Missouri Long-Term Care Information Update

Pioneer Network Hot Topics – Culture Change in Action

November 16, 2021: Recharge with a Nature Fix
Speaker: Tammy Marshall, Biophiliac & Longevity Expert and Founder & CEO of Biophilia Pharma

Join Pioneer Network for the last of the 2021 Share the Vision webinars, where speaker, Tammy Marshall, Biophiliac & Longevity Expert and Founder & CEO of Biophilia Pharma, will share with attendees the power of nature in supporting health and well-being – not only the residents you support, but for you!

Tammy will explain the value of nature as a health equity and the science behind nature immersion (Yes, spending all those hours outdoors engaging with nature has value beyond just the fact that you like it and it is fun!) She will share tips on how you can find yourself a nature fix, how it is all about knowing thyself.

In Tammy’s work, she has seen how supporting residents so that they can enjoy the outdoors is often very challenging for care communities, and as we approach the winter months, that challenge can become greater, and so Tammy will also be sharing ways to bring the outdoors in.

Action Pact’s Conversations with Carmen

November 19, 2021: Creating Connectedness
Presenter and Host: Carmen Bowman

LTC communities face daunting challenges when it comes to the difficulties of staffing right now. Employees have increased expectations of their leaders and managers than in the past. For organizations to thrive during rapid change, they need a mindset shift from traditional problem solving to an increased emphasis on the needs of the employee and the vital roles they hold. Learn to identify the top reasons why employees leave, and ideas for a culture that honors and includes employees like never before.

2021 Annual SLCR Provider Meeting – SAVE the DATE

Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation in partnership with MU Sinclair School of Nursing, this year’s SLCR Provider Meeting will be held virtually.

Wednesday, November 10, 2021

With the meeting being conducted virtually this year, registration will be required. The link to register along with session information will be coming soon. Please stay tuned to the LTC Information Update for more details.

RAI Manual Updates

CMS released a PDF file labeled “MDS 3.0RAIManualv1.17.1R.Errata.October.1.2021,” available in the Downloads section of the MDS 3.0 RAI Manual webpage. This file contains revisions to pages in Chapter 6 of the MDS 3.0 RAI Manual v1.17.1R that update the NTA Comorbidity Score Calculation table. Changed manual pages are marked with the footer “October 2019 (R).” The errata document begins with a table that lists all identified revisions and the pages to which they have been applied. Following the table are the actual corrected replacement pages for insertion into the printed manual.

CMS Memo QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)

Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:

  • Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach. See Table 1.
  • Routine staff testing is now based on the facility’s county level of community transmission instead of county test positivity rate. The link to determine county level of community transmission is in the memo. The frequency of testing has also been updated. See Table 2.

 

Table 1: Testing Summary

Testing Trigger

Staff

Residents

Symptomatic individual identified

Staff, vaccinated and unvaccinated, with signs or symptoms must be tested.

Residents, vaccinated and unvaccinated, with signs or symptoms must be tested.

Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts

Test all staff, vaccinated and   unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual.

Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual.

Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts

Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility).

Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility).

Routine testing

According to Table 2 below

Not generally recommended

 

Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission

Level of COVID-19 Community

Transmission

Minimum Testing Frequency of

Unvaccinated Staff+

Low (blue)

Not recommended

Moderate (yellow)

Once a week*

Substantial (orange)

Twice a week*

High (red)

Twice a week*

+Vaccinated staff do not need to be routinely tested.

 

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.

New Enrichment Booklet for Residents

National Consumer Voice for Quality Long-Term Care has a NEW Enrichment Booklet offers residents a variety of activities to keep them entertained and active. This book includes puzzles, word searches and crosswords; prompts for residents to write about the connections in their lives; trivia questions, which can be done alone or with others; and more!

Download and print the Enrichment Booklet for free or purchase hard copies of the booklet from the online store.

MHCA Virtual Convention 2021

October 1-31, 2021: MHCA Virtual Convention

For those who attended the convention in-person but missed an education session, you now have access to any missed sessions as well. Therefore, all of the facilities that registered for the in-person Convention are automatically enrolled in the Virtual Convention! Please note – each facility registered for the Virtual Convention can allow an unlimited number of attendees from your registered facility to participate in the education sessions offered virtually.

If you could not attend the in-person Convention, you can register now for the Virtual Convention. Once the Virtual Convention begins, the education sessions will be available 24/7 and run through October 31.

Pioneer Network Hot Topics – Culture Change in Action

October 21, 2021: Someone Just for Me: Recognizing a Critical Role for Volunteers
Speaker: Dr. Paul Falkowski, Ph.D., Gerontologist, Author, Speaker, Educator

Long before COVID-19, professionals working in long-term care knew about the devastating effects of social isolation. Now because of COVID-19, social isolation has become an all too familiar term to the general population. We heard reports of people passing due to being disconnected from their families and friends during the past year. But what about the people who did not have family or friends?

Creating and sustaining intimate relationships takes time and commitment. In this session, you will learn the critical components for creating “authentic” relationships. You will learn how to recruit, screen for, and train a cadre of volunteers, who go on to become “companions” or, as one older woman observed, “…someone that is here just for me.” We’ll look at the transformational power volunteers like these can have on the people you serve, the people serving them, the volunteers themselves, and your surrounding community.

Action Pact’s Conversations with Carmen

October 15, 2021: Why Employees Leave and Ideas for Honoring, Retaining and Recruiting Them
Guest: Linda Shell, RN, PhD; with Host Carmen Bowman

LTC communities face daunting challenges when it comes to the difficulties of staffing right now. Employees have increased expectations of their leaders and managers than in the past. For organizations to thrive during rapid change, they need a mindset shift from traditional problem solving to an increased emphasis on the needs of the employee and the vital roles they hold. Learn to identify the top reasons why employees leave, and ideas for a culture that honors and includes employees like never before.

Action Pact’s Conversations with Carmen

November 19, 2021: Creating Connectedness
Presenter and Host: Carmen Bowman

LTC communities face daunting challenges when it comes to the difficulties of staffing right now. Employees have increased expectations of their leaders and managers than in the past. For organizations to thrive during rapid change, they need a mindset shift from traditional problem solving to an increased emphasis on the needs of the employee and the vital roles they hold. Learn to identify the top reasons why employees leave, and ideas for a culture that honors and includes employees like never before.

Community Education Webinar from VOYCE

November 9, 2021: Protect Your Hard Earned Assets – How to Stay Financially Secure
Presenter: Lauree Peterson-Sakai, SVP, Aging Risk Strategy Leader, Wells Fargo

Join VOYCE for this Community Education webinar. Remember the adage “Knowledge is Power”? That certainly applies to becoming well-informed on all that is involved with aging! Join Wells Fargo’s Aging Client Service Strategy Leader for an informative course on financial safety. Spend the hour breaking down what you need to know about identifying financial exploitation and providing easy tips on keeping you and your money safe throughout your golden years. Registration for this webinar is free.

For any enquiries, please contact jmcgeechan@voycestl.org.

10-Digit Mandatory Dialing Changes

10-Digit Mandatory Dialing Changes Will Impact Fire Alarm Panel Automatic Dialing

The Federal Communications Commission (FCC) has adopted an order approving the designation of “988” as the 3-digit abbreviated dialing code for the National Suicide Prevention Lifeline. As a result of this designation, beginning October 24, 2021, a 10-digit telephone number (area code + phone number) will be required to complete all local calls from area codes 314, 417, 660, and 816. All licensed long-term care facilities in Missouri are required to have a fire alarm panel that dials a monitoring company during a trouble call or fire signal. It is imperative that facility staff verify or reprogram the fire alarm panel to ensure it will dial out with the area code. This will need to be confirmed with the fire alarm and/or monitoring company. For additional information regarding 10-digit mandatory dialing changes, please refer to the FAQs About 10-Digit Dialing document developed by the Missouri Public Service Commission.

Advoque Safeguard Issued Respirator User Notice

On September 17, 2021, Advoque Safeguard issued a user notice identifying 6 very small lots of the model SG100 N95 Particulate Filtering Respirator (TC-84A-9284) that require additional sampling for pressure testing. Any individual or organization in possession of any ASG100 product in the 6 lots should isolate the product and contact Advoque Safeguard Quality Control (qc@advoquesafeguard.com).

More information can be found on the NIOSH Manufacturer Notice webpage: https://www.cdc.gov/niosh/npptl/usernotices/noticesmanufact.html under Advoque Safeguard.

VOYCE Professional & Community Education Series Webinar

October 12, 2021: Cannabis and CBD for Older Adults and LTC Residents

The use of cannabis and CBD products as alternative medical treatments has been widely contested in the United States. Yet, the use of these products can be highly beneficial to patients with a variety of health conditions – many of which are prevalent in aging and long-term care populations. Join us for a discussion with local experts about the function, benefits, and options for medical cannabis and CBD use. This course will also discuss the legal considerations for individuals and long-term care organizations interested in trying these alternative therapies. This webinar is available to both long-term care serving professionals and interested community members.

VOYCE Professional Education Series Webinar

September 28, 2021: Eliminating Elderspeak through Compassionate Communication

Understanding elderspeak as a type of biased communication is vital to prevent future ageist behavior towards older adult patients and, thus, improve health outcomes. Elderspeak, most commonly found in long-term care settings, has been identified as a growing communication barrier between younger and older generations, especially in healthcare. Effective communication between patients and providers improves trust and adherence to treatment plans. Health communication and cultural sensitivity training are crucial for incoming, young health providers. As Boomer clinicians age and retire, they will be replaced by millennials who will need to learn how to navigate intergenerational relationships with their new Boomer patients.

Monoclonal Antibody Infusion Medication Information

There has been a significant change in the ordering process for monoclonal antibody infusion medications. If you are currently utilizing these medications, please review the attached notice and plan on attending the webinar tomorrow. Also attached is information on reporting usage through the Teletracking system. Reporting through this system is highly encouraged as the usage reported will determine future amounts allocated to the state.

 Status Update re: Monoclonal Antibody (mAb) Infusion Medication Ordering:

Missouri Department of Health and Senior Services (DHSS) was notified by U. S. Department of Health and Human Services (HHS) yesterday, September 14, 2021, that effective immediately the states are responsible to review and approve all monoclonal antibody medication orders. This includes orders for REGEN-COV (casirivimab and imdevimab) and the Eli Lilly cocktail of bamlanivimab/etesevimab through AmeriSource Bergen. This was DHSS’ first notification of this change. We had no prior information to allow for planning, development of platforms for ordering/approvals or procedures, or messaging. Thus, all of this is occurring currently and as quickly as possible. Information on this change is still forthcoming from HHS, thus we may have process implementation delays at the state level as a result.

mAb Request Process Implementation and Timeline:

DHSS will host a webinar to introduce the state’s new mAb request process, details are below:

Friday, September 17, 2021

10:30-11:30 a.m.

Join from the meeting link

https://stateofmo.webex.com/stateofmo/j.php?MTID=mcb62b527fff05778bd574584e06c8b6d
 

Join by meeting number

Meeting number (access code): 2462 582 1044

Meeting password: pcGjudFE679
 

Tap to join from a mobile device (attendees only)
+1-650-479-3207,,24625821044## Call-in toll number (US/Canada)
+1-312-535-8110,,24625821044## United States Toll (Chicago)

NHSN COVID-19 Vaccination Data Reporting – Additional Dose Questions

Recently, NHSN launched two new questions in the weekly COVID-19 vaccination module. During the reporting week of 8/23/2021 through 8/29/2021, facilities began reporting on the number of individuals eligible to receive additional or booster doses of COVID-19 vaccine (question #4) and the number of individuals who received additional or booster doses (question #5).

Facilities should refer to the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States to determine which individuals are eligible to receive additional or booster doses. According to the current guidance, an additional mRNA COVID-19 vaccine dose is recommended for moderately to severely immunocompromised people after they completed an initial 2-dose mRNA vaccine series. Therefore, facilities should include the following individuals in question #4 as eligible to receive an additional dose of the COVID-19 vaccine:

  1. Received an initial complete 2-dose mRNA COVID-19 vaccine series at this facility or elsewhere since December 2020 (question 2); AND
  2. Eligible to receive an additional or booster dose of the COVID-19 vaccine, per CDC guidance noted above.

In response to questions, NHSN received about reporting additional COVID-19 vaccine dose or booster data, scenario examples are provided below to assist in determining how to respond to these new questions.

  • Facility A is unsure how to determine who in their facility is considered eligible for an additional dose or booster at this time.

Facilities should refer to the CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States to determine individuals who are eligible to receive additional doses or boosters after receiving an initial completed vaccination series. For more information about COVID-19 vaccine indications for individuals who are immunocompromised, please see the FAQs at: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/immunocompromised.html.

  • Facility B has a staff member who only received dose 1 of the Moderna COVID-19 vaccine. However, this staff member expressed an interest in receiving an additional dose of the vaccine.

The facility would not include the staff member in questions 4 and 5 on the data collection form since he/she did not complete an initial COVID-19 vaccination series.

  • Facility C cannot determine if an individual is eligible for an additional dose at this time because they do not know the individual’s health status to determine if they are immunocompromised.

If a facility is unable to determine whether an individual is considered eligible to receive an additional dose or booster at this time, the individual should not be reported in question 4 or question 5 on the data collection form.

For reporting through the NHSN COVID-19 vaccination modules, assume these two staff members were eligible to have received an additional dose of the COVID-19 vaccine. Include these two staff members in question 4 and question 5 of the data collection form.

  • After reviewing the current Interim Clinical Considerations for Use of COVID-19 Vaccines, facility E does not have any individuals who are eligible to receive an additional dose or booster of COVID-19 vaccine.

This facility should report that zero individuals are eligible to receive an additional dose or booster of COVID-19 vaccine in question 4. The new question 4 and question 5 on the data collection form are required fields. A value must be entered for each of these questions for the form to be saved successfully. A zero (“0”) should be entered for question #4 and a zero “0” entered for question #5 (select any manufacturer from the dropdown). This will allow the form to save successfully.

Updated resources, including training materials, data collection forms, table of instructions documents, and other supporting materials are available on the following webpages:

Weekly HCP & Resident COVID-19 Vaccination | LTCF | NHSN | CDC
Weekly HCP COVID-19 Vaccination | HPS | NHSN | CDC
Weekly Patient COVID-19 Vaccination | Dialysis | NHSN | CDC

Frequently asked questions (FAQ) have also been updated (please see questions 23-27) and can be accessed using this link: https://www.cdc.gov/nhsn/hps/weekly-covid-vac/faqs.html.

We appreciate your efforts to report these critical data accurately and completely. We encourage updates to previously entered data as needed. If you have any questions or concerns, please let us know. As always, questions can be sent to NHSN@cdc.gov using ‘COVID-19 vaccination’ in the subject line of the message.

COVID Testing Information

State Orders for Abbott BinaxNOW Tests

Missouri is experiencing constrained supplies of the BinaxNOW COVID antigen test cards. Thus, effective September 9, 2021, DHSS is implementing a revised BinaxNOW test ordering cadence in order to conserve supply and assure the optimum availability of BinaxNOW COVID antigen tests for all users. Until further notice, please order no more than two weeks supply of BinaxNOW tests for use by your facility or organization. If our supply allows larger quantities to be ordered, we will modify this process accordingly at that time and notify all users. https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/testing-resources.php

To Reinstate Direct Shipments of Abbott BinaxNOW from the Federal government:

Providers should email their facility information, shipping address and the BinaxNOW delivery Point of Contact for the facility and request to be added back onto the direct shipment list to Binax.Team@hhs.gov. Please be aware reinstatement depends upon available supply of tests to the Federal government and this can take several weeks to begin receiving shipments again.

Reimbursement for OUTBREAK Testing

A reminder that in order to furnish immediate aid and relief in response to the state of emergency due to the spread of COVID-19, the State of Missouri has made some funds from the Coronavirus Relief Fund available to Missouri Long Term Care facilities with COVID-19 Outbreaks. These funds are available to Long-Term Care facilities that experience an outbreak (one or more positive cases) and are conducting base-line facility testing and some immediate follow-up testing in order to contain outbreaks. For more information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

Transfer and Discharge Procedures – REGULATION UPDATE NOTICE

The Department of Health and Senior Services, Section for Long-Term Care Regulation has drafted emergency and proposed amendments affecting the transfer and discharge hearings referenced in regulation set 19 CSR 30-82.050.

The emergency amendment for 19 CSR 30-82.050 was filed on September 1, 2021, with an effective date of September 16, 2021 and expiration of March 14, 2022. The emergency amendment can currently be viewed at https://www.sos.mo.gov/adrules/EmergenciesforInternet/emergency. The proposed amendment covering this same material will also be published in the same issue of the Missouri Register. The Register publication date is October 1, 2021 for the emergency and proposed amendments and can be found at http://www.sos.mo.gov/adrules/moreg/moreg.asp.

NOTE: The public comment period for the proposed amendments will be from October 1, 2021 – October 31, 2021. The Department will be accepting comments during the comment period by mailing the comments to: Carmen Grover-Slattery, Regulation Unit Manager, Section for Long-Term Care Regulation, Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to: RegulationUnit@health.mo.gov.

The proposed amendment can be reviewed on our website at: https://health.mo.gov/about/proposedrules/.

LTC Bed Availability Portal Reminder

Reminder: After submitting the initial survey, a confirmation email will be provided for a link to update your survey each day (instead of submitting a new survey). Submitting a new survey results in multiple surveys showing on the map with different bed numbers. This makes it difficult to know which totals are current. Please use the link emailed after the initial submission to edit facility bed availability. Please do not submit an “initial” submission more than once. If information does not change from day to day, the submitter can simply update the date and submit – the prior day’s information will populate.

The survey information will populate an accompanying dashboard that will be available to hospitals to use as a tool in finding placement for those patients who would be best served in a long-term care setting. This dashboard may be accessed at https://mophep.maps.arcgis.com/apps/opsdashboard/index.html#/f1e0745f93fe46b482d8ff4585f821bf. To view instructions on utilizing the dashboard, click on ‘Instructions’ under the map for information.

Action Pact’s Conversations with Carmen

September 17, 2021: Living Life Outside of Groups – Dispelling the Pressure to Hold Them

Most residents end up spending most time in their room, with or without a pandemic. We have needed to hone helping people live life outside of groups all along. Groups can never be 24/7 or meet everyone’s needs anyway. Gift residents with lots of ideas of things to do beyond the norm and beyond television. Encourage people with time on their hands to try something new, do things they have not done in a while, refocus their capabilities, live out passions in adaptive ways and not lose their taste for life no matter their abilities. Work with people to tell their life story, share wisdom, leave a legacy, develop the invention, book or song in their heart, armchair travel, plan, sing, study, sort photos, serve others, and more. What a great moment in time to get creative and go deeper with people. Learn how to have every team member honor and validate every individual’s’ life role/contribution to your community.

DHSS COVID-19 Vaccination Booster Doses Survey

The Department of Health and Senior Services is planning for the upcoming approval of booster COVID-19 vaccination doses and long-term care facilities will be a priority. The federal pharmacy program used to administer first and second doses will not be available, so it is important to ensure long-term care facilities receive the needed support for the administration of booster doses. We are asking for your feedback regarding your facility’s readiness to administer booster doses. https://www.surveymonkey.com/r/VTT296F

For those SNFs (Medicaid/ Medicare certified) that already completed the NHSN survey, we already have your results no further action is needed.

For questions regarding this survey, please contact Lana Hudanick at Lana.hudanick@heatlh.mo.gov or 314-982-8260. Please reply by September 15, 2021.

COVID-19 After Action Report (AAR) Survey – Deadline Extended

The deadline to complete the DHSS COVID-19 After Action Report (AAR) Survey has been extended to Friday, September 3, 2021. Your assistance in helping us gather this important data is greatly appreciated. Please feel free to share the link with your state, regional, and local partners in the following categories:

  • Public Health/LPHA
  • Hospital
  • EMS
  • Emergency Management
  • Behavioral Health
  • Healthcare Coalition Leadership
  • State Agency Partners

https://survey123.arcgis.com/share/d20126ad3a05496d87dbf3b4b65d7592?portalUrl=https://mophep.maps.arcgis.com

Please let us know if you have any questions or difficulties with the survey.
John Whitaker – John.Whitaker@health.mo.gov
Brendan Bagby – Brendan.Bagby@health.mo.gov