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 fever, coughing, and shortness of breath. There is not yet a treatment or vaccine. You can keep up with the facts here.

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.

Right now, if you’re using recommended infection prevention precautions, have practiced your emergency plan, and are keeping up with local and state requirements, you’re in good shape, according to the subject matter experts consulted.


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.


What’s New?

As of April 9, there were 429,460 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 at noon Monday through Friday and posts preliminary numbers on Saturday and Sunday, which it then confirms on Monday. We’ll update this toolkit when new information is learned about this virus or if recommendations change.

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.

Our COVID-19 webinar, co-hosted with ASHA on March 25, included topics such as updates for community practices, answers to staffing and exposure questions, and ideas and resources for reducing and handling stress for workers at all levels. See the presentation here. Members can access the recording here.

In addition to the content below, you can also review the latest federal and state updates.

New for April 9:

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

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

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.

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

Links to sample letters to help communicate with families have been added to Community Life, under Communications.

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.

Preventing the Spread

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.

PPE

Guidance on Using PPE

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 youre-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.

Monitoring and surveillance are critical in this situation. Do what you can to stay healthy.

If you feel sick, whether you’re an employee, a visitor, or a resident, speak up and stay home.

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.

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

Testing

Guidance

The testing situation is changing rapidly. As of April 6, even people at high risk are generally not being tested without a screening call first.

Some providers are performing tests in their communities, and others are considering this option. Argentum has compiled COVID-19 Testing Information that can help you evaluate options and plan accordingly.

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

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

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

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. 

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.

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.

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 controlat 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.

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

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.

Food Safety

Some shortages of disposable dining supplies have been reported.
ServSafe is offering free online training in COVID-19 related food safety.

Register for Upcoming COVID-19 Member Webinars

Member Only Content
Join us every other Monday from 1-2:15 PM ET for member webinars on mitigation strategies.

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Federal & State Updates

Here, you can find information about federal priorities Argentum is advocating for and additional federal resources. Additionally, you can find state updates, but encourage you to check with your state’s health department or regulatory agency for the most up-to-date and relevant information.

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


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. 

The CARES act includes more than $350 billion in loans and grants for small businesses with fewer than 500 employees. Argentum recommends eligible operators apply as soon as possible. Here are some resources to help:  

This FAQ explains the CMS suspension of Medicare fee-for-service medical review 

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.

We have received a resolution from the USPS in response to our inquiry about mail delivery. Senior living communities have three options for receiving mail:

  1. Arrange with their local post office for mail to be placed in a receptacle outside and for mail to be picked up.
  2. Arrange to have mail held at their local post office.
  3. Open a P.O. Box at their local post office.

The latest bulletin on civil rights, HIPAA, and COVID-19 from U.S. Health and Human Services (HHS) outlines responsibilities for meaningful access, care, and reducing stigma.

The CMS telehealth toolkit has information on waivers, reimbursement, and policy guidance. The HHS Office of the Inspector General issued a new policy statement on telehealth, notifying "physicians and other practitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules, subject to the conditions specified herein." 

The U.S. Equal Opportunity Commission has updated its links and FAQs addressing questions such as doctor’s notes and screening applicants for COVID-19.

The White House has issued “15 Days to Slow the Spread,” a readable, two-page guide to individuals, states, and the country for dealing with coronavirus. It encourages all older adults to stay home and all Americans to avoid groups of 10 or more.

The following includes updated guidelines and information we’ve received from our state partners. Please refer to their websites as needed for additional information.

To immediately visualize, state by state, the projected numbers of COVID-19 deaths and the virus’ toll on available hospital resources, see the Institutes for Health Metrics and Evaluation resource. The projections are based on measures being taken by each state and will be updated as new information becomes available.

This interactive map from Fiscal Note shows the latest state, county, and city legislation and rules related to COVID-19, as well as appropriations and orders regarding stay-at-home, schools, and gatherings.

The CDC has requested residents of New York, New Jersey, and Connecticut refrain from non-essential domestic travel for 14 days. This is the Department of Homeland Security’s list of what workers are considered essential.


ARIZONA

  • State regulators announced they would waive certain licensing requirements in the state, including the requirement for CPR temporarily waived. based on concerns raised by Arizona ALFA in a meeting with Gov. Doug Ducey.

CALIFORNIA

  • CCLD has released PIN 20-07-CCLD: Suspension of all annual inspections to allow technical assistance for licensee regarding the coronavirus disease (COVID-19).
    All annual inspections are suspended to allow CCLD to focus on containing and mitigating COVID-19 impacts. This PIN also announces that a LPA and a registered nurse from the California Department of Public Health (CDPH) will jointly make scheduled visits to every RCFE and ARF to provide technical assistance.
  • DSS is looking into options to assist with childcare as a way of alleviating staffing shortages due to school and day care closures.
  • All persons 65 and older should self-isolate.
  • There is a prohibition on visitors to ALs and SNFs, except in end-of-life situations.

FLORIDA

  • In response to concerns raised by the Florida Senior Living Association, state regulators announced that due to supply shortages, they will not penalize facilities that are unable to follow a directive for staff in long-term care setting to wear masks. However, be sure to contact your local emergency management office to request PPE.
  • ALFs in counties with populations of 500K or more people will be asked to conduct voluntary COVID-19 worker testing to provide samples to DOH of any contamination among health care workers.
  • Florida counties are now initiating one-per-county supply drop off areas; we’ll share that location list when available.

GEORGIA

LOUISIANA

  • No state regulatory waivers being granted at this time.

MARYLAND

Executive Order 20-04-05-01 instructs long-term care facilities, including assisted living, to comply with Department of Health directives to monitor, treat, prevent, reduce the spread of, and suppress COVID-19.

MASSACHUSETTS

Authorization and relief was given to assisted living residences to provide appropriate skilled nursing care, as well as waive staffing and training requirements. More details are available in Secretary Chen’s full letter. 

NEW YORK

  • The Department of Health has stated that “No resident shall be denied re-admission or admission to the ACF solely based on a confirmed or suspected diagnosis of COVID-19.” Any denial of admission or re-admission must be based on the ACF’s inability to provide the level of care required by the prospective resident, pursuant to the hospital’s discharge instructions and based on the ACF’s current licensure or certification.

  • DOH has updated the advisory on returning to work after COVID-19 exposure. 
  • Argentum New York has successfully gotten clarification on Executive Orders 202.5 and 202.10, stating that extended time afforded to submit information to the Home Care Worker Registry also applies to Enhanced Assisted Living Residences, and that ACFs and assisted living residences are allowed to employ out-of-state licensed LPNs and RNs.

    In addition, Executive Order 202.10 also applies to physicians, physician's assistants, nurse practitioners, LPNs and RNs and shields them from civil liability for injury or death sustained directly in the course of providing care in support of the COVID-19 crisis, with an exception due to gross negligence. 

  • The health department is not issuing Operating Certificates nor emailing Operating Certificate renewal forms and reminder notices until operations return to normal. ACFs/ALRs due for a renewed Operating Certificate can find the form online and email the completed form to: ACFCON@health.ny.gov. ALR certification fees will not be processed at this time.  

    March 28 health advisory has guidance on employee furloughs and returning to work after exposure or confirmed/suspected COVID-19, and on release from isolation. LINK TO PDFs

  • New guidance covers topics including the process for requesting PPE; clarification that criminal history record check (CHRC) rules remain in effect; guidance on required medical evaluations for staff and residents; clarifications on the utilization of the Uniform Assessment System; procedures regarding congregate dining and medication management; clarifications on activities, visitors, deliveries, and facility repairs; and requirements related to plans of correction (POC).

NORTH CAROLINA

  • Waive provisions of any regulation or ordinance of a state agency, which restricts the immediate relief of human suffering.
    • The Secretary of NCDHHS may, upon finding that the waiver will provide necessary relief to child care facilities and families responding to the COVID-19 pandemic and will not endanger the public health, welfare, or safety, waive the effect and enforcement of any or all of the provisions.
    • The Secretary of NCDHHS may, upon finding that the waiver will provide necessary relief to local health departments responding to the COVID-19 pandemic and will not endanger public health, waive local health department mandated services requirements under 10A NCAC 46 Section .0200 and extend the time period for public health nurses to complete training sponsored by NCDHHS under 10A NCAC 46 .0301(2)(b).
    • Upon subdelegation of authority from the Secretary of NCDHHS, the Local Health Department Accreditation Board may, upon finding that the waiver will provide necessary relief to local health departments responding to the COVID-19 pandemic and will not endanger public health, waive the accreditation scheduling requirements of 10A NCAC 48A .0205 and grant an extension of accreditation of no more than twelve (12) months.
    • Encourages communities across the state in counties, cities, and municipalities to support the continued operation of child care facilities for children of all ages. 
    • Prohibition of mass gatherings, defined as 50 or more people.
    • Long-term care facilities shall restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, for example, an end­ of-life situation. This restriction does not include essential health care personnel.
    • North Carolina’s Wake County’s emergency declaration sets limits on visitors and sets screening requirements, including that employees who have had contact with someone under investigation for COVID-19 cannot return to work for 14 days.
  • Gov. Roy Cooper announced that state agencies are working to identify childcare options for essential workers, to include nursing and adult group home staff. Parents and families with urgent childcare needs may call (888) 600-1685 to find high-quality, safe childcare for children, for infants through 12 years old.
    Childcare Flyer in English
    Childcare Flyer in Spanish

OKLAHOMA

  • The order on visitation has been clarified to “permit such ‘compassionate care’ visits to Oklahoma’s nursing homes, long-term care facilities, and retirement homes, if conducted in accordance with the guidelines” in this CMS Memorandum.

  • The Department of Health has issued this guidance for extending PPE.
  • Fingerprint rule waived March 25
  • Governor issued a Statewide Executive Order asking Oklahomans:
    • DO NOT visit nursing homes, retirement, or long-term care facilities.
    • Suspended several regulations on telemedicine to ease capabilities for Oklahomans to receive medical support from a doctor without leaving home.
    • Established expedited process for nurses with inactive licenses to get re-certified.
    • Extended expiration dates for all occupational licenses issued by any state agency, board, or commission during the Declared State of Emergency Period.
  • Fingerprint background checks are suspended.
  • All state surveys have been suspended through April 6 as of now.
  • All enforcement actions have been suspended through April 6.
    • There are 10 surveyors that have been fitted with PPE and are ready to act should a positive test come back on a resident.

PENNSYLVANIA

  • Stay-at-home order for 10 counties as of 3/25/2020. All non-essential business are closed.
  • Requests for waiver/grace periods for several regulations have been requested. 

TENNESSEE

The Board for Licensing Health Care Facilities April 1 approved several waivers to address COVID-19 and comply with Executive Orders issued by the governor.

TEXAS

VIRGINIA

The Virginia Board of Long-Term Care Administrators has announced it is granting an extension of continuing competency requirements for a period of six (6) months after the deadline for any renewal due by March 31, 2020 as a result of cancellations of training events or health situations during the COVID-19 pandemic. Please contact the Board of Long-Term Care Administrators with any questions using the Board’s e-mail address, ltc@dhp.virginia.gov.

WASHINGTON STATE

An emergency ruling immediately suspends TB testing requirements in assisted living communities.

FAQ on health profession license renewal extensions

 

Have questions about COVID-19?

Additional Resources

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

"Stop and Ask Yourself" Flyer

Source: Brookdale Senior Living

"Wipe-Down Wednesday" Flyer

Source: Brookdale Senior Living

Hashwashing Video

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

About the Virus

How it spreads: The coronavirus is thought to spread mainly from person to person, between people who are in close contact with each other (defined as within about six feet), and through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Symptoms: The principle symptoms are fever, coughing, and shortness of breath. Currently, CDC believes that symptoms may appear in as few as two days or as long as 14 days after exposure.

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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