Visitation and Communal Dining/Group Activity Guidance

Today, the Department of Health and Senior Services released guidance impacting facilities wanting to allow outdoor visits and visits through an open window for residents who are bedbound or who cannot otherwise leave their room. Additionally, guidance is being provided for facilities wanting to allow communal dining and group activities. The State asks that several items be considered when determining these plans, but each facility will ultimately decide on their own protocols. Facilities should be notifying residents’ families of their procedures for visitations once they are in place.

Visitation Guidance 6-15-20
Communal Dining and Group Activity Guidance 6-15-20

Guidance for Long Term Care Facilities – Testing Invoicing Process

Long Term Care facilities, including Assisted Living facilities, Residential Care facilities, Intermediate Care facilities, and Skilled Nursing Facilities (LTCs) that experience an outbreak (one or more positive case) of COVID-19 are working with the state to conduct base-line facility testing and some immediate follow-up testing in order to contain the outbreaks. In order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the state is making some funds from the Coronavirus Relief Fund available to LTCs, so that cost is not a barrier to this important testing. Questions regarding this process should be submitted to COVID19invoice@dss.mo.gov.

LTC Guidance Invoicing Process

Governor Announcement – Phase 2 “Show Me Strong Recovery”

Pending expiration of Phase 1 on June 15, Governor Mike Parson announced yesterday that Missouri will fully reopen and enter Phase 2 of its “Show Me Strong Recovery” Plan on Tuesday, June 16, 2020. During Phase 2, there will be no statewide health order. All statewide restrictions will be lifted, though local officials will still have the authority to put further rules, regulations, or ordinances in place. While Missouri will fully reopen on June 16, Governor Parson emphasized the importance of continuing social distancing and practicing proper hygiene to prevent the spread of COVID-19. For more on the announcement, see the press release here – https://governor.mo.gov/press-releases/archive/governor-parson-announces-missouri-will-fully-reopen-enter-phase-2-recovery.

Community Testing

Community testing events serve the residents of Missouri. DHSS is partnering with the Missouri National Guard, local health departments, health care providers to offer these events, and different communities will be reached at different times. If you do not see any community testing events in your area, you can continue to check back with this page https://dcphdo02redcap.azurewebsites.net/redcap/surveys/?s=DEX3J7THHM as new sites will be added as events are planned. Below is a list of currently planned events.

Peculiar, Cass County

June 11-12

7am-7pm

Washington, Franklin County

June 13-15

7am-3pm

Warrensburg, Johnson County

June 14

7am-3pm

Sedalia, Pettis County

June 15

10am-6pm

Higginsville, Lafayette County

June 16

12pm-6pm

Richmond, Ray County

June 16

12pm-6pm

Wright City, Warren County

June 17

7am-3pm

Carrollton, Carroll County

June 17

2pm-6pm

Keytesville, Chariton County

June 17

2pm-6pm

Troy, Lincoln County

June 18-19

7am-3pm

Lewistown, Lewis County

June 19

7am-2pm

California, Moniteau County

June 19

7am-2pm

California, Moniteau County

June 20

12pm-4pm

Bowling Green, Pike County

June 19

10am-4pm

Memphis, Scotland County

June 20

12pm-4pm

Montgomery City, Montgomery County

June 20

12pm-6pm

Linn, Osage County

June 20

12pm-6pm

Salem, Dent County

June 20

8am-8pm

CDC COCA Call: Applying COVID-19 Infection Prevention and Control Strategies in Nursing Homes

June 16, 2020: Applying COVID-19 Infection Prevention and Control Strategies in Nursing Homes
Presenters: LCDR Kara M. Jacobs Slifka, MD, MPH (USPHS), Infection Prevention and Control Team, COVID-19 Response, Centers for Disease Control and Prevention and Nimalie D. Stone, MD, Infection Prevention and Control Team, COVID-19 Response, Centers for Disease Control and Prevention

During this COCA call, presenters will use case-based scenarios to discuss how to apply infection prevention and control guidance for nursing homes and other long-term care facilities that are preparing for and responding to COVID-19.

If you are unable to attend the live COCA Call, the recording will be available for viewing on the COCA Call webpage a few hours after the live event ends.

The slide set will be available under “Call Materials” on the COCA Call webpage.

Please click this link to join the webinar: https://www.zoomgov.com/j/1615543668.

How Nursing Homes Will Receive Important Information from CMS

CMS announced on the QTSO website (https://qtso.cms.gov/news-and-updates/how-nursing-homes-will-receive-important-information-cms) that they will utilize the CASPER Shared folders to communicate important information regarding findings of noncompliance with the requirement to report COVID-19 data to the Centers for Disease Control and Prevention (CDC) through the National Healthcare Safety Network (NHSN). This includes the CMS 2567 and Enforcement Notices. You will not receive a notice if you are found in compliance with the reporting requirement.

Additional resources to assist you with this reporting requirement:

Having trouble registering/reporting with NHSN?
SAMS Help Desk
Monday-Friday, 8:00AM to 6:00PM EST (Excluding U.S. Federal Holidays)
877-681-2901
samshelp@cdc.gov

QIN-QIOs Targeting Assistance to Nursing Facilities to Improve Infection Control

The Centers for Medicare & Medicaid Services (CMS) has funded Health Quality Innovators (HQI) to deliver no-cost assistance to nursing homes in Missouri through the CMS Quality Innovation Network – Quality Improvement Organization (QIN-QIO) Program.

Through this initiative, which HQI calls the Health Quality Innovation Network (HQIN), facilities that have an opportunity to improve their infection control efforts based on publicly available data on Nursing Home Compare are being tapped by HQIN to receive targeted virtual assistance. Selected facilities will receive performance data reports, quality coaching, improvement tools, peer-to-peer forums and educational programming.

HQI has been providing free, expert help to nursing homes for more than 35 years. Their team of quality improvement experts is made up of seasoned post-acute nurses and administrators, including an Infection Preventionist, MDS specialists and QAPI-Certified professionals.

To learn more about HQI and HQIN, visit www.hqin.org or contact Dana Schmitz, dschmitz@hqi.solutions.

Consumer Voice Webinar for Family Members on Advocating for Residents During COVID-19

Families are facing many new issues as they support and care for their loved ones in long-term care facilities during the COVID-19 pandemic. Join Consumer Voice for a webinar on Thursday, June 18 at 2:00pm ET to gain information and tips on how to advocate for quality care individually and through family councils.

The webinar will also cover topics of particular concern to family members, including visitation, facility transparency and reporting requirements, transfers and discharges, COVID-19 testing and more. Register here »

COVID-19 Data Update

The Department of Health and Senior Services posted a State of Missouri COVID-19 analytics update on June 3. The link is here: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/analytics-update060320.pdf.

This analytics updated includes multiple data points inform Missouri’s COVID-19 response. Check the update to find out more about:

  • Syndromic surveillance
  • Healthcare system capacity (bed, PPE, and staff availability)
  • Testing
  • COVID-19 cases and deaths
  • Economic and social impact
  • Insights from U.S. states, nationally, and other countries
  • Evidence from scientific literature
  • Mathematical disease modelling

Suicide Prevention Training

Department of Mental Health is offering free Question, Persuade, Refer (QPR) Gatekeeper Training for anyone who wants to:

  • Recognize the warning signs of suicide
  • Know how to offer hope
  • Know how to get help and save a life

See the flyer to register for these virtual suicide prevention trainings. Suicide is the 10th leading cause of death in Missouri. Register soon as virtual seating is limited.

Community Testing Opportunities

Upcoming Testing Locations:

County

Location

Testing Dates

Greene County

Ozark Empire Fairgrounds, Springfield

June 4 & 5

Cape Girardeau County

Arena Park, Cape Girardeau

June 5

Buchanan

St. Joseph 4th Street & Francis Parking Garage

June 9

More community testing sites are being developed and will be added, please check this link to stay up-to-date on community testing options.

https://dcphdo02redcap.azurewebsites.net/redcap/surveys/?s=FAMNRL3LF7

Phase 1 Extension

Governor Parson extends Phase 1 of “Show Me Strong Recovery” plan through June 15.

See the press release here – https://governor.mo.gov/press-releases/archive/governor-parson-extends-phase-1-show-me-strong-recovery-plan-through-june-15.

Also, this link will take you to local public health orders. Check here to see what is going on in your county or town – https://governor.mo.gov/press-releases/archive/governor-parson-extends-phase-1-show-me-strong-recovery-plan-through-june-15.

Reminder – Community Testing Opportunities, some open to all Missourians

Missouri continues to announce community testing events across the state. Several communities will be conducting COVID-19 testing over the next two weeks. For these testing events, participants will not be required to have a doctor’s authorization and there will be no charge to participants. Anyone who wants to be tested may participate – you will not be required to have a known exposure or be experiencing symptoms. If you are experiencing symptoms and have struggled to be tested, you can register for one of these testing events. Many of these testing events do not require you to be a resident of the county conducting testing. You must, however, be a resident of Missouri.

Pre-registration for each event is strongly encouraged – https://dcphdo02redcap.azurewebsites.net/redcap/surveys/?s=FAMNRL3LF7. Check this site often as new testing locations will be added as they are finalized.

Upcoming Testing Locations:

County

Location

Testing Dates

Jackson

Silverstein Eye Center Arena-Independence

May 26-30

Andrew County

Savannah Fire Department

May 29

Pemiscot County

Pemiscot Memorial Hospital, Hayti

May 29-30

St. Charles County

Youth Activity Park, Dardene Prairie

May 29 & 30

Grundy County

First Christian Church, Trenton

May 30

Boone County

Hickman High School, Columbia

June 1 & 2

Jefferson County

Faith Community Church, House Springs

June 1 & 2

Jefferson County

Hillsboro Civic Center, Hillsboro

June 3

Greene County

Ozark Empire Fairgrounds, Springfield

June 4 & 5

Cape Girardeau County

Arena Park, Cape Girardeau

June 5

 

World Elder Abuse Awareness Day Webinar Series

June 3, 2020
June 10, 2020
June 19, 2020
June 24, 2020

In recognition of World Elder Abuse Awareness Day (June 15th), there will be a series of free webinars throughout the month of June that are designed to raise awareness of elder abuse risk factors in the current pandemic. The 45-minute webinars are being hosted by The St. Louis Elder Financial Protection Multidisciplinary Team and The Oasis Institute.

Please see the flyer for details including instructions on how to register.

SLCR Region 2 Office Move

The Section for Long-Term Care Regulation, Region 2 Office in Poplar Bluff will be moving to a new address on May 27, 2020. Please note only the address is changing. The phone and fax numbers will remain the same.

Section for Long-Term Care Regulation, Region 2 Office
1903 Northwood, Suite 4
Poplar Bluff, MO  63901
Phone:  (573) 840-9580
Fax:  (573) 840-9586

Paid Feeding Assistants Waiver

Please review the updated CMS guidance – COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) including the waiver for Paid Feeding Assistants. The waiver now allows training to be conducted in 1 hr. vs. 8 hrs. However, the content for the training remains the same.

Please refer to our website for the content: https://health.mo.gov/safety/cnaregistry/feedassistant.php.

Questions regarding this waiver should be directed to CNARegistry@health.mo.gov.

COVID-19 Community Testing

Community testing events serve the residents of the county where the event is being held. DHSS is partnering with local health departments and health care providers to offer these events, and different communities will be reached at different times. Also, some events may not require you to be a resident of the county where an event is taking place. If you are not a resident of a county currently holding a community testing event, you can continue to check back at the link as new sites will be added as events are planned. Please review the information or check your local health departments social messaging for more information.

Click this link to access the information: https://dcphdo02redcap.azurewebsites.net/redcap/surveys/?s=FAMNRL3LF7.

Here is list of currently scheduled community testing opportunities.

  • John and Beacon, Kansas City – May 19, 20, & 21
  • Savannah High School, Andrew County – May 22
  • Andrew County – May 22 & 29
  • New Madrid County – May 26 & 27
  • South Harrison High School, Harrison County – May 27
  • Pemiscot County – May 28 & 29

New COVID-19 Dashboard

This NEW dashboard contains tons of COVID-19 data that the public can review at will. Cases by county info is still included and is expanded to show daily % increase in cases, 7-day % increase in cases and number of new cases over the last 14-days. In addition, the dashboard includes information on testing, demographics, deaths and hospitalizations.

The link to the dashboard is http://mophep.maps.arcgis.com/apps/MapSeries/index.html?appid=8e01a5d8d8bd4b4f85add006f9e14a9d.

DHSS Revised Guidance for Facilities with COVID-19 Positive Cases

These guidelines describe implementation steps to help limit the spread of infection when a staff member or resident develops COVID-19 in your facility. The guidance can be found under the Long Term Care Facilities Link at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php#collapseSix. The title of document is COVID-19 LTCF Guidance.

** Please review the document as there are important changes to the guidance, including facility-wide testing upon identification of a positive case and routine follow-up testing.

NHSN- Missouri Group Request

Many long-term care facilities have begun reporting COVID-19 data into the CDC’s NHSN Long-term Care Component. In an effort to have a more complete representation of COVID-19 data for the State of Missouri, we are asking facilities who are not yet reporting to consider reporting data through the CDC’s NHSN Module and those facilities that are currently reporting to begin sharing their data (conferring rights) with DHSS. In order to share the data you enter into the CDC’s NHSN site, you must join the “Missouri Group” within NHSN and select the option to “Confer Rights”.

Once you have completed the NHSN enrollment process and received your acceptance notification from NHSN, you can login to the NHSN site to:

  1. Access the COVID-19 Module within the Long-Term Care Component
  2. Join the Missouri Group (using the guidance below)
  3. Confer rights to grant the state health department access to your facility’s information.

How do I join the Missouri Group and confer rights to the department?

NHSN website provides instructions – https://www.cdc.gov/nhsn/pdfs/groups-startup/JoinGroup-current.pdf.

The document is titled: NHSN Data Sharing: Joining a Group and Accepting the Confer Rights Template.

Please use the following information to join the Missouri group:
Group ID: 20503
Use password: MHIRS29

DHSS is also encouraging facilities to report each day. This will allow more accurate and timely data that could be used for increased allocation of resources for facilities that start to see increased cases, rather than responding up to a week later when outbreaks are identified.

Congregate Facility Order

Please see attached order requiring all congregate living facilities to report positive polymerase chain reaction (PCR) test results on one or more residents or one or more staff members, who physically worked at such facility within fourteen days prior to testing positive, within 24 hours. Congregate living facilities include residential care facilities, assisted living facilities, intermediate care facilities and skilled nursing facilities.

See this guidance for specific reporting details.

2020 Online Enhanced Leadership Development Academy for RNs and NHAs in Long-Term Care (ELDA)

MU Nursing Outreach is pleased and excited to now offer the ELDA in a totally online format.

Open enrollment – start when you are ready. A full year to complete. You are in control!

Join us for the MU Leadership Development Academy for Nurse Leaders and Nursing Home Administrators in Long-term Care. We know that Long-term Care can be challenging. With an 11 year proven track record, hundreds of graduates and life-changing testimonials, this leadership course is designed for busy LTC professionals, all while earning 50 hours of CE credit. The academy has been proven to increase leadership skills and improve confidence, which will help to create a working environment that encourages teamwork and quality improvement. Thanks to support from the Missouri Department of Health and Senior Services, this proven certificate program is offered at NO COST to RNs and NHAs from Skilled Nurse Facilities in Missouri. The complimentary option is available to Missouri SNFs since the support for this Academy is provided by CMP funds designated for Missouri.

For more information visit our website: https://extension2.missouri.edu/programs/nursing-outreach/enhanced-leadership-development-academy or contact Todd Winterbower at winterbowert@missouri.edu, 573-882-0215.

PPE Updates

In an effort to expand the PPE reserves and simplify the PPE process, the state has created a new COVID-19 webpage dedicated to be a one-stop shop for all information related to PPE. The PPE webpage will provide Missouri’s latest information and resources in three categories including how to access PPE, guidance for use and optimization for maintaining your PPE supply for the duration of the COVID-19 epidemic.

You can use this website to access the PPE marketplace, too.

Also, NEW to this website and to the state is the State PPE Reserves option.

Missouri has limited PPE reserves to assist in filling these critical needs and will prioritize healthcare providers providing direct care to confirmed or suspected COVID patients. Note requests should only be submitted after all normal supply chains, including the Missouri COVID Supply Solution (aka Missouri PPE Marketplace), have been exhausted and you have a supply of fourteen days or less on hand as the quantities and types of PPE available through the state are limited. Use this link https://survey123.arcgis.com/share/35c0d11050b04a809028d2caf9fd45fd?portalUrl=http://mophep.maps.arcgis.com to access the PPE Request Form. You will receive an automatically generated email notifying you of receipt of your request. Requests will be evaluated in the order in which they are received. If your request is approved, either in full or partially, you will receive an electronic notification upon shipment. If denied, you will receive an electronic verification of the decision.

 

PPE options for Non-profits and Governmental Entities

Because we know many of you continue to struggle with obtaining PPE items, we wanted to make sure you are aware that not-for-profit entities may purchase items from Missouri Vocational Enterprises (MVE). MVE operates through Missouri’s Department of Corrections and produces and sells a number of items. MVE may sell these items to any state agency, local government entities, or any not-for-profit agency.

MVE has a variety of janitorial supplies, personal products (soap, toilet tissue, etc.), laundry supplies, and disinfectant supplies. Most of these items can be found on the MVE website (https://docservices.mo.gov/mve/products/consumables/consumable.html). In addition, MVE has recently begun selling certain PPE items including cloth face coverings, isolation gowns, and hand sanitizer (gallon jugs). These items are not listed on their website at this time but information is attached or below. PPE items are being prioritized to state agencies but may also be purchased by local government and not-for-profit entities as supplies are available. For awareness, DMH has received cloth face coverings and hand sanitizer but have not yet received our order for isolation gowns. As with all PPE, some items are more readily available then others.

If you have a need for these items, we would encourage not-for-profit providers to explore all avenues to obtain needed items, including those available through MVE. You can visit their website to see items available and details for the ordering process. To order cloth face masks, isolation gowns, or sanitizer, you may need to call and speak with their customer service staff, they are very helpful – contact numbers can be found on the website. Again, only not-for-profit entities, state agencies, and local government entities may purchase items from MVE.

Finally, in regards to hand sanitizer, it is available in one gallon jugs only. The price per gallon is $20. Orders are limited to 100 gallons per order and no more than one order per week. The product number is F-617 Hand Sanitizer.

 

We hope this information is helpful to you. Thank you so much for all you do and are doing to provide care and services to our vulnerable populations.

Missouri PCR Testing Update for Providers

The Department of Health and Senior Services would like to notify Missouri health care providers of changes in guidance due to expanded COVID-19 testing availability within the state. The testing landscape has shifted significantly in the past eight weeks, and through partnerships with private laboratories, we encourage testing of both symptomatic and asymptomatic individuals. DHSS does not need to approve testing when performed outside of the State Public Health Laboratory.

See the attachment or visit this link to read this full guidance: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/mo-pcr-testing-update-providers.pdf.