Downloadable AHCA/NCAL waivers on 3-day stays and benefit-periods for Medicare Part A SNF PPS.

Guidance on when to discontinue transmission-based precautions when admitting patients from hospitals.

Policy and Procedure to follow for New Admissions during the COVID-19 Pandemic.

Policy and Procedure to follow for New Admissions during the COVID-19 Pandemic. (Spanish version)

AHA created a summary of adjustments to cardiopulmonary resuscitation (CPR) algorithms in patients with suspected or confirmed coronavirus disease 2019 (COVID-19).

Discuss current CMS guidance on communal dining, Identify conditions and steps to gradually open dining service, Discuss best practices used in various dining setting

AHCA/NCAL CEO Mark Parkinson speaks on Provider Relief Funding.

A summary from AHCA of the recent CMS QSO memo updating the State Operations Manual (SOM) Appendix Z that outlines emergency preparedness (EP) requirements.

Infection prevention is the vital first line of defense against COVID-19. Observational audits are the best way to understand if your staff fully comply with infection prevention practices because audit observations are made while staff perform their usual duties. Auditing allows you to obtain accurate compliance rates and identify process failures, such as a step in the handwashing process that some staff miss. These are the data points you need for an effective Quality Assurance and Performance Improvement (QAPI) project.

In honor of Mental Health Awareness month, AMDA wishes to formally acknowledge the pain we have all endured, and continue to endure, by launching the “Healing Together” campaign. We begin today by sharing an extensive list of resources assembled by the Behavioral Health Advisory Council. These are meant to be shared with all partners in this work, from food services professionals to medical providers, to administrative staff and environmental services teams, and everyone in between.

The Nursing Home Reform Act of 1987 says that nursing homes "must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing of each resident in accordance with a written plan of care". This toolkit was developed to assist you in updating your current care plans to address the COVID-19 pandemic. Facilities across the country are being cited for not having updated, comprehensive care plans to address the risks associated with the virus, isolation, decline in ADLs, etc. This toolkit will give you some examples and is not intended to be the end-all but rather the beginning!

The Nursing Home Reform Act of 1987 says that nursing homes "must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing of each resident in accordance with a written plan of care". This toolkit was developed to assist you in updating your current care plans to address the COVID-19 pandemic. Facilities across the country are being cited for not having updated, comprehensive care plans to address the risks associated with the virus, isolation, decline in ADLs, etc. This toolkit will give you some examples and is not intended to be the end-all but rather the beginning! (Spanish version)

Thorough documentation is critical to the facility’s success to support proper assessment and care and services were provided to the resident. Here is some guidance to guide you.

Thorough documentation is critical to the facility’s success to support proper assessment and care and services were provided to the resident. Here is some guidance to guide you. (Spanish version)

Items to record and/or copy and put in COVID-19 Response File. This will enable you to best demonstrate the actions you have taken (and continue to take) in response to the pandemic.

Items to record and/or copy and put in COVID-19 Response File. This will enable you to best demonstrate the actions you have taken (and continue to take) in response to the pandemic. (Spanish version)

Advance care planning is a process of documenting your health care service wishes for your health care team so that in the event you are no longer capable of making independent choices, your care preferences will be respected. Advance care planning is important for residents, families and health care providers as it assists in avoiding crisis-based decisions and avoids unwanted treatments.

Voluntary ACP is a face-to-face service between a Medicare physician (or other qualified health care professional) and a patient to discuss the patient’s health care wishes if they become unable to make decisions about their care.

Each resident has the right to formulate an advance directive, including the right to request, refuse and/or discontinue treatment. This sample policy can be modified to your facility.

Each resident has the right to formulate an advance directive, including the right to request, refuse and/or discontinue treatment. This sample policy can be modified to your facility. (Spanish version)

Additional precautions are required when performing CPR during this pandemic, use this sample policy & procedure and customize for your facility.

Additional precautions are required when performing CPR during this pandemic, use this sample policy & procedure and customize for your facility. (Spanish version)

Questions and answers regarding FEMA funeral assistance related to COVID-19

To date, there is no evidence of persons having been infected from exposure to the body of persons who died from COVID-19. The dignity of the deceased, their cultural and religious traditions/beliefs, and their family will be respected and protected on an individual basis, balancing family wishes and the risk of exposure. The safety and well-being of caregivers who provide post-mortem care is a high priority.

To date, there is no evidence of persons having been infected from exposure to the body of persons who died from COVID-19. The dignity of the deceased, their cultural and religious traditions/beliefs, and their family will be respected and protected on an individual basis, balancing family wishes, and the risk of exposure. The safety and well-being of caregivers who provide post-mortem care is a high priority. (Spanish version)

The dignity of a resident who has died including their cultural and religious traditions/beliefs and their family will be respected and protected while providing postmortem care to the extent possible during a pandemic. (Spanish version)

To help stop the spread of COVID-19, take these 3 key steps NOW while waiting for your test results

To help stop the spread of COVID-19, take these 3 key steps NOW while waiting for your test results (Spanish version)

The World Health Organization has put together a helpful infographic to remind Health Care Workers when they should practice hand hygiene.

6 Step infographic from the EPA on safe disinfectant use.

About a year ago, theWorld Health Assembly (WHA) met virtually for the first time since the creation of theWorld Health Organization (WHO) in 1948. Last year’s WHA adopted a resolution asking states to intensify action to fight COVID-19. Yet a year on, there have been 3.7 million deaths reported, with the real number estimated as more than 7 million. From May 24-31, 2021, the 74th WHA (WHA74) was again held virtually amidst this historic pandemic. The WHA created a member states working group on strengthening WHO preparedness for and response to health emergencies to make recommendations to next year’s WHA.1 Here are 9 steps to end this pandemic and prevent the next one.

If you are accepting the admission of a resident with suspected or positive COVID, consider the tips outlined here.

If you are accepting the admission of a resident with suspected or positive COVID, consider the tips outlined here. (Spanish version)

Things to consider when admitting residents from a hospital setting during the COVID-19 Pandemic.

Things to consider when admitting residents from a hospital setting during the COVID-19 Pandemic. (Spanish version)

Examples of commonly performed medical procedures that are considered aerosol-generating and are more likely to generate higher concentrations of infectious respiratory aerosols.

There have been increasing reports of fraud related to three 3M surgical respirator models. 3M had put out a notification to help evaluate respirators by considering some common signs of counterfeit.

The Personal Protective Equipment (PPE) COVID-19 Observational Audit Data Tracking Tool helps facilities efficiently collect, record, analyze, review, and act on observational audit data to improve compliance with the steps in donning and removing PPE.

The Personal Protective Equipment COVID-19 Observational Audit Data Tracking Tool and User Guide help nursing homes identify performance patterns and target improvement more readily with an analytic tool to compile personal protective equipment (PPE) audit data.

This user guide provides step-by-step instructions for nursing home staff to use the Personal Protective Equipment (PPE) COVID-19 Observational Audit Data Tracking Tool to efficiently collect, record, analyze, review, and act on observational audit data to improve compliance with the steps in donning and removing PPE.

Decisions to implement contingency and crisis strategies are based upon these assumptions

Limited FFR reuse refers to the practice of using the same N95 FFR or other filtering facepiece respirator for multiple encounters with patients but removing it (doffing) after each encounter. Decontamination is a process to reduce the number of pathogens on used FFRs before reusing them. It is used to limit the risk of self-contamination. Decontamination and subsequent reuse of FFRs should only be practiced where FFR shortages exist.

There are many types of masks you can use to protect yourself and others from getting and spreading COVID-19. When choosing a mask, choose one that fits snugly. Learn more about how to choose a mask that fits well and offers the best protection.

Infographic outlining the differences between the two

Updates for For Contingency Capacity Strategies, and Crisis Capacity Strategies

The CDC recommends community use of masks, specifically non-valved, multi-layer, cloth masks to prevent transmission of SARS-CoV-2.

The 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.

Letter from the U.S. Senate Special Committee on Aging to CMS: After decades of funding rebalancing, there are still no generally accepted quality measures for HCBS. It remains impossible to compare states’ Medicaid HCBS along quality measures in a scorecard, such as CMS compiles for other Medicaid elements. Last year, the U.S. Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) noted its programmatic oversight work “consistently demonstrates that patients and programs may be vulnerable to fraud and abuse in home and community-based settings. Moreover, home-based services may not meet quality of care requirements.” Effective solutions to improve quality of care and prevent fraud in Medicaid HCBS are imperative to ensure that older Americans can age at home.

The purpose of this letter is to provide guidance to states on the implementation of section 9817 of the ARP, as well as to describe opportunities for states to strengthen the HCBS system in response to the COVID-19 Public Health Emergency (PHE), increase access to HCBS for Medicaid beneficiaries, adequately protect the HCBS workforce, safeguard financial stability for HCBS providers, and accelerate long-term services and supports (LTSS) reform under section 9817 of the ARP.

CMS continues to review the need for existing waivers issued in response to the Public Health Emergency (PHE). Over the course of the PHE, nursing homes have developed policies or other practices that we believe mitigates the need for certain waivers. Therefore, CMS is announcing it is ending: *The emergency blanket waivers related to notification of Resident Room or roommate changes, and Transfer and Discharge notification requirements; *The emergency blanket waiver for certain care planning requirements for residents transferred or discharged for cohorting purposes. *The emergency blanket waiver of the timeframe requirements for completing and transmitting resident assessment information (Minimum Data Set(MDS). • CMS is providing clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs)

The CONNECT for Health Act of 2021 promotes higher quality of care, increased access to care, and reduced spending in Medicare through the expansion of telehealth services.

We note that in many instances, the general statements of the FAQs referenced above have been superseded by COVID-19-specific legislation, emergency rules, and waivers granted under section 1135 of the Act specifically to address the COVID-19 public health emergency (PHE). The policies set out in this FAQ are effective for the duration of the PHE unless superseded by future legislation.

On Friday, March 13, 2020, the President declared a national emergency which triggered the Secretary’s ability to authorize waivers or modifications of certain requirements pursuant to section 1135 of the Social Security Act (the Act). Under section 1135(b)(5) of the Act, CMS is prioritizing surveys, including infection control surveys for nursing homes. This toolkit includes the survey preparation checklist, entrance conference guide and several policies related to containing the spread of COVID-19 to assist you in preparing for a focused survey.

On Friday, March 13, 2020, the President declared a national emergency which triggered the Secretary’s ability to authorize waivers or modifications of certain requirements pursuant to section 1135 of the Social Security Act (the Act). Under section 1135(b)(5) of the Act, CMS is prioritizing surveys, including infection control surveys for nursing homes. This toolkit includes the survey preparation checklist, entrance conference guide and several policies related to containing the spread of COVID-19 to assist you in preparing for a focused survey. (Spanish version)

Letter requesting that Congress act to provide reasonable liability protections during this health crisis by expanding the protections in section 3215 of the CARES Act to all health care professionals and front-line facilities.

This fact sheet educates Medicare physicians, nonphysician practitioners, hospitals, other providers, and suppliers on the updated regulations at 42 Code of Federal Regulations (CFR) Section 424.516(f). It gives information on updated documentation maintenance and access requirements for billing services to Medicare patients. It also tells you how long to keep the documentation and who is responsible for providing access.

A policy & procedure that follows CDC and CMS guidelines regarding Compassionate Care Visitation.

A policy & procedure that follows CDC and CMS guidelines regarding Compassionate Care Visitation. (Spanish version)

Sarcopenia, a loss of muscle mass, can begin after only 2 days of bed rest, decreasing muscle strength by 1%-3% per day. One week of bed rest can result in a 20% decrease in muscle strength and an additional 20% muscle strength loss for each week on bed rest! The purpose of this program is to introduce a mobility program designed to maintain baseline mobility and functional capacity, decrease the incidence of delirium, and decrease the length of stay in hospitalized patients.

Sarcopenia, a loss of muscle mass, can begin after only 2 days of bed rest, decreasing muscle strength by 1%-3% per day. One week of bed rest can result in a 20% decrease in muscle strength and an additional 20% muscle strength loss for each week on bed rest! The purpose of this program is to introduce a mobility program designed to maintain baseline mobility and functional capacity, decrease the incidence of delirium, and decrease the length of stay in hospitalized patients. (Spanish version)

A policy & procedure that follows CDC and CMS guidelines and best practices for outdoor visitation.

A policy & procedure that follows CDC and CMS guidelines and best practices for outdoor visitation. (Spanish version)

A policy & procedure that follows CDC and CMS guidelines regarding reopening and group activities.

A policy & procedure that follows CDC and CMS guidelines regarding reopening and group activities. (Spanish version)

Factors to assist in making informed decisions for reopening and relaxing restrictions in nursing homes.

Factors to assist in making informed decisions for reopening and relaxing restrictions in nursing homes. (Spanish version)

As communities emerge and reopen their dining venues, we all have a fantastic opportunity to give the residents an exciting and safe return. They are so excited to get back to some socialization around the dining experience, let’s give it our best shot!! A guide from Strategic Dining Services.

ADvancing States took action during the novel coronavirus (COVID-19) crisis to assist state aging and disability agencies in responding to, and meeting the needs of, facility residents and an older adult population sheltering at home. This resource was created through one-on-one conversations with states and a call for ideas in the Friday Update, a weekly email reaching over 15,000 aging and disability professionals. This resource is intended to assist states and others with creative and thoughtful approaches to social isolation and loneliness in older adults, and to also facilitate sharing and learning across states. It is our hope this collection of ideas and actions across states and organizations will reduce social isolation for some of the country’s most vulnerable older adults during the COVID-19 crisis.

Here are some helpful suggestions to implement at your facility to assist in pampering your residents during this challenging time

Here are some helpful suggestions to implement at your facility to assist in pampering your residents during this challenging time (Spanish version)

The CDC Morbidity and Mortality Weekly Report from March 5, 2021 regarding state-issued mask mandates and allowing on-premises restaurant dining.

If you are fully vaccinated, you can start doing many things that you had stopped doing because of the pandemic. When choosing safer activities, consider how COVID-19 is spreading in your community, the number of people participating in the activity, and the location of the activity. Outdoor visits and activities are safer than indoor activities, and fully vaccinated people can participate in some indoor events safely, without much risk. If you haven’t been vaccinated yet, find a vaccine.

Just like those of us without dementia, residents living with dementia have different personality types. We've put together a toolkit of activities based on personality type. You can try these to keep your residents active and engaged.

Just like those of us without dementia, residents living with dementia have different personality types. We've put together a toolkit of activities based on personality type. You can try these to keep your residents active and engaged. (Spanish version)

When it is determined by state and local health departments that beautician and barber services may resume, this center will provide these services following the guidelines from the CDC and state and local health departments.

We've reached out to our members and collected the best ideas for the engagement of our residents during isolation. We've put them all together in a "recipe" book that you can follow!

Staffing shortages continue to dominate the industry rendering it difficult for long-term care providers to maintain consistent levels of staff and quality care. Most providers are watching their staff quit the industry entirely or switch over to temporary staffing agencies to make more money. To ease the staffing burden, providers are requesting assistance from staffing agencies. While this is an efficient solution, providers should try and avoid some common pitfalls when it comes to signing staffing agreements.

One continuous knowledge gap identified during this time has been the need for information for front-line healthcare and social services workers to use prior to and during a disaster such as the COVID-19 pandemic to recognize and reduce their stress levels and maintain resilience. These mini-modules are designed for healthcare workers in all settings, but primarily hospital-based providers, staff, and leaders.

Process for dealing with asymptomatic staff who may be exposed to coronavirus

Process for dealing with asymptomatic staff who may be exposed to coronavirus. (Spanish version)

The COVID-19 pandemic has had a major effect on our lives. Many of us are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. Public health actions, such as social distancing, are necessary to reduce the spread of COVID-19, but they can make us feel isolated and lonely and can increase stress and anxiety. Learning to cope with stress in a healthy way will make you, the people you care about, and those around you become more resilient.

Here are some staff considerations during the COVID-19 pandemic:

As a condition of employment, all employees are required to receive the COVID-19 vaccination. Exemptions to this policy will be provided only for employees with an approved medical or religious exemption, as described below. Employees who do not timely receive the vaccine and do not obtain an exemption will be considered to have refused to comply with this policy and to have voluntarily resigned their employment.

Guidance to help employers seek information about an employee’s health that would typically be limited by the ADA, in order to help prevent the spread of COVID-19.

Guidance to help employers seek information about an employee’s health that would typically be limited by the ADA, in order to help prevent the spread of COVID-19. (Spanish version)

Under the ADA, prior to making a conditional job offer to an applicant, disability-related inquiries and medical exams are generally prohibited. They are permitted between the time of the offer and when the applicant begins work, provided they are required for everyone in the same job category.

CDC Clinician Outreach and Communication Activity (COCA) Webinar on Thursday, September 9, 2021. At the conclusion of today’s session, the participant will be able to accomplish the following— 1. Outline updates on the Advisory Committee on Immunization Practices recommendations for 2021-22 influenza vaccination season. 2. Discuss general influenza vaccination guidance during the COVID-19 pandemic. 3. Describe clinical considerations and best practices for coadministration of influenza vaccines and COVID-19 vaccines.

Unvaccinated employees due to a medical or religious exemption acknowledge that they must agree to abide by all Community Infection Prevention/Infection Control rules to protect the safety of residents and other staff in the community.

CDC and FDA scientists have evaluated reports from people who experienced a type of severe allergic reaction, anaphylaxis, after getting a COVID-19 vaccine. Anaphylaxis after COVID-19 vaccination is rare and occurred in approximately 2 to 5 people per million vaccinated in the United States based on events reported to VAERS. This kind of allergic reaction almost always occurs within 30 minutes after vaccination. Fortunately, vaccination providers have medicines available to effectively and immediately treat patients who experience anaphylaxis following vaccination.

AHCA/NCAL has created the checklist for use when administering vaccines.

Vaccination Administration Records from AHRQ with instructions on how to use them.

Information on the COVID booster shot from AMDA.

The Society for Post-Acute and Long-Term Care Medicine have provided a letter that facilities can use to inform families about the safety of the COVID-19 vaccines.

The Society for Post-Acute and Long-Term Care Medicine has released a Q&A about the COVID-19 vaccine.

Tip sheet from TRACIE updated February 10, 2021.

Before ordering laboratory testing for post-COVID conditions, the goals of testing should be clear to the healthcare professional and to the patient. Laboratory testing should be guided by the patient history, physical examination, and clinical findings.

The pandemic has impacted everyone but perhaps none more than people living in long-term care and their families and friends. Our journey of recovery from this unprecedented global pandemic will involve a unique combination of trauma-informed care and disaster relief. On this webinar, we discussed the principles and interventions of moving forward while supporting ourselves and our families. We talked specifically about visitation in long-term care; as facilities transition to in-person visitation, reconnection with loved ones may present challenges.

During the pandemic, guidance from the Centers for Medicare and Medicaid Services (CMS) has limited (except for compassionate care situations) indoor visitation for residents in post-acute care facilities when the COVID-19 county positivity rate is >10% or when there is an outbreak occurring in the facility. Relaxing current restrictions on indoor visitation might increase the risk for transmission of SARS-CoV-2 in post-acute care facilities. However, vaccination of residents and HCP can mitigate some of these risks, and expanding visitation has substantial benefits to residents.

According to CMS, we strongly encourage everyone to get vaccinated, visitation can occur regardless of the visitor’s vaccination status

CMS recommends continuing to take precautions to reduce the risk of transmission of COVID-19, however, remains vitally important

Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE, including the impact of COVID-19 vaccination.

CMS is providing clarification to recent guidance for visitation (see CMS memorandum QSO-20-39-NH REVISED 11/12/2021). While CMS cannot address every aspect of visitation that may occur, we provide additional details about certain scenarios below. However, the bottom line is visitation must be permitted at all times with very limited and rare exceptions, in accordance with residents’ rights. In short, nursing homes should enable visitation following these three key points: • Adhere to the core principles of infection prevention, especially wearing a mask, performing hand hygiene, and practicing physical distancing; • Don’t have large gatherings where physical distancing cannot be maintained; and • Work with your state or local health department when an outbreak occurs.

With the spread of the coronavirus, facilities must also devote time to ensure that their residents do not succumb to the negative effects of social isolation. With this in mind, staff may consider adopting the following practices to encourage communication with residents’ family and friends.

With the spread of the coronavirus, facilities must also devote time to ensure that their residents do not succumb to the negative effects of social isolation. With this in mind, staff may consider adopting the following practices to encourage communication with residents’ family and friends. (Spanish version)

Infographics/Signage with reminders of the core principles of Indoor Visitation

Infographics/Signage with reminders of the core principles of Indoor Visitation (Spanish version)