel last?
    • If no, what is fire watch plan?
    • If no, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner?
      • Obtain generator- is the home set up to receive generator power once delivered? Estimated time for delivery? Estimated time when generator power will be established.
      • Evacuation- Where is facility relocating to, distance from facility, transportation to get there, staffing, sufficient supplies/medications, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner (does the location have a functional emergency generator?) If relocating to a SNF – will the home be over capacity? Is there sufficient beds/space in the receiving facility to house the extra residents?
    • Documentation may be requested, including:
      • If evacuated, a list of residents and were they went
      • Room temperature logs
      • Fire watch documentation

Here are a few things to consider in examining your emergency preparedness plan, specifically as it relates to snow, ice, and power outages.

  • If there is a loss of the primary power, how will the facility ensure adequate temperatures of the facility will be maintained during the emergency situation?
  • Is the plan feasible?
    • Plan for the worst. Most events do not occur on a sunny Tuesday afternoon and the plan should account for things such as poor weather, road conditions, weekends/holidays, evenings, staff ability to travel to work, and other obstacles that may cause issue during the actual emergency.
  • Are staff knowledgeable of the plan and have access to what is needed in order to implement the plan?
    • Phone numbers, contact persons, contracts.
  • Do staff know what to do during an emergency and know who is in charge? If the administrator is not onsite, who is in charge and does that person know all their duties?
    • This may be the DON, but it may also be a charge nurse (or another designated onsite staff) if the event happens in the “middle of the night”. Depending on when the administrator or someone higher up on the order of succession can arrive at the facility, that person (i.e. night charge nurse) may be in charge for an extended amount of time.
  • Is the plan detailed enough?
    • Is there a detailed plan that describes when the residents will evacuate during an emergency? If loss of power, does the plan instruct the staff to start the evacuation prior to the point when the facility is below appropriate air temperatures and to maximize their safety during travel? What is the distance to the emergency evacuation site? What types of roads do they have to traverse, such as “side roads”, bridges, or interstates; all of these roads can have their challenges. Does the facility have more than one contracted emergency site?
      • Is it likely that emergency events will also impact the surrounding areas? It is also possible that the evacuation site may be so far away, residents may not be able to get there when road conditions are less than optimal. Does the contracted site meet all the criteria to allow the residents to shelter in place at that location?
    • Is there a contract for transportation and will that transportation be able to get the residents to and from their current location to the contracted emergency location in a snow/ice storm? If the services have other contracted uses, such as school buses, will they be available at 3:00 P.M. on a school day or can they get drivers at 3:00 A.M. on a Wednesday?
  • Does the facility have a generator?
    • Is there enough fuel, a contract to get more fuel, and a list of what it does and does not operate?
      • Facilities (and the staff in charge) need to know in advance, what their generator will operate. At a minimum, this listing must include whether it runs: Life safety equipment (such as E-lights and fire alarm system(s)), magnetic door locks/door alarms (where applicable for safety), HVAC systems, cooking systems, what outlets residents and staff will be able to be use, and computer equipment/Wi-Fi (if electronic medical records (EMR) are utilized).
      • This list needs to be detailed so staff will know specifically what items will and will not work during a power outage. Many generators will run every second or third ceiling light for emergency lighting, but not all lights in the facility will work during a power outage. This needs to be listed so all staff will know that information.
    • If a facility does not have a generator, what are the plans when it may not be easily able to evacuate due to poor road conditions or other factors that may prohibit a smooth transition from a facility to another location?
      • If the facility plans to have a generator delivered during a loss of power, does the facility have a contract with the generator company to deliver one to them? This contract should include the size of the generator that the facility will need in order to ensure the safety and care needs of the residents are met during the emergency.
        • The building will need to be wired and ready to accept the generator in advance. The facility will not be able to install a generator during the emergency event unless the wiring for the generator has already been completed.
      • Facilities must maintain at least their fire safety equipment (E-lights, fire alarm, sprinkler system, range hood (if any cooking occurs), food, water, heating and cooling, and sewage disposal to shelter in place.
        • There must be a plan of how this will be achieved, emergency supplies, the detailed list of what the generator will run, and any contracts that will be needed during the emergency to ensure these services can continue during the emergency event.
          • Sometimes trucks will not be able to run regular schedules and it may take several days before the facility can get their first delivery after an emergency starts; depending on the extent and severity of the disaster.
        • A power outage may be as simple as a blip, may last for hours, or may last for days – depending on the extent of the power grid damage and when the crews can access the problem(s).
          • The facility needs a plan of when, how, and where they will evacuate if they cannot provide at least the components of the previous bullet point.

During a disaster is the least ideal time to learn an emergency plan will not work or to search for a contracted service. All contracted services including, but not limited to, transportation, fuel needs, evacuation location, food, and water needs to be in the emergency plan. The emergency preparedness team needs to consider and plan all services and contract prior to an actual emergency. During an emergency, it may be very difficult or impossible to get a contracted service due to volume of request, road conditions, and/or other factors.

Thank you for preparing in advance and keeping us informed!

Memorandum Summary

  • Acute Respiratory Illness Reporting Requirements: The LTC facility requirements for reporting COVID-19-related data expired on December 31, 2024, except for reporting COVID-19 resident and staff vaccination status. On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2025 Home Health Prospective Payment System Rate Update. The rule broadens the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) reporting requirements for nursing homes. Beginning on January 1, 2025, LTC facilities are required to electronically report information about COVID-19, influenza, and respiratory syncytial virus (RSV) in a standardized format and frequency specified by the Secretary.
  • Survey Process and Enforcement: CMS expects LTC facilities to comply with all facility requirements. These requirements will be incorporated into the survey process once guidance to LTC facility surveyors is released.

Please see the full memo for details located at https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos/policy-memos-states-and-cms-locations/long-term-care-ltc-facility-acute-respiratory-illness-reporting-requirements.

The NHSN Long-Term Care Team and Vaccination Team provided a refresher training about the newly combined reporting form for Respiratory Pathogens and Vaccination. The team also reviewed upcoming required reporting fields beginning January 1, 2025.

NHSN LTCF Component: Respiratory Pathogens & Vaccination Reporting Requirement Updates – December 2024

Register in advance for the webinar replay on January 7: https://cdc.zoomgov.com/webinar/register/WN_Sd8zLQXEQCWl9vKCrfJcpw#/registration.

More resources can be found at https://www.cdc.gov/nhsn/ltc/covid19/rpv-resources.html.

Center of Excellence for Behavioral Health in Nursing Facilities – Webinar Opportunity

Holiday Seasonal Depression: Ways to Support Nursing Facility Residents

The holidays can be tough for both residents and those who support them. The Center of Excellence of Behavioral Health in Nursing Facilities is hosting a live virtual event on 12/17/24 @ 1:00 PM CST to talk about the fundamentals of Seasonal Affective Disorder (SAD) and its effects on holiday depression. This training FREE, available to residential care, assisted living, skilled nursing, Ombudsman, and state survey agency team members. It is designed to provide participants with a basic understanding of depression, seasonal onset, symptoms, and treatments to support residents experiencing challenges from SAD. Register today- as space may be limited.

Please see the attached as a similar letter is being sent out by DHSS and the Healthcare-Associated Infections & Antimicrobial Resistance team of epidemiologists regarding some education for C auris (emerging fungal infection).

The Association for Professionals in Infection Control and Epidemiology along with American Association of Post-Acute Care Nursing, has released a practice guidance tool and resource guide to help implement EBP in skilled long-term care facilities. The practice guidance tool outlines when EBP should be implemented for residents, provides infection control recommendations for routine care activities, and includes case study examples with a self-quiz to help reinforce learning. The resource guide also provides a comprehensive list of infection control websites and references. More information including the guide can be found here.

Myers and Stauffer to conduct MDS Documentation Requirements Refresher

Please see the attached flier for the MDS Documentation Requirements Refresher scheduled for December 17, 2024 from 9:00 AM – 10:30 AM CST. Please click the link within the flier (or below) to register for the webinar. Registration is required.

Link to Register: https://mslc.webex.com/weblink/register/rc0eb002a1e79b4ee18d8f94400fe85b4

The training materials and recorded webinar will be available for download after the training should you be unable to attend the live session. Please direct any questions to MO_MDSINFO@mslc.com.

Special Information Related to COVID-19 Reporting:

  • Facilities performing their own COVID-19 testing must report positive results to DHSS unless they are reporting lab tests via the National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.
  • Submitters preferring to send COVID-19 testing records in bulk via HL7 instead of using MODROP should contact the Missouri Data Exchange Team to be onboarded for bulk reporting. This e-mail account is monitored from 8AM-5PM CST Monday-Friday.
  • All entities ordering COVID-19 tests from an external laboratory should enter positive case information into MODROP/ShowMe WorldCare.

The original MODROP portal was developed in conjunction with the EpiTrax application. DHSS transitioned from EpiTrax to the ShowMe WorldCare application on August 26, 2024. A new version of MODROP is now available through ShowMe WorldCare: The Missouri Disease Reporting Online Portal (MODROP).

Active users of the earlier version of MODROP were notified of the system transition via the email address linked to their MODROP account. These users were provided with new account credentials prior to the launch of ShowMe WorldCare in August 2024. If an individual needs to utilize MODROP and has not already received this information via email, a new request for an account must be submitted.

Use this link for more information on electronic laboratory reporting and electronic case reporting for reportable conditions: Electronic Laboratory Reporting and Electronic Case Reporting for Reportable Conditions in ShowMe WorldCare.

For the state regulations regarding reporting infectious, contagious, communicable, or dangerous diseases go to Missouri Secretary of State: Code of State Regulations.

SLCR recently had an opportunity to meet with Livanta, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) that receives the appeals of non-coverage (SNF ABN and NOMNC) required in F582. A couple items to note- the required forms are updated periodically- so please make sure the most recent forms are being used. The most recent forms and instructions for their use can be found here: Beneficiary Notices Initiative (BNI) | CMS. Changes were made in November 2024 and additional changes will be effective beginning January 1, 2025.

SLCR has heard recent concerns from facilities and residents regarding Medicare Advantage beneficiaries being denied services or delays in services. If you hear these concerns, please share with Medicare Advantage residents and/or families that the NOMNC has been modified to reflect regulations providing enrollees additional fast-track appeal rights when they untimely request an appeal to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), or still wish to appeal after they end services on or before the planned termination date (See: CMS-4205-F, p. 30827).

These notices should be provided timely to beneficiaries whose Medicare covered services will end to inform them of their rights and protections related to financial liability and appeals under the Fee-for-Service Medicare and Medicare Advantage (MA) programs.

Additionally, facilities and beneficiaries can find contact information for Missouri’s BFCC-QIO, Livanta, here: https://www.livantaqio.cms.gov/en/states/missouri.

The 2024 Long Term Care Annual Facility Survey will become available in the NHSN application, January 2025. Facilities that currently, or plan to, participate in the Healthcare Associated Infection (HAI) modules, such as urinary tract infections, laboratory-identified events for C. difficile and/or multidrug resistant organisms, and/or prevention process measures are required to complete the survey by March 1, 2025.

Facilities that complete the annual survey help drive significant improvements within the NHSN surveillance system, enabling the development of targeted resources, surveillance guidance, and meaningful performance comparisons among Long-Term Care Facilities.

Here are a few reasons why completing the 2024 Annual Facility Survey is important:

  • Infection Prevention & Control: The survey provides valuable data to help identify areas where LTCFs may need additional support in infection prevention and control activities.
  • Antibiotic Stewardship: It offers insights into the resources needed to implement or improve antibiotic stewardship programs, which are vital for resident safety and effective care.
  • Resident and Care Services: It helps gather essential information about types of residents your facility serves, as well as specific care services provided.

Please note that for facilities primarily reporting in the Respiratory Pathogens Vaccination module, the annual survey is not mandatory. However, we strongly encourage all Long-Term Care Facilities (LTCFs) to complete the survey, as it provides valuable benefits, as outlined above, for your facility.

If you have questions, please contact NHSN-ServiceNow and include “2024 LTCF Annual Facility Survey” in the subject line. The portal can be accessed here or through your SAMS account. After logging into SAMS, the NHSN-ServiceNow link is located at the bottom of the page.

If you are unable to access ServiceNow, you can email the NHSN Help Desk at nhsn@cdc.gov.

Thank you for your continued commitment to improving care in long-term care settings.
The NHSN LTCF Team

DHSS Section for Long Term Care would like to say thank you to all that were able to take time out of their busy schedules to attend the webinar, “An Engaged Medical Director: A Real Asset to a LTCF,” on 11/20/2024, presented by Dr. Michael Nash. We would like to extend this thank you to Dr. Nash for sharing his wealth of knowledge and passion with us at DHSS, LTCF staff, educators, and providers. We believe the insights shared will be greatly beneficial for long-term term care facilities and Medical Directors.

This recorded presentation is now available on demand, along with the slides from the presentation.
Recording Link: “An Engaged Medical Director: A Real Asset to a LTCF”
Presentation Slides: Engaged Medical Director Presentation for MO DHSS 11-20-24 v2 MN edits

CDC recommended lowering the age for routine adult pneumococcal vaccination from 65 to 50 years old. Adults who are 19 through 49 years old with certain risk conditions should continue to get vaccinated against pneumococcal disease. There are now three pneumococcal conjugate vaccines (PCV15, PCV20, PCV21) available for adult vaccination. Healthcare providers can use any of these products to vaccinate adults against pneumococcal disease. Typically, only one dose of pneumococcal vaccine is needed as an adult. However, if PCV15 is used, a second type of vaccine (pneumococcal polysaccharide vaccine, PPSV23) is needed.

Job aids for adult pneumococcal vaccination‎
Shared clinical decision-making: This job aid should assist vaccine providers in discussions with older adults considering PCV20 or PCV21 vaccination.
Vaccine timing for adults: This job aid should help vaccine providers interpret adult pneumococcal vaccine recommendations.

During the Summer of 2024, COMRU implemented several enhancements to the online application system. To test the effectiveness of those enhancements, on September 1, 2024, COMRU began reviewing newly submitted applications as well as reviewing applications submitted prior to September 1.

COMRU is current with reviewing newly submitted applications and has made significant progress in reviewing applications submitted prior to September 1. Only applications submitted July 22 to August 31, 2024, are pending review. COMRU expects to have all applications submitted prior to September 1 reviewed by the end of the calendar year.

Please note: Applications returned to the submitter for correction will be deleted from the online application system if corrections are not made and resubmitted to COMRU within 60 days. he submitter may access the online application at any time to check the status of a pending application. Training on how to check the status of an application can be located on COMRU’s webpage (Under Trainings/WebEx Training – Level One Online Form Feb 2024).

 

Tips and Reminders

  • All attachments to the online application must be in PDF format – please do not include web links. Applications including web links will be returned for correction. All application documents are scanned by COMRU for retention purposes; web links are not stable and cannot be scanned.
  • For Level 1 applications, attachments should be a limited number of pages and only include the information requested. For example, if an applicant is in the hospital, the submitter must either type in the date/reason for hospitalization or attach a hospital H&P that includes this information. The entire H&P from the hospital is not necessary – only those pages that include the date/reason for hospitalization are required.
  • Please review all diagnoses for the applicant including those on the diagnosis list and those listed in any other attachments and answer the application questions accordingly. The most common errors related to diagnoses are:
    • Section D, Question 6: Does the individual have a diagnosis of Major Neurocognitive Disorder (MDNC), i.e., dementia or Alzheimer’s?
    • Section E, Question 2a: Does the individual have a suspected diagnosis or history of an Intellectual Disability/Related Condition?

Many applications have one of these diagnoses listed and this question is answered “no” when the answer should be “yes”. When the question is marked “yes” follow-up questions populate; marking “no” results in an incomplete application which will be returned for correction.

For additional information and answers to frequently asked questions, please review the online training posted on the COMRU webpage.

CDC has designated November C. diff awareness month. They’ve complied several educational resources that can be used for families, staff, and partner providers. Please see the ICAR team’s flyer for more information.

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 7/1/24 through 9/30/24 is due November 14, 2024. Please submit PBJ data as soon as possible to avoid delays.

 

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. The following data must be submitted no later than 11:59 p.m. on November 18, 2024:

  • MDS data for 4/1/24 through 6/30/24;

  • NHSN data for COVID-19 Vaccination Coverage Among Healthcare Personnel for 4/1/24 through 6/30/24;

 

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

Beginning November 1, 2024, VOYCE is the contracted ombudsman service provider for Aging Matters in southeast Missouri. If Aging Matters was your local Ombudsman Program, please contact VOYCE at 314 918-8222 or 866 918-8222 for Ombudsman assistance. Please email your transfer/discharge logs to Chien Hung, VOYCE Program Director at chung@voycestl.org.

Dementia care and antipsychotic medication resources, tools, and data reports are now housed on the CMS Quality Improvement Organizations website. Helpful information is also available on the CMS National Partnership website. Below are direct links to this information.

CMS National Partnership to Improve Dementia Care in Nursing Homes Website: https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/national-partnership-improve-dementia-care-nursing-homes

CMS Quality Improvement Organizations Website: https://qioprogram.org/landing-page – Search with the keywords ‘dementia’ and ‘antipsychotic’

Antipsychotic Medication Use Data Report: https://qioprogram.org/tools-resources/antipsychotic-medication-use-data-report

Antipsychotic Use by State: https://qioprogram.org/tools-resources/antipsychotic-use-state

If you have additional questions, please let us know. Specific questions related to the data reports can be directed to CMSQINQIOProgram@cms.hhs.gov.

Election Day is Tuesday, November 5th.

Individuals receiving long-term services and supports retain their voting rights, no matter where they live or what type of care they receive. Federal regulations guarantee residents’ rights, including their rights as citizens, which includes the right to vote. As local elections approach, now is the time for residents of long-term care to make a plan for voting.

Visit our website for information on preparing to vote, finding voting rules in your area, learning what is on your ballot, and suggestions for ways facilities can support residents’ right to vote.

The 2025 edition of the Staying Engaged enrichment booklet has a variety of activities aiming to keep long-term care consumers mentally engaged, prompt self-reflection, and remind consumers of the importance of advocating for your rights, especially your right to make choices about how to live your life.

Included in the activities are a maze, a word search, a crossword, word unscramble puzzles, sudoku, self-reflection prompts, an ice breaker scavenger hunt, and an art page.

Download for free or pre-order a hard copy – the booklets will be available to ship in a couple weeks.

Initial Webinar

November 19, 2024: 1:00 PM Eastern Time (US and Canada)

Register in advance for the initial webinar on November 19: https://cdc.zoomgov.com/webinar/register/WN_3AMj__gqSkarSwKquC-T3A

 

Replay Session

December 3, 2024: 1:00 PM Eastern Time (US and Canada)

Register in advance for the webinar replay on December 3: https://cdc.zoomgov.com/webinar/register/WN_84q-qGZ3RHWOxlL7jhnPhQ

 

The content of both webinars is the same. After registering, you will receive a confirmation e-mail containing information about joining the webinar.