Richter is pleased to provide the following COVID-19 information and resources as a means to helping all facilities on the long-term post-acute care (LTPAC) spectrum better understand the virus, minimize its spread among residents/patients, employees and visitors, and manage suspected cases within facilities.
Please note: As the pandemic continues to evolve, some facts and figures in these webinars may have changed since the original presentation date, so we appreciate your understanding.
- Effective April 1, 2020 the ICD-10 code for COVID-19 is U07.1
- Department of Health and Human Services Relief Fund Payment Terms and Conditions
- The Department of Health and Human Services (HHS) is distributing stimulus payments to healthcare providers who received Medicare fee-for-service reimbursement in 2019. This payment should be received within the next two weeks. The payment will be roughly 6.2% of the total reimbursement amounts for both Part A and B in 2019, and will be made to provider billing organizations based on their Taxpayer Identification Numbers. You should refer to your 2019 PS&R Report for the gross reimbursement totals in order to estimate the payment amount. UnitedHealth Group is distributing the payments, so if they have a bank deposit on file for your facility it will be paid ACH into your bank account. If not, the payment will be sent via check.
This does NOT need to be paid back, and the provider will need to determine how they want this to be recorded on their financial statements. Within 30 days of receiving the payment, the contact on the account must sign an attestation confirming receipt of the funds.
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Coronaviruses are viruses that circulate among animals, but some of them are known to affect humans (e.g., SARS and MERS). Corona is Latin for crown and this name was used due to the spike-like protrusions on the virus surface.
In December 2019 a novel (new) coronavirus was identified in China, and this new strain has not been previously seen in humans. It is now known as COVID-19 or SARS-CoV-2 and is spreading globally.
The virus invades the cells of the lungs, and the body’s own immune system begins to attack the lung cells, causing acute respiratory failure in approximately 20% of those infected; 80% of those infected will have mild symptoms.
Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed COVID-19 cases.
A study released March 4, produced by researchers at Peking University’s School of Life Sciences and the Institut Pasteur of Shanghai, found that two types of the coronavirus appeared to exist: a more aggressive one, and a less aggressive one.
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Spread of COVID-19 in the U.S.
The first cases of COVID-19 were confirmed in a Washington State SNF in late February. In less than one month, cases were confirmed in all 50 U.S. states.
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COVID-19 Quick Facts
- Incubation period: 2 to 14 days
- Transmission: via respiratory droplets
- Shortness of breath
- Muscle pain
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There currently is no vaccine. The first human vaccine trials began in March 2020. We are still at least 12 to 18 months away from a vaccine.
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The Centers for Disease Control (CDC) recommendations to prevent the spread of COVID-19 in LTPAC facilities are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.
- Avoid contact with sick people
- Social distancing – stay at least six feet away from other people outside of your home whenever possible
- Wash your hands frequently with soap and water
- If you have a cough, wear a mask
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Centers for Medicare and Medicaid Services (CMS) COVID-19 Updates
- Effective immediately and, until further notice, state survey agencies and accrediting organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse – beginning with nursing homes and hospitals.
- Critically, this shift in approach, first announced by Vice President Pence, will allow inspectors to focus their energies on addressing the spread of COVID-19.
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Facility Disaster Plan Recommendations for COVID-19 or Similar Pathogens
As part of a facility’s regular risk assessment, LTPAC facilities should develop plans to prepare for and respond to potential outbreaks and/or pandemics. Plans developed for pandemic influenza are reasonable models to use in addressing the prevention and management of COVID-19. Key measures for this include:
Recommendation #1: Develop and Deploy a Structure for Planning and Decision-making
- Develop a COVID-19 planning committee.
- Incorporate COVID-19 into emergency management planning and exercises for the facility.
- Create a multidisciplinary planning committee to specifically address pandemic COVID-19 preparedness.
- Assign a specific person responsible for coordinating preparedness planning, referred to as the “pandemic COVID-19 response coordinator.”
Recommendation #2: Develop a Written Pandemic COVID-19 Plan
- Obtain copies of relevant sections of the HHS Pandemic COVID-19/Influenza Plan (available at hhs.gov/pandemicflu/plan/), and review available state, regional or local plans for incorporation into the facility’s plan.
- Identify in the plan the person(s) authorized to implement it and the organizational structure that will be used.
Recommendation #3: Include Essential Elements in the COVID-19 Pandemic Plan
Ensure that plans are in place for:
- Surveillance and detection of the presence of the pandemic in residents and staff
- Facility-wide communication
- Education and training to ensure that all personnel, residents/patients and family members of residents/patients understand the implications of, and basic prevention and control measures for, pandemic COVID-19
- Infection control for managing residents and visitors with pandemic COVID-19
- Occupational health for addressing staff absences and other related occupational issues
- Vaccine and antiviral use plan (knowing that a vaccine is not currently applicable)
- Ensure that issues related to surge capacity during a pandemic have been addressed
Recommendation #4: Identify Disaster Supplies Needed
These include but are not limited to:
- Personal protective equipment
- Adult briefs
- Treatment/medical supplies
- Cleaning and laundry supplies
- Soap and towels
- Paper towels/toilet paper
- Alcohol-based hand rub (ABHR)
Recommendation #5: Review and Update Infection Prevention and Control Policies and Procedures for COVID-19
- Hand hygiene
- Respiratory hygiene/cough etiquette
- Personal protective equipment (PPE)
- Sick leave policies and procedures
- Staff exposure policy
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LTPAC Surveillance Practices
Active monitoring and surveillance are important to early detection and recognition of potential outbreaks of all infectious illnesses in LTPAC settings. Facilities should already have an active surveillance program in place capable of identifying cases, clusters and outbreaks of disease. Some points to consider:
- Facilities should immediately reassess their surveillance program and take any necessary steps to optimize its performance.
- Healthcare personnel should monitor their local and state public health sources to understand COVID-19 activity in their community to help inform their evaluation of individuals with unknown respiratory illness.
- If there is transmission of COVID-19 in your community, in addition to implementing the precautions described above for residents/patients with acute respiratory infection, facilities should also consult with public health authorities for additional guidance.
- Notify facilities prior to transferring a resident/patient with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
- Report any possible COVID-19 illness in residents/patients and employees to the local health department, including your state HAI/AR coordinator.
- Follow CDC’s recommendations for using a face mask.
- CDC does not recommend that people who are well wear a face mask to protect themselves from respiratory diseases, including COVID-19.
- Face masks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of face masks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a healthcare facility).
- CDC has developed a new laboratory test kit for use in testing patient specimens for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.
- The test kit is called the “Centers for Disease Control and Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel.” It is intended for use with the Applied Biosystems 7500 Fast DX Real-Time PCR Instrument with SDS 1.4 software.
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Preventing Spread of COVID-19
- Assess residents’/patients’ symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents/patients.
- Monitor residents/patients and employees for fever or respiratory symptoms.
- Restrict residents/patients with fever or acute respiratory symptoms to their room. If they must leave the room for medically necessary procedures, have them wear a face mask (if tolerated).
- In general, for care of residents/patients with undiagnosed respiratory infection, use Standard, Contact and Droplet Precautions with eye protection unless suspected diagnosis requires Airborne Precautions (e.g., tuberculosis).
- Because healthcare personnel reside in the community and work in facilities, they have the potential to introduce infections into LTPAC populations. As with all situations, healthcare personnel who are ill should stay home and seek healthcare advice through their regular provider.
- Those with mild symptoms are encouraged to call, rather than going in person, for medical advice.
- Healthcare providers should avoid working while ill.
- Healthcare facilities should immediately develop staff policies to allow and account for potential absenteeism during community-wide outbreaks.
- If there is evidence of community-wide COVID-19 illness, facilities should screen staff at entry into the facility for respiratory signs and symptoms and fever.
- Follow the CDC and State guidance which prevents visitation with the exception of compassion visits for the terminally ill
- Like healthcare personnel, visitors may also inadvertently foster the spread of infections in LTPAC settings. Given the unique nature of LTPACs, it will not likely be possible to prohibit all visitors in the event of community-wide COVID-19 illness. For example, individuals on hospice should be able to visit with family members who are not ill.
- Consistent with good routine practice, we recommend posting signs requesting that people with acute respiratory illness refrain from entering the LTPAC facility. This applies whether or not there is COVID-19 activity in the community.
- We recommend individuals (regardless of illness presence) who have a known exposure to someone with COVID-19, or who have recently traveled to areas with COVID-19 transmission, refrain from entering the nursing home.
- If there is community-wide transmission of COVID-19, we recommend facilities consider screening visitors at entry to the facility.
- Review the visitor policy and make adjustments as needed.
- Facilities should post signs requesting that people with acute respiratory illness refrain from entering the facility. This applies whether or not there is COVID-19 activity in the community.
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How to Manage Suspected Cases of COVID-19 in the Facility
- Identify dedicated employees to care for COVID-19 residents/patients and provide infection control training.
- Provide the right supplies to ensure easy and correct use of personal protective equipment (PPE).
- Post signs on the door or wall outside of the resident/patient room that clearly describe the type of precautions needed and required PPE.
- Make PPE, including face masks, eye protection, gowns and gloves, available immediately outside of the resident/patient room.
- Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE.
- Guidance on implementing recommended infection prevention practices is available in CDC’s free online course, “The Nursing Home Infection Preventionist Training,” which includes resources and checklists for facilities and employees to use.
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Hand and Respiratory Hygiene Tips for You, Employees, Residents and Visitors
- Support hand and respiratory hygiene.
- Encourage cough etiquette by residents/patients, visitors and employees.
- Ensure employees clean their hands according to CDC guidelines, including before and after contact with residents/patients, after contact with contaminated surfaces or equipment and after removing PPE.
- Put alcohol-based hand rub in every resident/patient room (ideally both inside and outside of the room).
- Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.
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Center for Disease Control and Prevention
Centers for Medicare & Medicaid Services (CMS)
Occupational Safety and Health Administration
Arizona Department of Health Services
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Questions about COVID-19 or other LTPAC clinical challenges? Please contact Jennifer Leatherbarrow, RN BSN RAC-CT IPCO QCP CIC, Manager of Clinical Consulting for Richter at 866-806-0799.