Missouri Long-Term Care Information Update

February 18th, 2021

The Missouri Department of Health and Senior Services continues to offer FREE COVID-19 testing to Missouri residents. Individuals seeking this testing opportunity should visit our website at www.health.mo.gov/communitytest for a listing of events and a link to register. Residents are encouraged to visit this website frequently as new events will be added regularly. While registration guarantees testing, walk-ins to the event will be accommodated if registration slots are still available.

Upcoming events include:

Date	Time	City	County	Location
February 18, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
February 18, 2021	10AM – 4PM	St. Charles	St. Charles	Harvester Christian Church
February 19, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
February 19, 2021	9AM – 1PM	Joplin	Jasper	ACCESS Family Care
February 22, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
February 22, 2021	9AM – 3PM	Kansas City	Jackson	Bruce R. Watkins Cultural Center
February 22, 2021	8AM – 5PM	Lexington	Lafayette	Health Care Collaborative of Rural Missouri
February 22, 2021	8:30AM – 3PM	Rolla	Phelps	Your Community Health Center
February 22, 2021	8:30AM – 11:30AM	Florissant	St. Louis County	James J. Egan Civic Center
February 22, 2021	9AM – 1PM	Branson	Taney	Cox Health
February 22, 2021	9AM – 11AM	Seymour	Webster	Between Twin Dragon Restaurant & Seymour Elementary School
February 22, 2021	8AM – 10AM	Kansas City	Jackson	Bartle Hall (Front Entrance on 13th Street)
February 23, 2021	9AM – 3PM	New London	Ralls	Forget-Me-Not Senior Center
February 23, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
February 23, 2021	8:30AM – 2PM	Salem	Dent	Salem Community Center
February 23, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
February 23, 2021	8AM – 12PM	Springfield	Greene	Old Price Cutter Building
February 23, 2021	12PM – 3PM	Fulton	Callaway	C&R Market (Parking Lot)
February 24, 2021	8:30AM – 4PM	St. Louis	St. Louis County	NAACP St. Louis County Building
February 24, 2021	9AM – 6PM	Kansas City	Clay County	Worlds of Fun
February 24, 2021	8:30AM – 11:30AM	Florissant	St. Louis County	James J. Egan Civic Center
February 24, 2021	1PM – 3PM	Camdenton	Camden	Mid-County Fire
February 25, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
February 25, 2021	10AM – 4PM	St. Charles	St. Charles	Harvester Christian Church
February 26, 2021	9AM – 11AM	St. Louis	St. Louis County	Riverview Gardens High School
February 26, 2021	9AM – 1PM	Lamar	Barton	ACCESS Family Care
February 26, 2021	12PM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
February 26, 2021	10AM – 2PM	St. Joseph	Buchanan	St. Joseph Aquatic Center
February 26, 2021	12PM – 3PM	Columbia	Boone	Moser’s Foods Parking Lot

February 11th, 2021

Battelle CCDS™ was built as a temporary emergency program to help alleviate the critical PPE gap in the N95 supply chain. Battelle was recently notified by the Defense Logistics Agency (DLA) and the Department of Health and Human Services (HHS) that CCDS^TM operations will not be extended again and the program will officially end on March 31, 2021.

Please note the following critical dates:

The last day to send your N95 masks for decontamination to your CCDS™ sites will be March 18, 2021.
All FedEx return shipments to your facilities will be completed by March 25, 2021.

If you have any questions about the CCDS™ program ending, please contact Battelle at ccdscustomerservice@battelle.org.

February 11th, 2021

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls – Volume 8, Issue 2.

In this issue:

To Vaccinate or Not to Vaccinate
During These Depressive Times
The Role of the Charge Nurse
Infection Control Assessment and Response
Housekeepers: Another Important Team Member
Employee Engagement
No More BUTS!

Please visit QIPMO’s website here for this and other previous newsletters.

February 10th, 2021

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. 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.

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 attached. 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

Thank you for preparing in advance and keeping us informed!

February 10th, 2021

Information for NHSN users – Important Information for Long-term Care Facility Users

The NHSN team will offer trainings providing basic guidance for data entry for the NHSN Long-term Care Facility COVID-19 Point of Care (POC) Test Reporting Tool as well as tool updates released on February 4, 2021. The trainings may be a live presentation or a previously recorded presentation, but all sessions will allow for submission of audience questions with NHSN staff response. A recorded webinar will be posted for on-line viewing.

The NHSN option enables nursing homes to enter POC laboratory test data into the NHSN application. NHSN, in turn, will report the nursing home POC laboratory test data electronically to the public health agency, state or local, that has jurisdictional authority and responsibility to receive and use the nursing home’s data. Deidentified nursing home POC laboratory data will also be reported via existing public health reporting mechanisms to the US Department of Health and Human Services in accordance with the U.S. Coronavirus Aid, Relief, and Economic Security (CARES) Act requirements.

**Please note the webinars have the same link. Attendees will be able to choose which session they are able to attend. Both webinars are identical in content, so please plan to attend once.

Topic: Point of Care Test (POCT) Reporting Tool for COVID-19 – Updates
Date: Thursday, Feb 11, 2021
Time: 2:00 – 3:00 PM Eastern Time

Register in advance for this webinar:
https://cdc.zoomgov.com/webinar/register/WN_dp03SRQnSYeOfcBFy2CAmQ

After registering, you will receive a confirmation email containing information about joining the webinar.

Topic: Point of Care Test (POCT) Reporting Tool for COVID-19 – Updates
Date: Friday, Feb 12, 2021
Time: 1:00 – 2:00 PM Eastern Time

Register in advance for this webinar:
https://cdc.zoomgov.com/webinar/register/WN_dp03SRQnSYeOfcBFy2CAmQ

After registering, you will receive a confirmation email containing information about joining the webinar.

Please do not reply to this email. Responses to this email will not be received by the NHSN Team. To contact NHSN, please send a new email to: nhsn@cdc.gov.

February 8th, 2021

All LTC facilities (SNF-ICF-RCF-ALF) may submit for reimbursement of outbreak testing through March 31, 2021.

All Skilled Nursing Facilities may invoice for other necessary COVID-19 expenditures up to a maximum cap of $345 per licensed bed. The previous cap of $303, which originally expired on December 30, 2020, has been extended to March 31, 2021 and the cap increased to $345 which is a $42 per licensed bed increase. Facilities cannot bill for expenses that have been previously invoiced.

All other facilities may submit invoices for other necessary COVID-019 expenses up to the previous existing cap of $330/licensed bed, which originally expired on December 1, 2020 and has been extended to March 31, 2021. Facilities cannot bill for expenses that have been previously invoiced.

If any facility previously submitted for reimbursement and did not get reimbursed up to the cap, they can submit for additional reimbursement up to the cap. If you have previously submitted invoices for reimbursement that meets or exceeds the cap, please do not resubmit those items. They are being re-reviewed at this time.

Please see this link for the portal and other additional information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

February 5th, 2021

The Department of Health and Senior Services, Section for Long Term Care Regulation (SLCR) is soliciting public comments on the below proposed rulemaking. The proposed rulemaking will be published in the February 16, 2021 Volume 46, Number 4 of the Missouri Register at http://www.sos.mo.gov/adrules/moreg/moreg.asp.

19 CSR 30-81.030 Evaluation and Assessment Measures for Title XIX Recipients and Applicants

NOTE: The public comment period will be from February 16 – March 18, 2021. The Department will be accepting comments during the comment period by mailing the comments to Steve Bollin, Director of the Division of Regulation and Licensure, PO Box 570, Jefferson City, MO 65102-0570 or by emailing to RegulationUnit@health.mo.gov.

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

February 5th, 2021

Cultivating LTC Leaders: Topics in Regulatory, Legal and Compliance Management – 12-month webinar series
January – December 2021

Standards of Care: Master the Core Elements of LTC Clinical Excellence – 12-month webinar series
January – December 2021

Medicare from Start to Finish – Virtual workshop
February 9-10, 2021

RAI Process from Start to Finish – Virtual Workshop
March 16-18, 2021

Federal Review Course for Nursing Home Administrators – Virtual Workshop
April 19-20, 2021

February 5th, 2021

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for July 1 – September 30 (Q3) of CY 2020 must be submitted no later than 11:59 p.m. on February 16, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to IRFs, LTCHs, and 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.

More information about SNF QRP can be found on the following webpages:

CMS SNF QRP Data Submission Deadlines webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Data-Submission-Deadlines
CMS SNF QRP Help webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-QRP-Help
CMS SNF QRP Measures and Technical Information webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information
CMS SNF QRP Training Webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training
SNF QRP CASPER Reports – https://qtso.cms.gov/system/files/qtso/cspr_sec13_mds_prvdr_5.pdf

February 5th, 2021

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 10/1/20 through 12/31/20 is due on Sunday, February 14, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center (1-800-339-9313) no later than the Friday before the submission deadline as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

CMS PBJ webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ
PBJ Reference Manuals – https://qtso.cms.gov/vendors/payroll-based-journal-pbj-vendors/reference-manuals
PBJ Training – https://qtso.cms.gov/training-materials/payroll-based-journal-pbj
PBJ FAQs – https://qtso.cms.gov/reference-and-manuals/payroll-based-journal-pbj-frequently-asked-questions-052020

February 3rd, 2021

February 18, 2021: The Artifacts of Culture Change 2.0 – It’s Here
Guides: Karen Schoeneman, Karen Schoeneman Consulting: Quality of Life and Culture Change, and Carmen Bowman, Regulator turned Educator, Edu-Catering: Catering Education for Compliance and Culture Change

The Artifacts of Culture Change (ACC), originally developed in 2006 by Karen Schoeneman and Carmen Bowman as a CMS funded project, has recently been updated and expanded into the ACC 2.0, reflecting the many culture change and person-directed practices that are part of turning an institution into a home/community. The ACC 2.0 is integral to the culture change movement and a great way for communities to assess and measure where they are on the culture change journey, celebrate accomplishments, and generate goals and action plans for the journey. There are now two ACC 2.0 tools: one for nursing homes and the other for assisted living communities ACC-AL). Life plan communities have their choice of the two.

This webinar will provide an overview of the ACC 2.0 for nursing homes and the new ACC-AL for assisted living. Karen and Carmen will explain why and how the 2.0 versions were developed, introduce the subsections with examples, and describe best practices for completing the tool as a team.

And there’s more. Pioneer Network will soon be hosting web-based versions of both tools for download and/or online completion, along with videos to assist in completion of the tools. New web pages will soon be available with helpful resources to support teams in learning how to implement the practices reflected in the tool.

February 3rd, 2021

February 19, 2021: Increasing Movement Intentionally – Video, Virtual, Visual During Family Visits and with Validation®
Guest: Kim Eichinger, Executive Director of Dynamic Living at Country Meadows Retirement Communities

Join Kim and Carmen, both certified in the Validation Method® for a variety of ideas on increasing movement during a pandemic. From items placed in the room that naturally create movement to ideas for roommates to consider; from doorway exercises to prompts from all staff team members; from video suggestions to virtual and family visit options. Get your creative juices flowing using Validation to match the natural rhythms of the person. The results can be amazing, as opposed to forcing a person to do what we think they should.

February 3rd, 2021

March 3-5, 2021: 30^th Annual Nursing Home Administrator Conference – VIRTUAL

Due to the COVID-19 pandemic and in the best interest of the health and safety of our attendees, the Missouri League for Nursing’s Nursing Home Administrator Conference is being held VIRTUALLY this year. This VIRTUAL conference will offer 20 hours of CE in 2.5 days.

Nursing Home Administrators will be provided with essential information needed to effectively serve long-term care residents and successfully perform their leadership role and job responsibilities.

February 3rd, 2021

March 10-12, 2021: 2021 Winterfest Conference & Trade Show: Refresh, Refocus, Renew
Location: Ameristar Hotel & Spa, St. Charles

Missouri Association of Nursing Home Administrators is pleased to invite you to attend their midyear conference, Winterfest. We have all experienced a very challenging year and need to Refresh, Refocus, Renew! The goal of this conference is to provide long-term care administrators and their staff practical and inspirational education hours along with the opportunity to network and socialize with colleagues. It is also the only MANHA-sponsored conference that provides a chance to view the latest technology, products, and services offered by suppliers.

February 3rd, 2021

The State of Missouri is partnering with the Missouri Primary Care Association and MAKO Medical to continue hosting free COVID-19 testing events throughout the state.

Community testing events are scheduled in the following counties over the next two weeks: Adair, Barton, Benton, Cape Girardeau, Clay, Cole, Crawford, Dent, Greene, Harrison, Howell, Iron, Jackson, Jasper, Lafayette, Macon, Marion, Morgan, Pettis, Phelps, Platte, St. Charles, St. Louis City, and St. Louis County.

Missourians can register online for testing events at health.mo.gov/communitytest and continue to check back for future opportunities.

Missouri residency is the only requirement; individuals do not have to live in the county in which they are tested, and they do not have to be experiencing symptoms. Any Missouri residents who wish to be tested with an anterior nasal swab to determine if they have an active COVID-19 infection can do so at no cost to the individual.

Those experiencing symptoms of COVID-19 should seek testing at a community testing event or their nearest testing site. Those who have had significant contact with someone with confirmed COVID-19 should also consider being tested.

Why should a healthy person consider being tested for COVID-19?

To rule out the possibility that you have COVID-19 and don’t know it.
Make sure that you are not an asymptomatic carrier of the virus. Asymptomatic spreaders are a major reason containing this virus has been so challenging.
To take action early if you do have COVID-19.
If you are in the early stages of a COVID-19 infection, detecting it early allows you to quickly isolate, rest and recuperate, monitor your symptoms and seek medical care if needed.
To spend time with friends and family–especially those at high risk.
If you plan to spend a prolonged period of time with loved ones, especially older adults or those with underlying conditions, stay away from high risk activities for 10 days and then get tested.
To help get the virus under control.
Widespread testing among healthy people helps to stop the spread of COVID-19. Screening healthy people, staying on top of positive cases, identifying new outbreaks quickly, and being aware of how the virus spreads among people without symptoms, are powerful tools in our efforts to suppress the virus.

It is important to remember that a COVID-19 test is a one-time assessment, and will only show if you are infected at the time of the test. Everyday prevention measures, such as handwashing, physical distancing and mask-wearing should always be practiced, even after you have been tested.

To register for community testing events in Missouri, visit health.mo.gov/communitytest.

February 3rd, 2021

Missourians in Phase 1A and Phase 1b Tiers 1 & 2 can access vaccinations through a variety of settings including their employer, health care providers, and mass vaccination events. Missouri’s latest press release with vaccine information can be found here. Below you can find information about a number of vaccine events that will be occurring during the month of February. Visit the websites for facilities listed below , watch your local news, talk with your medical provider, and/or visit the website of your local public health agency to get registered for these events. In addition, you can visit https://covidvaccine.mo.gov/events/ to register for some events as they become available. This site should be updated later in the week with new events, and regularly updated. PLEASE NOTE, events will fill quickly and some may already be filled due to sign ups through local channels such as local public health agencies and health care providers. Continue to watch for vaccine information from your local news, officials, and healthcare providers. Events will continue to be scheduled each week throughout the state.

For the month of February Missouri will be directing just over half of Missouri’s distribution of vaccine to selected hospitals across Missouri. These facilities will be able to vaccinate individuals in the activated Phases. Specific hospitals that will be hosting vaccine clinics are listed below.

In addition to these efforts, there will be Missouri National Guard supported events throughout Missouri. These events will continue on a rotating basis through the regions with additional locations added for subsequent weeks. Continue to watch for vaccine information from your local news, officials, and healthcare providers and check https://covidvaccine.mo.gov/events/. Events will continue to be scheduled each week throughout the state.

DHSS Led Events
Week of Feb 1-Feb 6
Region	Location
A	Henry County—Clinton Friday, February 5, 2021 8am-5 pm (or until supply is out) Clinton First Baptist Church 1531 N Vannsant Rd Clinton, MO 64735
B	Marion/Ralls County—Hannibal Friday, February 5, 2021 9am-6pm (or until supply is out) Hannibal Inn & Conference Center 4141 Market Street Hannibal, MO 63401
C	St. Francois—Farmington Thursday, February 4, 2021 8:30 am-7pm (or until supply is out) Community Civic Center 2 Black Knight Drive Farmington, MO 63640
D	Greene—Springfield Friday, February 5, 2021 8:30 am-5:30 pm (or until supply is out) Ozark Empire Fair Grounds 3001 N. Grant Ave Springfield, MO 65802
E	Pemiscot—Caruthersville Friday, February 5, 2021 9am-4pm (or until supply is gone) Centry Casino 777 E Third St. Caruthersville, MO 63830
F	Cole—Jefferson City Friday, February 5, 2021 8am-4pm (or until supply is gone) The Linc 1299 Lafayette St Jefferson City, MO 65101
G	Douglas—Ava Saturday, February 6, 2021 8am-5pm (or until supply is gone) MOCH Wellness Center 603 NW 10^th Ave Ava, MO 65608
H	Livingston/Harrison—Chillicothe/Bethany Site 1 Thursday, February 4, 2021 8:30 am-5:00 pm (or until supply is gone) Methodist Church 1414 walnut Street Chillicothe, MO 64601 Site 2 Saturday, February 6, 2021 8:30am-5:00 pm (or until supply is gone) South Harrison High School 3400 Bulldog Ave Bethany, MO 64424
I	Phelps—Rolla Thursday & Friday February 4-5, 2021 8am-5pm (or until supply is gone Phelps Health Respiratory Screening Station 1000 W 10^th St Rolla, MO 65401

January 19th, 2021

Since May 2020, the Missouri Department of Health and Senior Services (DHSS), Department of Natural Resources (DNR) and researchers at the University of Missouri – Columbia have been collaborating on a statewide project to test wastewater for genetic markers of SARS-CoV-2, the virus that causes COVID-19. The project recently received new funding through a grant from National Institutes of Health (NIH) to expand wastewater testing to additional congregate living facilities. Public health experts have identified wastewater testing as a useful tool for early detection of outbreaks, even as vaccination efforts progress and clinical testing improves. Please see the letter regarding information about this project and information on recruiting 20 congregate living communities to participate in an expansion of this testing. Ideally, communities would have 50 or more residents who contribute to the sewer system.

Please contact the Department of Health and Senior Services Environmental Public Health Tracking Team at EPHTN@health.mo.gov or 866-628-9891 or 573-751-6102 to express interest in the project or to ask any additional questions. Communities who are interested will receive a follow-up contact from the Missouri Department of Natural Resources to determine if their sewer system will work for this type of testing.

January 15th, 2021

January 21, 2021: Working Together to Find Our Way to Yes

How many times have you or your team had a great idea about how to do something in your community, and you want to say ‘yes’, but are stopped short because it might be too risky, or the biggest reason heard, that the regulations say you can’t do it.

Even as we say this, we know that person-centered practices and the regulations are not at odds. Sometimes it’s the interpretation, or more often, it’s not WHAT we do, but HOW we do it that creates the conflict.

Pioneer Network is proud to bring together a dynamic panel of individuals from the field of aging services – all of them risk-takers at heart – to share and discuss ideas on how we can work together to find a way to say yes to the person-centered practices we strive to bring to our communities.

January 14th, 2021

Dr. Randall Williams has signed a standing order for Long-Term Care Facility staff to receive Abbott BinaxNow testing at the facility they work in to ensure timely testing and isolation of positive employees who are caring for Missouri’s most vulnerable residents, the elderly and disabled. Long-term care facilities should continue to obtain orders for residents through resident personal physicians or facility medical director/physician.

Standing Order – BinaxNOW – LTCF – Symptomatic or Asymptomatic 1-12-21

January 13th, 2021

Please find this week’s review of CDC’s COVID-19 resources and information. We continue to highlight COVID-19 vaccine information in addition to resources specific to healthcare quality and worker safety and health.

COVID-19 VACCINE RESOURCES
CDC COVID Data Tracker — Vaccinations are now being tracked on CDC’s COVID Data Tracker. Numbers reported on CDC’s website are validated through a submission process with each jurisdiction and may differ from numbers posted on other websites. Differences between reporting jurisdictions and CDC’s website may occur due to the timing of reporting and website updates.

How to Report COVID Vaccine-Related Adverse Events — As Americans start receiving their first COVID-19 vaccines, additional data on potential adverse events are needed in real time. Healthcare providers will play a critical role in reporting vaccine-related adverse events through the Vaccine Adverse Event Reporting System (VAERS). Providers can also encourage individual patients to self-report potential adverse events as they occur through v-safe, CDC’s new patient reporting platform. Read more in this new CDC Medscape Expert Commentary by Dr. Tom Shimabukuro, CDC’s COVID-19 Vaccine Safety Team Lead.

Updated Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States — This guidance has been updated to include the following:

Additional information on antibody therapies and COVID-19 vaccination
Information on COVID-19 vaccination and outbreak management
Additional information on vaccination of immunocompromised persons
Updates to contraindications and precautions to vaccination
Information on COVID-19 vaccination and tuberculin skin testing

To learn more, please visit: mRNA COVID-19 Vaccines.

Frequently Asked Questions about COVID-19 Vaccination in Long-Term Care Facilities (LTCF) — Making sure LTCF residents can receive COVID-19 vaccination as soon as vaccine is available will help save the lives of those who are most at risk of dying from COVID-19. CDC updates frequently asked questions for Healthcare Infection Prevention and Control and Healthcare Professionals regularly based on feedback from professionals on the ground.

ADDITIONAL RESOURCES
US COVID-19 Cases Caused by Variants — The cases identified are based on a sampling of SARS-CoV-2-positive specimens and do not represent the total number of B.1.1.7 lineage cases that may be circulating in the United States and may not match numbers reported by states, territories, tribes, and local officials.

SARS-CoV-2 Transmission from People Without COVID-19 Symptoms — Researchers used a model to assess the proportion of COVID-19 spread that likely occurs from infected people who do not have symptoms. They found that more than 50% of new COVID-19 infections were estimated to have come from people without symptoms. These findings underscore the importance of measures such as wearing masks, social distancing, and washing hands to slow the spread of COVID-19. Strategic testing of people who are not ill, such as those who have been exposed to COVID-19 or those with frequent contact with the public, can also reduce the spread of COVID-19 until safe and effective vaccines are widely available.

Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages — This quick reference summarizes CDC’s strategies to optimize personal protective equipment (PPE) supplies in healthcare settings and provides links to CDC’s full guidance documents on optimizing supplies which provide additional strategies and details.

Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during Shortages — This summary is intended to help healthcare facilities optimize supplies of disposable N95 filtering facepiece respirators when there is limited supply during the COVID-19 pandemic.

Updated People with Certain Medical Conditions — Revisions were made on December 23, 2020 to reflect recent data supporting increased risk of severe illness among persons with Down Syndrome from the virus that causes COVID-19. Revisions also include addition of sickle cell disease and chronic kidney disease to the conditions that might increase the risk of severe illness among children.

Morbidity and Mortality Weekly Report (MMWR) — Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020 — This report summarizes the clinical and epidemiologic characteristics of people in the U.S. with anaphylaxis and non-anaphylaxis allergic reactions following administration of a first dose of Pfizer-BioNTech COVID-19 vaccine during December 14-23, 2020. Monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination. Post-event follow-up indicates that the patients experiencing anaphylaxis fully recovered following treatment. You can learn more here: Morbidity and Mortality Weekly Report

Morbidity and Mortality Weekly Report (MMWR) — Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020 — A federal mandate issued by the Centers for Medicare & Medicaid Services (CMS), required nursing homes to commence enrollment and routine reporting of COVID-19 cases among residents and staff members by May 25, 2020. This report uses the NHSN nursing home COVID-19 data reported during May 25–November 22, 2020, to describe COVID-19 rates among nursing home residents and staff members and compares these with rates in surrounding communities by corresponding U.S. Department of Health and Human Services (HHS) region. You can learn more here: Morbidity and Mortality Weekly Report

Morbidity and Mortality Weekly Report (MMWR) — Assessment of Day-7 Postexposure Testing of Asymptomatic Contacts of COVID-19 Patients to Evaluate Early Release from Quarantine — Vermont, May–November 2020 — On May 8, 2020, the Vermont Department of Health (VDH) issued a Health Update recommending shortening the duration of quarantine for persons exposed to SARS-CoV-2, the virus that causes COVID-19. Exposed persons who were in quarantine could be tested by polymerase chain reaction (PCR) on or after quarantine day 7. Those who had remained asymptomatic throughout quarantine and who received a negative SARS-CoV-2 PCR test result on or after day 7 could end quarantine. You can learn more here: Morbidity and Mortality Weekly Report

UPCOMING CALLS/WEBINARS
COVID-19 Partner Update Call: CDC COVID-19 Case Investigation and Contact Tracing Guidance and Tools – Thursday, January 21, 2021, 2:00 p.m. – 3:00 p.m. (Eastern Time) — Dr. Cliff McDonald, Acting Chief Medical Officer, and Dr. Melanie Taylor, Deputy, COVID-19 Contact Tracing Innovations Support will present. Ms. Michelle Putnam, Deputy, Policy Unit Partnerships & Risk Management Team will moderate. Dr. McDonald will share updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others. In addition, Dr. Taylor will provide an overview on contact tracing guidance and tools. All questions will be collected in advance of the webinar. Click here to register

The call will be recorded and posted with previous Partner Update webinars here.

Clinician Outreach and Communication Activity (COCA) – Treating Long-COVID: Clinician Experience with Post-Acute COVID-19 Care — The Clinician Outreach and Communication Activity (COCA) will hold a call Thursday, January 28, 2021, from 2:00–3:00 p.m. (Eastern Time). During this COCA Call, presenters will share their firsthand experiences with treating long COVID, focusing on the pulmonary, neurologic, and psychological aspects. They will also describe their experiences with establishing clinics that provide care for patients with these long-term effects. For more information, please visit: COCA Calls/Webinars

IN CASE YOU MISSED IT — Clinician Outreach and Communication Activity (COCA) – COVID-19 Vaccines: Update on Allergic Reactions, Contraindications, and Precautions — The Clinician Outreach and Communication Activity (COCA) hosted a call Wednesday, December 30, 2020. During this COCA Call, presenters gave an overview of recommendations for use of COVID-19 vaccines in certain populations. Clinicians learned more about the recent reports of anaphylaxis following vaccination, as well as CDC’s updated clinical considerations around contraindications and precautions to vaccination. For the recording of this call, please visit: COCA Calls/Webinars

January 11th, 2021

The federal government is sending Abbott BinaxNOW rapid antigen test kits to states for distribution. There is limited availability of these tests to Missouri Long Term Care Facilities (RCF, ALF, ICF, and SNF) and private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) with a CLIA certificate.

Department of Health and Senior Services (DHSS) and the State Emergency Management Agency (SEMA) will distribute available tests to LTCFs for use. Because there are a limited number of tests available, these tests are best suited for use with patients or staff who are symptomatic and who may have had a credible exposure to COVID-19.

Demand will be high and so we ask homes to only request what they will need for a 45 day timeframe- that is not covered by other testing capacities. Our understanding is that federal shipments will begin again next week in counties with high positivity rates. This effort is to supplement existing testing capacity- not to replace it.

APPLICATIONS FOR TEST KITS MUST BE RECEIVED BY JANUARY 22, 2021 at this link: https://arcg.is/1XvLeP.

January 11th, 2021

We have received a couple emails regarding this, so passing along CDC guidelines on receiving COVID vaccine after/before flu vaccines, TB testing, etc.:

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

Interpretation of tuberculosis test results in vaccinated persons

Inactive vaccines do not interfere with tuberculosis (TB) test results. There is no immunologic reason to believe either a Tuberculin Skin Test (TST) (administered by intradermal placement of 0.1 cc of purified protein derivative) or blood draw for interferon gamma release assay (IGRA) would affect the safety or effectiveness of mRNA COVID-19 vaccines. We have no data to inform the impact of the COVID-19 mRNA vaccines on either TB test for infection (i.e., TST or IGRA).

For healthcare personnel or patients who require baseline TB testing (at onboarding or entry into facilities) at the same time they are to receive an mRNA COVID-19 vaccine:

Perform TB symptom screening on all healthcare personnel or patients.
If utilizing the IGRA, draw blood for interferon gamma release assay prior to COVID-19 vaccination.
If utilizing the TST, place prior to COVID-19 vaccination.
If vaccination has been given and testing needs to be performed, defer TST or IGRA until 4 weeks after COVID-19 vaccine 2-dose completion.
- All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.

If a facility has a concern regarding delaying the TST or IGRA, because of vaccination- then they can rely on the state waivers currently in place to delay the TB test, if necessary.

Another question we have received has been regarding CDC guidance related to co-administration with other vaccines.

Coadministration with other vaccines

Given the lack of data on the safety and efficacy of mRNA COVID-19 vaccines administered simultaneously with other vaccines, the vaccine series should routinely be administered alone, with a minimum interval of 14 days before or after administration with any other vaccine. However, mRNA COVID-19 and other vaccines may be administered within a shorter period in situations where the benefits of vaccination are deemed to outweigh the potential unknown risks of vaccine coadministration (e.g., tetanus toxoid-containing vaccination as part of wound management, measles or hepatitis A vaccination during an outbreak) or to avoid barriers or delays to mRNA COVID-19 vaccination (e.g., in long-term care facility residents or healthcare personnel who received influenza or other vaccinations prior to/upon admission or onboarding). If mRNA COVID-19 vaccines are administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.

January 8th, 2021

SLCR has received many questions regarding COVID-19 vaccinations and the impact those vaccinations will have on infection control guidelines. At this time, there are still many questions unanswered regarding vaccination that make infection control changes uncertain right now. Current CDC can be found here: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.

Vaccination is one important tool (not the only) in our tool belt to address COVID-19 infections. Vaccinating healthcare personnel and residents is essential to helping prevent individuals (who may not be able to recover) from getting COVID-19. For long-term care facilities, vaccinations are vital to protecting healthcare capacity. Staff who are sick cannot work and provide the necessary case and services to residents to ensure their health and safety.

The toolkit includes some helpful information for staff and residents/loved ones regarding the vaccine as well.

LTCF Staff pdf
LTCF Residents & Loved Ones pdf

January 6th, 2021

CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care. In addition, CMS has provided Frequently Asked Questions related to health, emergency preparedness and life-safety code surveys.

See the memo for details.

January 6th, 2021

COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC, and front line staff and providers
Wednesday, 6, 2021, at 3:00 pm (Central Time)

Join The Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) for a fireside chat on vaccine safety. This is the second discussion in a special series, a part of the CMS National Nursing Home Stakeholder Call Series, aimed at addressing staff questions and concerns about the new COVID-19 vaccines. Each session will be moderated by CMS with speakers from CDC and representatives of front line staff and providers.

This chat will continue to address myths surrounding vaccine danger with the following panelist:

Dr. Lee Fleisher, CMS Chief Medical Officer and Director, Center for Clinical Standards and Quality (CMS)
Dr. Amanda Cohn, Chief Medical Officer (Acting), Office of Vaccine Policy, Preparedness, and Global Health, Office of the Director (CDC)
Cassandra Lowe, Certified Nursing Assistant (CNA)

Preparing for the call:

Would you like to submit questions for the panel to discuss? Questions can be sent to COVID-19@cms.hhs.gov. There will not be a Q&A session during the call.
Resource: Long term Care toolkit: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.

Target Audience: Nursing Home Frontline staff, Chief Nursing Officers

Register in advance for this webinar (After registering, you will receive a confirmation email containing information about joining the webinar): https://cms.zoomgov.com/webinar/register/WN_VQnfc77zTaOho3-yYrtGUAA

Missouri Long-Term Care Information Update

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