Corona Virus COVID-19 Information
Corona Virus COVID-19 Information

The recent novel corona virus, COVID-19 has taken the world by literal storm. The virus has had an effect on society not seen in generations the risk of death to vulnerable adults has lead to the closing of most businesses and a lock down on travel and forced social distancing.

Minnesota Department of Health Information about Corona Virus COVID-19

According to the MDH:

  • COVID-19 is a viral respiratory illness caused by a coronavirus that has not been found in people before.
  • Because this is a new virus, there are still things we do not know, such as how severe the illness can be, how well it is transmitted between people, and other features of the virus. More information will be provided when it is available.

Severity

  • Many cases have mild or moderate illness and do not require a clinic visit and most do not require hospitalization.
  • Those at highest risk for severe illness include older people or those that have certain underlying health conditions. These include such high risk conditions as a blood disorder, chronic kidney disease, chronic liver disease, compromised immune system, late term or recent pregnancy, endocrine disorders, metabolic disorders, heart disease, lung disease, neurological conditions. Check with your health care provider to see if you are considered high risk.

Symptoms of COVID-19

  • According to CDC, patients with confirmed COVID-19 have had mild to severe respiratory illness with symptoms of:
    • fever
    • cough
    • shortness of breath
  • Some patients have had other symptoms including muscle aches, headache, sore throat, or diarrhea.
  • These symptoms may appear 2-14 days after exposure.

How it spreads

  • The virus is thought to spread mainly from person-to-person through respiratory droplets produced when an infected person coughs or sneezes.
    • It spreads between people who are in close contact with one another (within about 6 feet).
    • These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
  • It is also possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. Washing your hands and cleaning frequently touched surfaces often is a good way to prevent you from getting COVID-19 from touching surfaces.
  • Some spread might be possible before people show symptoms (when they are asymptomatic); there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.
    • The virus spreads most easily when a person has symptoms and is coughing or sneezing.

Testing for COVID-19

  • People who do not have symptoms should not be tested for COVID-19. Due to national shortages of lab testing supplies, we do not have an unlimited capacity for testing.
  • We are currently prioritizing most testing for people who are hospitalized, health care workers, and people living or working in congregate living settings, such as nursing homes and others.

Corona Virus Impact on Elders

Aside from the direct impact to seniors and vulnerable adults themselves under lockdown and unable to see their family and friends, they are also the highest risk of serious complications or death from exposure.

According to CMS, it directs nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities inside nursing homes. The new measures are CMS’s latest action to protect America’s seniors, who are at highest risk for complications from COVID-19. While visitor restrictions may be difficult for residents and families, it is an important temporary measure for their protection.

The Guidelines Have Exceptions for Compassionate Care Reasons

The guidelines do make an exception for compassionate care reasons, such as end-of-life situations, which will be handled on a case-by-case basis. Visitors and essential health care providers should be actively screened prior to any visit. Essential health care workers include, but are not limited to, facility staff, therapists, home health, hospice providers, dialysis staff, physicians, necessary lab/X-ray staff, clergy, mobility drivers for transport to essential appointments, local public health, the ombudsman, state agency survey staff, and Minnesota Department of Human Services (DHS) staff. Any essential health care provider exhibiting acute respiratory symptoms will be prohibited from entering the building.

Minnesota Has Corona Virus Situation MDH Website Updated Daily

This MDH site provides information on the totals of persons, testing for the virus, those testing positive and deaths related to COVID-19.

MINNESOTA DEPARTMENT OF HEALTH, MDH – PROVIDES DAILY UPDATES ON THE CORONA VIRUS COVID-19

Elder Care Facilities Must Ensure Proper Infectious Disease Control to Protect Residents and Staff

Nursing homes always have a duty to implement proper disease control to prevent or reduce the spread of infectious disease. The need for personal protective equipment, PPE, compliance with infectious disease control protocols and sanitation is essential to protect vulnerable residents.

CENTER FOR MEDICARE MEDICAID SERVICES GUIDANCE FOR HEALTH CARE WORKERS

CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration

Hospital Patient Rights. CMS is waiving requirements under 42 CFR §482.13 only for hospitals that are considered to be impacted by a widespread outbreak of COVID-19. Hospitals that are located in a state which has widespread confirmed cases (i.e., 51 or more confirmed cases*) as updated on the CDC website, CDC States Reporting Cases of COVID-19, at https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html, would not be required to meet the following requirements:

• §482.13(d)(2) – With respect to timeframes in providing a copy of a medical record.

• §482.13(h) – Related to patient visitation, including the requirement to have written policies and procedures on visitation of patients who are in COVID-19 isolation and quarantine processes.

• §482.13(e)(1)(ii) – Regarding seclusion.

*The waiver flexibility is based on the number of confirmed cases as reported by CDC and will be assessed accordingly when corona virus COVID-19 confirmed cases decrease.

Long-Term Care Facilities and Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs)

• 3-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).

• Reporting Minimum Data Set. CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.

• Staffing Data Submission. CMS is waiving 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system.

• Waive Pre-Admission Screening and Annual Resident Review (PASARR). CMS is waiving 42 CFR 483.20(k) allowing states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should receive the assessment as soon as resources become available.

• Physical Environment. CMS is waiving requirements related at 42 CFR 483.90, specifically the following:

• Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements under § 483.90 to allow for a non-SNF building to be temporarily certified and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults. CMS believes this will also provide another measure that will free up inpatient care beds at hospitals for the most acute patients while providing beds for those still in need of care. CMS will waive certain conditions of participation and certification requirements for opening a NF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.

• CMS is also waiving requirements under 42 CFR 483.90 to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this purpose include activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long as residents can be kept safe, comfortable, and other applicable requirements for participation are met. This can be done so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department.

• Resident Groups. CMS is waiving the requirements at 42 CFR 483.10(f)(5), which ensure residents can participate in-person in resident groups. This waiver would only permit the facility to restrict in-person meetings during the national emergency given the recommendations of social distancing and limiting gatherings of more than ten people. Refraining from in-person gatherings will help prevent the spread of COVID-19.

•Training and Certification of Nurse Aides. CMS is waiving the requirements at 42 CFR 483.35(d) (with the exception of 42 CFR 483.35(d)(1)(i)), which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements under § 483.35(d). CMS is waiving these requirements to assist in potential staffing shortages seen with the COVID-19 pandemic. To ensure the health and safety of nursing home residents, CMS is not waiving 42 CFR § 483.35(d)(1)(i), which requires facilities to not use any individual working as a nurse aide for more than four months, on a full-time basis, unless that individual is competent to provide nursing and nursing related services. We further note that we are not waiving § 483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.


• Physician Visits in Skilled Nursing Facilities/Nursing Facilities. CMS is waiving the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform in person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.

• Resident roommates and grouping. CMS is waiving the requirements in 42 CFR 483.10(e) (5), (6), and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19, and separating them from residents who are asymptomatic or tested negative for COVID-19. This action waives a facility’s requirements, under 42 CFR 483.10, to provide for a resident to share a room with his or her roommate of choice in certain circumstances, to provide notice and rationale for changing a resident’s room, and to provide for a resident’s refusal a transfer to another room in the facility. This aligns with CDC guidance to preferably place residents in locations designed to care for COVID-19 residents, to prevent the transmission of COVID-19 to other residents.

• Resident Transfer and Discharge. CMS is waiving requirements in 42 CFR 483.10(c)(5); 483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), (c)(9), and (d); and § 483.21(a)(1)(i), (a)(2)(i), and (b) (2)(i) (with some exceptions) to allow a long term care (LTC) facility to transfer or discharge residents to another LTC facility solely for the following cohortingpurposes: 1. Transferring residents with symptoms of a respiratory infection or confirmed diagnosis of COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents; 2. Transferring residents without symptoms of a respiratory infection or confirmed to not have COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents to prevent them from acquiring COVID-19; or 3. Transferring residents without symptoms of a respiratory infection to another facility that agrees to accept each specific resident to observe for any signs or symptoms of a respiratory infection over 14 days.

Federal Law Mandates Infectious Disease Control in Nursing Homes

Pursuant to 42 CFR § 483.80 Infection control.

The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.

(a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements:

(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to § 483.70(e) and following accepted national standards;

(2) Written standards, policies, and procedures for the program, which must include, but are not limited to:

(i) A system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility;

(ii) When and to whom possible incidents of communicable disease or infections should be reported;

(iii) Standard and transmission-based precautions to be followed to prevent spread of infections;

(iv) When and how isolation should be used for a resident; including but not limited to:

(A) The type and duration of the isolation, depending upon the infectious agent or organism involved, and

(B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances.

(v) The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and

(vi) The hand hygiene procedures to be followed by staff involved in direct resident contact.

(3) An antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.

(4) A system for recording incidents identified under the facility’s IPCP and the corrective actions taken by the facility.

(b) Infection preventionist. The facility must designate one or more individual(s) as the infection preventionist(s) (IPs) who are responsible for the facility’s IPCP. The IP must:

(1) Have primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field;

(2) Be qualified by education, training, experience or certification;

(3) Work at least part-time at the facility; and

(4) Have completed specialized training in infection prevention and control.

(c) IP participation on quality assessment and assurance committee. The individual designated as the IP, or at least one of the individuals if there is more than one IP, must be a member of the facility’s quality assessment and assurance committee and report to the committee on the IPCP on a regular basis.

(d) Influenza and pneumococcal immunizations

(1) Influenza. The facility must develop policies and procedures to ensure that –

(i) Before offering the influenza immunization, each resident or the resident’s representative receives education regarding the benefits and potential side effects of the immunization;

(ii) Each resident is offered an influenza immunization October 1 through March 31 annually, unless the immunization is medically contraindicated or the resident has already been immunized during this time period;

(iii) The resident or the resident’s representative has the opportunity to refuse immunization; and

(iv) The resident’s medical record includes documentation that indicates, at a minimum, the following:

(A) That the resident or resident’s representative was provided education regarding the benefits and potential side effects of influenza immunization; and

(B) That the resident either received the influenza immunization or did not receive the influenza immunization due to medical contraindications or refusal.

(2) Pneumococcal disease. The facility must develop policies and procedures to ensure that –

(i) Before offering the pneumococcal immunization, each resident or the resident’s representative receives education regarding the benefits and potential side effects of the immunization;

(ii) Each resident is offered a pneumococcal immunization, unless the immunization is medically contraindicated or the resident has already been immunized;

(iii) The resident or the resident’s representative has the opportunity to refuse immunization; and

(iv) The resident’s medical record includes documentation that indicates, at a minimum, the following:

(A) That the resident or resident’s representative was provided education regarding the benefits and potential side effects of pneumococcal immunization; and

(B) That the resident either received the pneumococcal immunization or did not receive the pneumococcal immunization due to medical contraindication or refusal.

(e) Linens. Personnel must handle, store, process, and transport linens so as to prevent the spread of infection.

(f) Annual review. The facility will conduct an annual review of its IPCP and update their program, as necessary. [81 FR 68868, Oct. 4, 2016]

For a Free Consultation with an experienced elder abuse and neglect attorney call Kenneth LaBore at 612-743-9048.

Due to the lack of staffing and concerns about health care workers the residents are not only at risk of the virus and its complications, but also the ongoing common form of neglect in elder care facilities including for example medication management and administration or injuries from fall and fractures. Most forms of elder abuse are preventable with proper care and supervision.

Report Suspected Elder Abuse

Click Here For Link To Report Abuse To Adult Protection
Click Here For Link To Report Abuse To Adult Protection

If you have concerns about care provided to a resident in a nursing home, assisted living or any other type of elder care provider contact Attorney Kenneth LaBore for a Free Consultation to discuss your legal rights and options.

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Corona Virus Information For Elder Advocates
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