See a statement from James Balda, Argentum president & CEO, on the coronavirus. Read more.

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Overview

COVID-19, or coronavirus, is a respiratory illness that can spread from person to person. While much about the spread of the disease is still unknown, indications point to the fact that older people, and those with preexisting medical conditions, appear to be more vulnerable, according to the World Health Organization (WHO). Symptoms are cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, and new loss of taste or smell. There is not yet a treatment or vaccine. You can keep up with the facts here.


About the CDC’s Resources

The Centers for Disease Control and Prevention (CDC) has a dedicated site for COVID-19 and has posted guidance, in order of recency. Here are some direct links you may find useful:

In this toolkit, we’re adding relevant CDC updates as well as providing direct links to information those in senior living might need.

Read an updated a situation summary from the Centers for Disease Control and Prevention.

 


Lend Your Voice: Participate in our grassroots campaign, Standing With Seniors. It’s more important than ever for Congress to hear from you on what resources senior living needs due to COVID-19.
RESIDENTS STAFF FAMILY MEMBERS GENERAL ADVOCATE

What’s New?

As of August 5, there were 4,748,806 cases in the United States reported in 50 states and the District of Columbia, Puerto Rico, Guam, the Northern Marianas, and the U.S. Virgin Islands. The CDC updates this number Monday through Friday and posts preliminary numbers on Saturday and Sunday, which it then confirms on Monday.

As of April 14, CDC has changed its count methods. In addition, the CDC advises: “State and local public health departments are now testing and publicly reporting their cases. In the event of a discrepancy between CDC cases and cases reported by state and local public health officials, data reported by states should be considered the most up to date.”

New on August 5: 

The FDA is issuing warnings about aquarium products that can be mistaken for the human drug chloroquine phosphate, which should be taken only by prescription.

The CDC has developed COVID-19 tests that simultaneously test for influenza A and B. 

For an advance look at what’s ahead in COVID-19 testing technology, NIH has published a roundup of tests developed through its RADx Initiative that have been recently approved for manufacturing and scale-up.

Payment will be available to physicians and health care providers who provide patients undergoing COVID-19 testing counseling about how to self-isolate and why it is important. More information, including that on use of payment codes, and a checklist has been posted.

July 30, the CDC updated its pages of guidance on Errands and Going Out, which includes information on parks, beaches and pools, and using transportation.

As of July 30, the CDC July 30 updated its page on guidance for people with medical conditions that can put them at increased risk of severe illness from COVID-19. The list includes cancer, COPD, and heart conditions.

The FDA on July 27 added further warnings and more brands to its list of contaminated hand sanitizers. The products contain methanol, which can be toxic when absorbed through the skin or ingested.

The FDA has created a new website on Cancer & Covid-19 with timely information and resources for cancer patients.

The FDA July 22 added updates to its list of tests that should no longer be used.

The CDC July 22 has determined that 10 days of isolation after symptoms begin can be sufficient. This page spells out the conditions for this shorter period of isolation.

On July 20, the CDC updated several pages:

The FDA has updated its COVID-19 Frequently Asked Questions, which covers testing, devices, and fraud alerts.

The COVID-19 Prevention Network is receiving record numbers of volunteers for clinical studies. If you would like to join in, information and criteria are here.

The FDA is closing its COVID-19 Industry Hotline on July 17, but if you have questions about medical devices, tests, or PPE availability, this page supplies specific email contacts that can help.

More hand sanitizers containing methanol, which can be harmful when absorbed through the skin, have been posted on the FDA’s MedWatch page.

The CDC has updated its page on Optimizing Supply of PPE and Other Equipment During Shortages. 

The CDC has updated its page on practicing social distancing correctly.

The Administration for Community Living offers free recordings, slides, and transcripts of its COVID-19 related webinars,which include topics such as technology use with older adults, combatting social isolation, and mental health among older adults.

The CDC has created a communications One-Stop Shop for COVID-19 messages, with social media, flyers, presentations, and more. While there is not a specific category for senior living, it has resources for workplaces, community organizations, parks, and schools that can be useful to staff and in planning.

American Seniors Housing Association and ATI Advisory have produced a special issue brief, “Considerations for Balancing Seniors Housing Residents’ Safety as Communities Reopen: A Strategic Approach to the COVID-19 Pandemic.”

On July 9, the World Health Organization issued new guidelines on COVID-19 regarding instances of potential indoor airborne transmission.

The FDA has posted a page with information on donating convalescent plasma, or blood from recovered COVID-19 patients that contains antibodies for the virus.

U.S. Health and Human Services explains the accelerated program hoped to result in a coronavirus vaccine.

The CDC has produced an illustrated guide on how to wear cloth face masks correctly.

Argentum’s COVID-19 Advisory Council of industry CEOs, clinical executives, and other experts has published “Managing COVID-19 Restrictions,” a white paper with guidance on restrictions and re-opening decisions and practices. This guidance has been reviewed and refined through a series of calls with Argentum’s Quality Improvement Task Force.

Assisted living communities are encouraged to participate weekly in reporting to the CDC’s National Healthcare Safety Network’s Long-term Care Facility COVID-19 module. They are not required to do so. The page has links to find out who needs to report and how to do it.

CDC updated its Considerations When Preparing for COVID-19 in Assisted Living Facilities Rollout Plan to include guidance on visitor restrictions and group activities.

The National Restaurant Association assembled a group of experts to develop Updated Restaurant Reopening Guidance, which addresses best practices for social gathering for a meal—cleaning and sanitation, social distancing, and more—designed to build on ServSafe training.

Argentum has released a white paper, “The Need for a ‘Smart’ Testing Strategy,” developed by our COVID-19 Advisory Council of industry CEOs, clinical executives, and other experts, that outlines the need for a comprehensive, evidence-based testing strategy.

The following suppliers were identified by Argentum membership as offering critical supplies and services. Inventory is a fluid situation for all distributors, however, so inventory availability may vary. We recommend that you mention Argentum when contacting them.

PPE

Direct Supply: 3-ply masks, N95 masks, safety goggles, face shields, disposable isolation gowns, reusable isolation gowns.

Amazon Business: special service for health care organizations at nonprofit. Amazon business account required.

Ferguson Inc: offering gowns, masks (KN95 3-ply surgical), and potentially other PPE (michael.murphy@ferguson.com)

Pragmedx: defense contractor that has opened supply chain distribution of PPE to the healthcare industry (chris@twc.com)

Infection Control/Sanitation

Holt Environments: Space design, signage, sneeze guards, infection control kiosks, and hygiene stations. (mmoser@skyline-holt.com / 800-849-2601 )

Ecolab: cleaning, disinfection, hygiene procedures, products, and checklists to support your COVID-19 response (Barbara.Kane@ecolab.com)

Viking Pure Solutions: On-Site Generated Cleaning and Disinfecting Solutions that will replace all currently used Toxic Chemicals (Dan Lawson, dan@vikingpure.com, (386) 428-9800)

Polaris Group: Infection Control Risk Assessments and ongoing Infection Control Support Services (shelly.patton@polaris-group.com)

ServiceMaster SRM: COVID-19 cleaning and disinfecting experts, experience with other coronavirus outbreaks SARS and MERS (jeanetta.favour@smdsi.com)
Spartan Chemical Company: Sanitation Products and Solutions (dpeterson@spartanchemical.com, 800-537-8990)

Contact Tracing

CarePredict PinPoint: automatic contact tracing tool quickly traces all contacts an infected person had (whom, where, when, how long) in a community (rmontest@carepredict.com)

Testing

MDx Laboratory Services: COVID-19 and full respiratory pathogen testing by PCR with a rapid turnaround time (24-48 hours), David McCrea, (david@mdxpartners.com).

Vikor Scientific: LTC testing panel portfolio includes COVID-19 testing for Symptomatic and Asymptomatic residents and employees. Tests are 98.8% accurate, quick turnaround. For details contact LTC specialist Marc Yagoda (MYagoda@VikorScientific.com)

Teleheath
CCS Healthcare: Comprehensive medical and psychiatric care for seniors (888- 392-8889/215-512-1318, care@ccs-foryou.com

Additional COVID solution providers can also be found here.

 

 

Preventing the Spread

The CDC as of July 2 has updated and expanded resources for people at risk, increasing the number of people who fall into higher-risk groups. For older adults, it has removed the age threshold and updated with a warning that among adults, risk increases steadily as you age, and it’s not just those over the age of 65 who are at increased risk for severe illness. It also updated the list of conditions that increase risk of severe illness.

The CDC continues to make occasional updates to its Key Strategies to Prepare for COVID-19 in Long-term Care Facilities page.

The CDC has posted a Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes, with nine pages with instructions for different types of businesses and spaces, as well as a Cleaning and Disinfection Decision Tool that can help build a cleaning plan. While this is not specifically for senior living, it may apply to related areas and businesses.

A short video explains how COVID-19 can spread in a neighborhood or community, using a case in Chicago where those attending a funeral and a birthday party caught the virus.

The CDC has updated its guidance for retirement communities and independent living, with instructions on cleaning and disinfecting for reopening areas and ongoing mitigation and prevention practices. It has also updated guidance for shared and congregate housing.

See Argentum's Community Access and Infection Control guidance including FAQs and a sample screening checklist.

A CDC FAQ for healthcare providers on infection prevention and control has questions relevant to senior living communities.

On April 3, the CDC recommended the voluntary use of cloth face coverings for all, particularly in areas of significant community-based transmission. This is largely based on the knowledge that asymptomatic individuals and even those who are pre-symptomatic can transmit the virus to others before showing symptoms.

PPE

The FDA has published a notice that certain respirators “may not provide consistent and adequate respiratory protection” and should not be decontaminated and re-used.

The World Health Organization updated its guidance on masks, including a recommendation to wear medical-grade masks for the following: people 60 or older and people with underlying conditions, when social distancing isn’t possible; and health care providers even when not caring for people with coronoavirus.

In light of new evidence on the spread of the virus by asymptomatic people, the CDC has posted updated guidance on cloth face coverings, recommending they be worn “in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

If you’re purchasing respirators now or in the days ahead, the CDC’s list of factors to consider when purchasing respirators from another country can help.

Reminder that Direct Supply encourages senior living providers to send their supply need requests directly via email to: covidneeds@directsupply.com.

Guidance on Using PPE

The CDC has posted a page on proper use, safe removal, cleaning, and sewing cloth masks, including a pattern and instructions.

Crisis strategies for when N95 respirators are running low or unavailable and how to use stockpiled respirators that have passed their expiration dates have been updated by the CDC.

Our subject matter experts and the CDC recommend universal use of face masks in communities, and that PPE be used for all care activities, regardless of symptoms shown. Those working in communities may wear the same mask throughout their work period, however.

The CDC has a guide to using the right PPE for different situations in health care settings.

If you re-use PPE, as many are in this crisis, the CDC has been posting continually updated guidance on how to do this, as well as a reminder that this is not according to standard practice but can be used at this time.

Knowing the right way to put on and take off PPE including masks, gloves, and gowns is essential to staying safe. Here’s an illustrated flyer from the CDC to help in training.

The CDC has also created a simple, two-page guide with illustrations on how to use PPE.

CDC's National Institute for Occupational Safety and Health (NIOSH) is responsible for certification and approval of respiratory protective devices. The NIOSH database includes current PPE standards in detail. 

In consideration of respirator shortages, OSHA has posted revised guidance. See OSHA standards and regulations here. For those seeking alternatives to respirators, this Technical Bulletin from 3M on airborne hazards may be useful.

Supply and Access

The U.S. Food and Drug Administration coronavirus FAQ page has information on what’s being done about testing and PPE as well as a section on drugs and medicines. The FDA would also like providers, communities, and manufacturers to report supply disruptions via email.

This PPE “burn rate” calculator from the CDC helps you calculate how much PPE your community is using and how soon it will need more.

Organizations offering PPE matchups and donations:

  • GetUsPPE.org is a nonprofit that matches those who need PPE such as respirators and eye protection with those who are donating PPE. When you apply, click “Skilled Nursing” on the pull-down menu—the group recognizes all senior living in that category.
  • If volunteers want to create face masks, here are some health systems that offer instructions online: Providence health care system and Deaconess health care.

Infection Prevention

Handwashing training and reminders

Reinforce and remind yourself, residents, and staff about hand washing best practices. Watch or share this video, put this flyer on handwashing from ServSafe up in kitchen areas, and share the CDC’s instructions:

  • Wash with soap and water for at least 20 seconds.
  • Wash hands often, but especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with 60 percent to 95 percent alcohol.
  • If possible, provide hand sanitizer around the community and to residents who can safely use it.

Cough, sneeze, and distance etiquette:

  • Cover coughs and sneezes with a tissue, then dispose of it in a trash can, preferably one with a touchless lid opener.
  • Avoid touching your eyes, nose, and mouth. This makes it more difficult for the virus to get from a surface to yourself.
  • Check your community for supplies of tissues, touchless trash cans, hand sanitizer, and soap.
  • Practice social distancing: Keep about 6 feet between yourself and others.
  • Take note if you've been in close contact with someone with the virus. The CDC defines “close contact” as being within approximately 6 feet of someone with the virus for a prolonged period of time, such as through caring for, visiting, or sharing a health care waiting area or room with someone who has the virus. It can also mean having direct contact with infectious secretions of someone who has the virus—that is, being coughed on.

Surface cleaning

Check with your vendor to learn what cleaning products and supplies to use for disinfecting and how to use them properly. Use any cleaning products according to the manufacturer’s instructions, or they may not be fully effective.

Residents in their own apartments or homes can use the same cleaners or wipes in their residences as they usually do.

The major touchpoints to clean are the same as those for the flu:

Add disinfection wipedowns to the schedule and create a checklist of areas.

The EPA updates this list of disinfectants that meet criteria for use against the virus that causes COVID-19

Here’s the CDC’s step-by-step cleaning and disinfection guide, plus considerations for employers.

The CDC’s continually updated detailed guide to cleaning and disinfection includes guidance on cleaning electronics and soft surfaces and what to do after a suspected or confirmed case.

The CDC has updated guidance on cleaning and disinfection after a person with a suspected or confirmed case has been in a community facility.

If you have been using the Abbott ID NOW point-of-care test to diagnose COVID-19, check for more information here. The FDA has issued a notice that early data suggest the test could return false negative results.

The CDC has updated its Guidance for Older Adults, including long-term care testing and response.

The CDC has added several symptoms to the list of those associated with COVID-19; the list now includes chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. The page also has a self-checker that can be used to make decisions about consulting a doctor.

Remind yourself, staff, and residents to get plenty of rest; have regular, nutritious meals; and stay away from others who have cold and flu symptoms. By practicing self-care, you’re taking the best action against this virus. Encourage residents to report any illness they are experiencing, and staff should check residents for symptoms of fever, cough, shortness of breath every day.

The FDA has issued a Drug Safety Communication cautioning against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.

Continually updated guidance from CDC for communities and persons at risk:

Testing

If you’re using bulk-packaged swabs for specimen collection in testing, the CDC has updated guidance May 5.

Testing guidance and prioritization information was updated on the CDC site. The CDC reminds that this guidance can be adapted by state and local health departments.

The FDA has issued an Emergency Use Authorization for a COVID-19 test with a "home" collection option. This test allows the patient to collect their own sample, send it in for analysis, and receive their results online within one to two days. Testing requires a physician’s order (or equivalent) and is currently available to health care professionals and first responders. To purchase a test kit, users will be prompted to complete a short survey to confirm eligibility for testing. Because tests can show a false negative if it is too early in infection, only patients exhibiting symptoms should be considered for testing.

Find out which manufacturers and labs are offering tests, where to report shortages, and other answers on the FDA's page of testing FAQs.

Guidance

The testing situation is changing rapidly. Generally, people are not being tested without a screening call first.

Argentum on April 15 updated its COVID-19 Testing Information, which can help you evaluate options and plan accordingly.

Some providers are performing tests in their communities, and others are considering this option. 

A recording from the April 6 In-Community Testing Primer webinar is now available to Argentum members.

If you confirm a case of COVID-19 in your community, remember to notify your local health department using this CDC form.

The CDC has updated test guidance to allow self-collected nasal swabs.

The CDC also recommends that physicians test for other causes of respiratory illnesses, such as influenza.

If you're hearing about possible new treatments for COVID-19, the CDC has posted new guidance on what's known, clinical trials, and compassionate use.

A vaccine is estimated by most sources to be a year or more away, although teams of scientists all over the world are working on it. Antivirals that might have potential against the virus are also being explored.

Access

Test development and approvals explained: An FDA statement released March 30 outlines the process and who does what, when, in plain language.

The U.S. Food and Drug Administration coronavirus FAQ page has information on what’s being done about testing and PPE as well as a section on drugs and medicines. The FDA would also like providers, communities, and manufacturers to report supply disruptions via email.

This roundup with details from AHIP on how the major insurance plans are covering or waiving COVID-19 testing can be helpful to communities as well as to share with staff and families.

Suspected Cases

At-risk persons

Older adults, 65 and older, are at higher risk for severe illness. Having serious underlying medical conditions might also increase risk.

Here’s a 2-minute CDC video on what older adults need to know.

It can be helpful for older adults to have an individual emergency care plan, listing medications, conditions, physicians, etc. Here’s the CDC guide and a form to create one.

Implementing a “buddy” system is recommended by many sources, with residents checking in on each other, electronically if needed, or particular caregivers checking in on their buddy resident.

You may need to ask residents, staff, and family about travel. Travel advisories are changing, but generally, you’ll want to ask about any travel in the past 30 days as well as any planned travel by residents. The CDC has travel advisory guidelines that list the changing levels of restrictions. 

Signs and symptoms

Symptoms of COVID-19 can range from mild symptoms to severe illness and death. Symptoms may appear 2-14 days after exposure. Watch for fever, cough, and shortness of breath.

New research points to gastrointestinal symptoms (nausea, diarrhea), and some physicians are also reporting rash as a symptom, so subject matter experts are recommending these be added to the screening question list for residents, employees, and visitors.

If COVID-19 is suspected or detected...

  1. Monitor
  2. Separate
  3. Contact physician and health officials (health department, etc.)

If you're instructed to bring someone to a hospital or physician's office, call ahead to ensure they're prepared.

Using telehealth systems means residents avoid having to go to doctors’ offices or clinical centers. The emergency coronavirus funding includes waivers on some Medicare restrictions on telehealth. 

Contract tracing is still important. Health officials may ask community administrators to keep records or ask questions.

If there is a confirmed case, take your direction from the health department. As you would for the flu, keep watch for anyone else who may be showing symptoms. If two cases are confirmed within 72 hours of each other, the health department may ask for outbreak control measures.

Visitors

Refresh security practices:

  • Know who’s coming and going in the community.
  • Go over or create new visitor policies for changing circumstances.
  • Establish a single entrance to the community. 

This comprehensive letter to residents, families, friends, and volunteers explaining restrictions and what the community is doing can be used as-is or serve as a model for communications.

AHCA/NCAL has updated guidance for assisted living communities,including recommendations on limiting entry, restricting group activities, and setting up remote communication processes.

Policies

Make sure staff gets the message to monitor and report any symptoms they or the residents have. Review policies on sick leave and time off. You may want to check in at the beginning of work shifts to ask how staff are feeling, remind them to keep watching for symptoms among residents and visitors, and remind them of sick leave policies. Some communities are monitoring temperatures.

This care applies to any temporary, on-call employment services and third-party health care providers as well--review policies with the agency and in person, when any other worker arrives. Keeping an infectious disease out of the community is worth the time. As you work to protect residents and employees, staying in compliance with employment law is important.

Many senior living companies are issuing messages about changing policies on visiting and what's being done at their communities. Examples of such communication include those from Atria Senior LivingBrookdale Senior LivingEclipse Senior LivingMerrill Gardens, and Vi.

Questions about regulations? The CDC has posted a guide to regulations and laws that may apply during a pandemic and a guide to laws and responsibilities around quarantine and isolation.

Local and state policies on who may enter a community and what type of screening is needed vary greatly.

The Americans with Disabilities Act pandemic preparedness guidance gives guidance on when visitors and healthcare professionals may or may not be prohibited.

The CDC states: “Decisions about visitation during an end of life situation should be made on a case by case basis, which should include careful screening of the visitor for fever or respiratory symptoms. Those with symptoms should not be permitted to enter the facility. Those visitors that are permitted must wear a facemask while in the building and restrict their visit to the resident’s room or other location designated by the facility. They should also be reminded to frequently perform hand hygiene.”

Emergency plans

It can be helpful for older adults to have an individual emergency care plan, listing medications, conditions, physicians, etc. Here’s the CDC guide and a form to create one.

Isolation, quarantine & moving residents

As one of the first states to face the challenges of coronavirus in senior living, the Washington Health Care Association has assembled a collection of resources including letters seeking waivers and expedited processes and an FAQ specific to assisted living.

If you’re having trouble explaining the difference between “containment” and “mitigation,” or “isolation” and “quarantine,” this short plain-language guide from the Pennsylvania Department of Health can help.

The Society for Post-Acute and Long-Term Care Medicine has guidance on moving residents and is advocating re moving and cohorting people with illness.

As local surge response becomes more likely, guidance for setting up appropriate alternative care sites has been released by the CDC. For instance, this would apply to sending people who can be discharged from a hospital to a lower level of care in a setting such as a hotel or municipal center.

Billing & payment issues

The Center for Medicare and Medicaid Services has issued FAQS for healthcare providers regarding Medicare billing and payment. See the Federal and State sections for more guidance.

This roundup with details from AHIP on how the major insurance plans are covering or waiving COVID-19 testing can be helpful to communities as well as to share with staff and families.

Screening & Safety

Argentum and the National Association for the Support of Long Term Care (NASL) have prepared a guide, “Balancing Safety and Wellness in Your Rehab Therapy Program,” to help manage rehabilitation therapy in communities during pandemic precautions.

U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued an Updated Interim Enforcement Response Plan to consult as workplaces begin different stages of reopening, as well as an alert with COVID-19 related safety tips for employers.

The U.S. Dept. of Health and Social Services has created a COVID-19 Workforce Virtual Toolkit: Resources for Healthcare Decision-Makers Responding to COVID-19 Workforce Concerns, where decision-makers can consult and share practices, plans, tools, and templates on topics including funding, liability, and training.

The U.S. Equal Employment Opportunity Commission has posted more updates to its “What You Need to Know” page, dealing with topics such as testing employees and reasonable accommodation.

CMS has a new toolkit for states to help accelerate adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) pandemic.

The CDC has posted new interim guidance on essential workers, including that they “may be permitted to continue work following potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented…”

New guidance regarding essential workers with exposure to COVID-19, including how to handle break time and an illness on the job, has been posted by the CDC.

See Argentum's Community Access and Infection Control guidance including FAQs and a sample screening checklist.

Make sure staff gets the message to monitor and report any symptoms they or the residents have. Review policies on sick leave and time off. You may want to check in at the beginning of work shifts to ask how staff are feeling, remind them to keep watching for symptoms among residents and visitors, and remind them of sick leave policies. Some communities are monitoring temperatures.

This care applies to any temporary, on-call employment services and third-party health care providers as well--review policies with the agency and in person, when any other worker arrives. Keeping an infectious disease out of the community is worth the time. As you work to protect residents and employees, staying in compliance with employment law is important.

Screening Protocols

The CDC recommends temperature screening for employees be done with a no-touch thermometer.

You may need to ask residents, staff, and family about travel. Travel advisories are changing, but generally, you’ll want to ask about any travel in the past 30 days as well as any planned travel by residents. The CDC has travel advisory guidelines that list the changing levels of restrictions.

New research points to gastrointestinal symptoms (nausea, diarrhea), and some physicians are also reporting rash as a symptom, so subject matter experts are recommending these be added to the screening question list for residents, employees, and visitors.

Training Resources

Consult the CDC Guidance for Business and Employers and OSHA guidance for preventing workplace exposure.

Policies & Regulations

The U.S. Small Business Administration has put up a page with basics and questions answered about the Paycheck Protection Program (PPP) small business loans.

State, local, and municipal employment laws on sick leave and protection vary widely. As one of the first states to face the challenges of coronavirus in senior living, the Washington Health Care Association has assembled a collection of resources including letters seeking waivers and expedited processes and an FAQ specific to assisted living.

Review media, privacy, and social media policies at onboarding, training, and periodically with all staff.

Remind everyone of your policies to ensure the privacy and dignity of residents. Rumors can spread like wildfire, and incorrect information can do a lot of damage.

Sharing the name and personal information of anyone who may have this virus or illness of any kind requires great care to be done in compliance with HIPAA regulations, which allow disclosure only to health officials and disclosure to family members only under certain circumstances.

Leaders at all levels can model good communication. The more transparent and open about communication you can be, the less likely people will be to speculate among themselves.

The CDC has posted a guide to regulations and laws that may apply during a pandemic and a guide to laws and responsibilities around quarantine and isolation. 

Now is a good time for getting familiar with the Americans with Disabilities Act pandemic preparedness guidance, which includes answers to questions such as when you’re allowed to take an employee’s temperature, and the OSHA pandemic factsheet.

The outbreak could also trigger policies around the Fair Labor Standards Act and the Family Medical Leave Act. The Society for Human Resources Management, SHRM, has a coronavirus FAQ page that can help.

Essential workers

On March 28, the Department of Labor released updated guidance that provides an exemption for all senior living workers from expanded leave requirements. The guidance clarifies the definition of “Health Care Provider” for the purpose of employees who may be exempted from the expanded leave provisions to include “anyone employed at any … retirement facility … or any similar institution.”

The U.S. Department of Homeland Security issued an advisory on essential health care workers, which includes long-term care workers and rehabilitation therapists.

Argentum and members created a template to make a custom ID card and letter of permission to travel for employees in shut-down situations.

Returning to work

The CDC’s guidance on returning to work for healthcare personnel can be adapted by state and local health departments or form a basis for policy in non-healthcare settings. The guidance includes how long employees should be fever-free and strategies for staff shortages.

Assistance for Staff

 (See “Community Life” section for more ideas on activities and help with stress, family issues, etc.)

Child care

The CDC has posted updated guidance regarding childcare programs that remain open that may be useful to communities or organizations helping with child care for senior living workers.

Some Boys and Girls Clubs have made the decision to open childcare services for essential employees during this crisis. Visit bgca.org, select “Find a Club” to locate your nearest club, and make direct contact to inquire if they are providing services.

YMCA branches are offering childcare during the crisis: Find your local branch here.

Help for managers

Check cross-training levels and when possible offer changed roles to staff.

Educate and coach your staff on coronavirus, so they're working from a position of knowledge.

Encourage staff to recognize when they may feel stressed or afraid and send the message that it's OK to get help; watch for and remove signs of stigma and provide information on employee assistance programs or other support.

The Alzheimer’s Association has created tips and emergency preparedness guidelines for memory care community settings, as well as a template and communication tips for communities.

Communication

Most senior living operators have already implemented procedures to keep public health officials, residents, family members, legal representatives, staff, and other stakeholders aware of incidents of COVID-19 in communities. However, given the importance of transparency, Argentum has provided information to support operators making decisions on issues related to reporting and communications.

Subject matter experts recommend providers and communities be open and transparent on issues such as having confirmed cases of COVID-19, issues related to supply, and other challenges, and be proactive and timely in communicating with residents, family, staff, and other stakeholders.

Learn about winning communications tactics from “Communicating Effectively During the COVID-19 Crisis,” a webinar recording courtesy of MASS-ALA.

To help community administrators with informing families of COVID-19 status, The Society for Post-Acute and Long-Term Care Medicine (AMDA), has provided sample letters and resources. We recommend that your organization’s communications, legal, or compliance team review these before using.

AHCA/NCAL has also created a sample/template letter for residents and families in the event of a case of COVID-19 in the community.

Check the AMDA COVID-19 page for more resources, including a daily update email.

Argentum has offered sample messaging for residents, staff, visitors, and media; members can log in and access that messaging.

Administrators, managers, and executive directors can make an effort to keep track of all your communications and a record of actions you’re taking during this time. Put emails in a folder instead of deleting them; save correspondence; get screenshots of text messages, messages on your website, or social media posts; take phone photos or videos of signs and other actions. Even a written list of actions you’re taking can be useful later.

A comprehensive letter to residents, families, friends, and volunteers explaining restrictions and what the community is doing can be used as-is or serve as a model for communications.

The Alzheimer’s Association has created tips and emergency preparedness guidelines for memory care community settings, as well as a template and communication tips for communities.

The Alzheimer's Foundation offers help and support in 90 different languages for caregivers and families. Just start typing in the chat box in the lower left corner in the language you want, and responses will automatically be in that language.

Many senior living companies are issuing messages about changing policies on visiting and what's being done at their communities. Examples of such communication include those from Atria Senior LivingBrookdale Senior LivingEclipse Senior LivingMerrill Gardens, and Vi.

Senior Living Smart has issued a tips list for clear communication during the crisis and template letters, both internal and external.

Review and refresh your communication plans for critical, official, and operational communications:

  • Health department: This is the communication most critical to health. Viruses appear in clusters, so they’re best fought on the local level. Follow protocols given for state and local jurisdictions.

As most communities know, certain illnesses MUST be reported to the correct health department. If coronavirus presents itself, communicate early. The health department makes the rules--they’ll tell you what number or percentage of cases constitute a need for limited contact or quarantine.

Work from above AND below. Following the CDC website will help you keep up with the general trends and what’s happening. Communicating with your health department and watching local news will help you with specifics.

  • Other regulatory agencies: Review what your state or city requires in terms of limiting visitation, limiting gatherings, putting up signs, providing notice to vendors and visitors, and limiting new resident admissions in the event of an outbreak in your community.
  • Medical and emergency services: Review plans and procedures. Health care workers at this time are largely still practicing basic infection control at the flu level, too. If a physician recommends someone in your community go to a hospital or treatment center, call to let the hospital know, so they can get their infection prevention plan into action.
  • Suppliers, vendors, and maintenance: Make an effort to keep maintenance service people who periodically visit the community updated on any limitations in entering the community. Ask the supervisors or check websites to see if vendors and maintenance from outside the community have awareness and prevention programs in place. If this is not already part of your emergency plan, sketch out a scenario of what you’d do if they couldn’t enter your community--and act as needed to prevent that outcome.

If you’re having trouble explaining the difference between “containment” and “mitigation,” or “isolation” and “quarantine,” this short plain-language guide from the Pennsylvania Department of Health can help.

Language options: The Administration for Community Living has updated information and a Spanish-language guide to their resources for older adults, as well as links to videos in American Sign Language. The Washington State Department of Health has a fact sheet in more than a dozen languages, including Tagalog, Arabic, and Vietnamese.

Myths & Misinformation

Be prepared for residents, families, and staff alike to see sensationalized news reports. The more you communicate, even just to say hello, the more you’ll help avoid escalating their stress. Remind residents to communicate with family and each other: That can help reduce stress as well.

The World Health Organization reported on initial studies showing dexamethasone, a commonly used steroid and one considered affordable, can cut mortality by about one-third.

The NIH All of Us Research Program is seeking participants for a survey on how COVID-19 has impacted people’s lives as well as other research. All of Us has the goal of building a biomedical data resource that is as diverse as possible.

The U.S. Food and Drug Administration (FDA) revoked the emergency use authorization (EUA) that allowed for chloroquine phosphate and hydroxychloroquine sulfate; analysis of emerging data led the FDA to determine that chloroquine and hydroxychloroquine “are unlikely to be effective in treating COVID-19” and that the potential for serious side effects now outweigh potential benefits.

The National Institutes of Health has launched a centralized, secure enclave to store and study vast amounts of medical record data from people diagnosed with coronavirus, in order to study risk factors, effective treatments, and more. The National COVID Cohort Collaborative (N3C) welcomes organizations as partners, to get the most diverse and complete data.

This page from the FDA explains terms such as “EUA,” “FDA Approved,” and “off-label use.”

The FDA on May 7 updated its page on Fraudulent Coronavirus Disease Products. The list shows names of companies and products that have been issued FDA warning letters.

The CDC has made updates to its COVID-19 forecasts, which present national and state forecasts using several models.

In the concern over the virus, some scammers are taking advantage. CMS Administrator Seema Verma has written a blog post with advice on how to detect and avoid Medicare scams that may surface during the pandemic disruption.

This downloadable letter, endorsed by the Administration for Community Living and 20 national organizations, can be given to faith leaders to raise awareness about elder abuse and COVID-19 isolation.

Many people are interested in the progress of potential treatments or vaccines. Dr. Anthony Fauci invited those interested in participating in treatment studies visit clinicaltrials.gov, which lists more than 400 studies worldwide specific to coronavirus.

The World Health Organization April 14 released an updated Strategic Preparedness and Response Plan reflecting new worldwide knowledge about the virus, actions being taken, global supply chain issues and more.

Residents, families, and staff may come to you with concerns based on misinformation. Residents may be vulnerable to scam “cures” and supplements. Create an easy way for them to find accurate information by linking to this website on community communications, closed-circuit channels, and display signage: cdc.gov. The CDC site is well-labeled and easy to navigate.

The World Health Organization has a “Mythbusters” page that addresses all kinds of odd rumors and theories.

Conversation, concern, and searching for information are all part of a normal, automatic, and temporary psychological function. A certain amount of talking things over or vigilance even has the effect of lowering stress, psychologists say, and denial or silence makes it worse. Listening and validating concerns before offering advice or tips on precautions can help people through this process. You can find out more about this phenomenon here and here.

Cognitive Health & Socialization

The CDC has added to its information on how to reduce risks while visiting beaches and pools.

The CDC has issued Additional COVID-19 Guidance for Caregivers of People Living with Dementia in Community Settings, which can help families and loved ones in making decisions and raising awareness about hazards and symptoms.

The CDC May 22 released Interim Guidance for Communities of Faith, which may be helpful to consult. It recommends providing options to staff and congregants at higher risk of severe illness, including older adults.

Looking for virtual activities for your community? May is Older Americans Month, and the Administration for Community Living has put together activity ideas, including a list of “story prompts” to encourage sharing memories in writing or conversation.

The Michael J. Fox Foundation offers resources and tips for people with Parkinson’s disease on how to handle the coronavirus outbreak, isolation, and more.

Unfortunately, this information may be useful in communities: CDC guidance on what to do if a pet tests positive for the coronavirus.

Need help setting up virtual activities or virtual family visits? The National Certification Council for Activity Professionals (NCCAP) has provided resources to aid activity departments affected by social distancing, with links to how to conduct in-room activities, a virtual act of spiritual communion, puzzles and games, and more.

For people new to online communications and meeting technology, the National Council on Aging has a jargon-free, easy to use tip sheet.

New guidance from the CDC is about managing anxiety and stress in older people.

The National Alliance on Mental Illness has a guide of Q&As and resources for coronavirus issues impacting mental health and care.

Socialization is critical for residents’ cognitive health—yet difficult under social distancing and shutdowns. The Substance Abuse and Mental Health Services Administration has a page with warning signs and resources that apply to residents, staff, and families alike.

See Argentum's letters sent to Congress and the Administration regarding COVID-19 priorities.

CMS has released a toolkit to accelerate relief for state programs, including a 1915(c) Appendix K Template and a 1135 Waiver Checklist.

CMS has also updated guidance for payment details for codes for Medicare payment for COVID-19 diagnostic tests.


On May 15, the House passed the HEROES Act, a $3 trillion COVID-19 response package. The Senate will be proposing a compromise bill.

CMS April 30 announced another round of changes intended to more easily address COVID-19 needs, including efforts to increase access to testing and telehealth. Also, to keep up with news on CMS updates and get access to podcasts and Q&A phone conferences, visit the CMS newsroom.

CMS has released guidance on the possibility of restarting non-essential care under Phase 1 of the White House plan for Opening Up America Again.

On April 24, President Trump signed a $484 billion supplemental funding package to the CARES Act. It includes more funding for the depleted Paycheck Protection Program (PPP), for hospitals and health care providers, and to advance increased capacity for coronavirus testing. While the package includes additional funding for existing programs, it does not make any specific allocations or programmatic changes. 

On March 30, CMS announced it will be issuing new temporary rules and waivers for healthcare providers to better manage potential surges of COVID-19 patients. Many of these changes could prove beneficial for senior living providers, especially opportunities for hospitals to care for patients outside of a traditional setting, the increased access to testing for residents, and increased access to telehealth for Medicare Beneficiaries. See summary of changes.

On March 28, the Department of Labor released updated questions and answers regarding the Families First Coronavirus Response Act, signed into law March 18, 2020. The guidance provides an exemption for all senior living workers from expanded leave requirements, as requested by Argentum. The guidance clarifies the definition of “Health Care Provider” for the purpose of employees who may be exempted from the expanded leave provisions to include “anyone employed at any … retirement facility … or any similar institution.”

On March 27, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act into law, amounting to a $2 trillion in emergency relief. Argentum is pleased that the final package includes many of the priorities we have been advocating for, first and foremost of which was establishment of an emergency fund to support health care providers and senior living operators. The legislation includes $100 billion in grants for providers to prevent, prepare for, and respond to COVID-19, and reimburse eligible health care providers for lost revenues directly attributed to coronavirus. Additional relief packages are expected in the coming weeks, and we will continue to advocate for those who live and work in senior living.

President Trump has declared a national emergency, which frees $50 billion to provide emergency funding to state and local governments. 

To help keep up with fast-changing policy, this resource page from Fiscal Note offers an at-a-glance guide to legislation,appropriations, and what orders are in place in terms of stay-at-home, schools, and gatherings. For information on specific state actions, The National Conference of State Legislatures’ State Action on Coronavirus page lists enacted and pending coronavirus-related legislation.

See relevant news and media coverage

Access COVID-19 Member Webinar Recordings

Member Only Content
Access member webinar recordings on mitigation strategies as we work together as one industry to combat COVID-19 while ensuring a calm, safe environment for our employees, residents, and families.

Having trouble logging in? Email info@argentum.org for help.
ACCESS RECORDINGS

Join Sharing for Seniors Facebook Group

Share positive messages of connection, hope, and appreciation with seniors. Post a photo, video, message, or song (get creative!), that our network of senior living communities can share with their residents. #SharingForSeniors JOIN TODAY

Additional Resources

Source: Argentum

Managing COVID-19 Restrictions

White Paper
Source: Argentum

The Need for a "Smart" Testing Strategy

White Paper
Source: Argentum

COVID-19 Community Access and Infection Control

FAQs, Sample Screening Checklist
Source: Argentum/ASHA

Argentum/ASHA Webinar Recording 3/25

Member Only
Source: Argentum/ASHA

Argentum/ASHA Webinar Presentation 3/25

Source: Argentum/ASHA

Argentum/ASHA Webinar Recording 3/9

Member Only
Source: Argentum/ASHA

Argentum/ASHA Webinar Presentation 3/9

Source: Argentum

Argentum State Partner COVID-19 Toolkit

Member Only
Source: Argentum

Access Sample Essential Worker Letter/ID Card

Source: Brookdale Senior Living

Hashwashing Video

Access Coronavirus Preparation and Response Sample Messaging

Member Only Content
Read sample messaging you may choose to use when communicating with your residents and their families, staff, visitors, and media.

Having trouble logging in? Email info@argentum.org for help.
ACCESS MESSAGING

Acknowledgements

AHCA/NCAL (American Health Care Association / National Center for Assisted Living) has a continuously updated page specific to senior living. and guidance pages for assisted living communities. AHCA/NCAL Education is offering free, public access to its webinars and educational materials on coronavirus.

American Seniors Housing Association, “Coronavirus Preparedness and Response for Senior Living Communities,” by Paul Gordon and Hanna Lou, Hanson Bridgett, LLP

Brookdale Senior Living, COVID-19 Toolkit.

California Assisted Living Association (CALA), Josh Allen, board member and principal, Allen Flores Consulting Group

Chad Worz, PharmD, BCGP, executive director and CEO, American Society of Consultant Pharmacists

Ecolab. Extensive resources at its long term care and senior living coronavirus page, including videos, slide deck, and readiness kits.

Edwin L. Walker, deputy assistant secretary for aging, Administration for Community Living, U.S. Department of Health and Human Services

LeadingAge, Coronavirus: The Time for Calm Preparedness Is Now, an updated information page

Linda Anstotz, MJ, RN, NP, GNC, CPHQ, senior director of operational risk management, legal department, Brookdale Senior Living

Medline, Shawn Scott, vice president strategic business development, post-acute sales

National Restaurant Association, Coronavirus information and resources

Pillsbury Winthrop Shaw Pittman LLP, international law firm

Sheela Stevens, MSSW, CSW, Stevens Consulting

Willis Towers Watson, John Atkinson, managing director; JoAnne Carlin, MSN, RN, NHA, CPHRM, CDAL, Vice President Clinical Risk Services.

World Health Organization COVID-19 page, Infection Prevention and Control page, FAQ page


Argentum, its executive staff and consultants, have attempted to provide the best possible information as a service to the association’s membership in a situation that is very quickly evolving and about which so much is unknown. Therefore, Argentum can provide no assurances nor even make any representations about the reliability or accuracy of this information. Each senior living company and each community must make decisions that each regards as in the best interests of the health and safety of the residents. Argentum specifically disclaims responsibility or liability for the information it is providing from any legal, regulatory, medical, or compliance point of view.

 

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