Coronavirus Preparation and Response Toolkit

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:

• What you can do as an owner, executive director, resident, or worker is covered by Preventing the Spread of COVID-19 in Retirement Communities and Independent Living Facilities (Interim Guidance).
• For all older adults, not just those in senior living communities, the Coronavirus Disease 2019 (COVID-19) Checklist: Older Persons gives a concise and readable list of good actions to take.
• A preparedness checklist for nursing homes and long-term care settings helps in planning and implementation.

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 Living, Brookdale Senior Living, Eclipse Senior Living, Merrill 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.

• Sample letter from administrator to families for communities with no confirmed cases
• Sample letter from administrator to families; a longer version for communities with no confirmed cases
• Sample letter from administrator to families for communities with confirmed cases in the surrounding area, city, or municipality
• Sample letter from administrator to families when one or more cases is confirmed in the community

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 Living, Brookdale Senior Living, Eclipse Senior Living, Merrill 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 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.

The National Institutes of Health is beginning a clinical trial of hydroxychloroquine and azithromycin to treat COVID-19 that is anticipated to have many people older than 60 enrolled. This explains the study and tells where to find out about about getting involved.

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 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.