Coronavirus (COVID-19)

HOPE has compiled the following resource directory to provide information from CMS, ISDH, CDC and the EPA in one location. This is not, and should not, be considered an all-inclusive resource. Please check ISDH, CMS and CDC websites frequently, as information and/or directives are being released almost daily.

IMPORTANT NOTICE
At the request of Dan Rusyniak, MD and Chief Medical Officer at Indiana FSSA
All LTC facilities need to use this CDC check list to prevent the spread - Coronavirus Disease 2019 (COVID-19) Preparedness Checklist for Nursing Homes and other Long-Term Care Settings HERE
All LTC facilities should use this sheet to track their infection control activities and to track employees and patients with respiratory illness.
All LTC facilities should have a plan to rapidly implement, or implement now, how they will cohort confirmed or presumed covid-19 patients in their facility. This can be by wing, floor, or if available, by building(s). This should be done with expediency. See this from CMS QSO.
All LTC facilities should limit patient contact to only essential direct care providers (Nurse, CNA, QMA, Hospice, EMS etc), Notice
Once you have access to EMResources, every facility needs to update their status daily. This information is critically important for tracking PPE needs.
All LTC facilities should require those involved in direct patient care to wear a mask during their entire shift. Mitigation Strategies
a. If national and local supplies are at conventional capacity, then all staff in LTC facilities should wear a facemask per standard recommendations.
b. If national and local supplies are at contingency levels, only direct care staff should wear a mask and they should use one mask per shift.
c. If national and local supplies are scarce <1 week supply, then only direct care staff should wear a mask and they should use the same mask for multiple days
d. If national and local supplies are at crisis capacity, then direct patient care staff should wear a mask if available. If masks are not available, they should use alternative methods to cover their mouth and nose and decrease respiratory droplet spread.
All LTC facilities need to have updated lists of all residents’ code status. Plans should be in place for how to provide hospice and comfort care to those patients with DNR orders who develop COVID-19.
ISDH has a team available to come into facilities to rapidly test residents and staff who are suspected of having COVID-19. If your facilities have patients or providers who are symptomatic and need to be tested, please contact COVID-19 Outbreak Response Logistics Coordinator Tami Johnson at 317-412-2127 or tamjohnson@isdh.in.gov to schedule testing at your facility.
If you would like to discuss the need for testing at your facility or COVID-19 prevention such as PPE donning and doffing, please contact Casey Cummins, COVID-19 Outbreak Response Chief Nurse Consultant, at 317.954.2591 or ccummins@isdh.in.gov.

UPDATES BY DATE:

MARCH 22, 2020
March 22 ISDH Newsletter HERE
ISDH Updates:
MARCH 20, 2020
ISDH Authorizes Additional Staffing Options: Temporary COVID-19 Personal Care Attendant (PCA)
Please contact Nancy Adams 317-233-7119 or nadams1@isdh.in.gov with questions.
Personal Protective Equipment Available
Dr. Kristina M. Box, MD, State Health Commissioner, has requested that all long term care facilities have all healthcare workers wear a face mask during their work shift. Staff should be instructed to mask up at the beginning of the shift and wear the mask until they leave. The mask does not need to be a N95 mask.
From this guidance, the ISDH Division of LTC has been informed that Indiana Local Public Health Departments (LHD) have personal protective equipment available for comprehensive care facilities and residential care facilities. Facilities should contact their local public health department for details.
Link to ISDH Latest Newsletter with this article: newsletter
IMPORTANT - HOPE Offers Additional Observations to PPE Available
  • Please note, the article does not suggest or require staff to wear N-95 masks
  • I have confirmed that supplies are reaching county health departments and you should contact you contact them as soon as possible. Indiana Local Public Health Departments
  • Due to critical hospital shortages it has been reported that some county health departments sent these supplies to hospitals. This was reported in Vanderburgh County.
Emergency Order Granting Temporary Blanket Waivers
Comprehensive Care Facilities
Pursuant to the “Declaration of Public Health Emergency for Coronavirus Disease 2019 Outbreak” issued by Governor Eric Holcomb on March 6, 2020 and IC4-21.5-4-1, and as authorized by IC 16-28-1-10 and the September 18, 1991 resolution of the Executive Board of the Indiana State Department of Health (ISDH), the Indiana Health Commissioner hereby ORDERs as follows:
  1. Living Arrangements
  2. Transfer and Discharge Rights
  3. Personnel
  4. Personnel
  5. Physician Services
  6. Activities
  7. Dining Assistant
Residential Care Facilities
Pursuant to the “Declaration of Public Health Emergency for Coronavirus Disease 2019 Outbreak” issued by Governor Eric Holcomb on March 6, 2020 and IC4-21.5-4-1, and as authorized by IC 16-28-1-10 and the September 18, 1991 resolution of the Executive Board of the Indiana State Department of Health (ISDH), the Indiana Health Commissioner hereby ORDERs as follows:
  1. Resident Rights
  2. Health Services
MARCH 19, 2020
Indiana Submits a 1135 Waiver Request Found HERE
Summarized, if approved by CMS, the waiver seeks to:
  • The ability to temporarily allow modifications to PASRR process allowing a level 1 screen to be conducted by the admitting facility within 24 hours of admission and level 2 screen to be delayed until 30 days after admit.
  • The ability to waive prior authorization requirements for select providers most impacted by COIVD-19.
  • The ability for providers to gain extended prior authorizations through the termination of the emergency declaration.
  • The ability to temporarily allow modifications to PASRR process allowing a level 1 screen to be conducted by the admitting facility within 24 hours of admission and level 2 screen to be delayed until 30 days after admit.
  • The ability to waive prior authorization requirements for select providers most impacted by COIVD-19.
  • The ability for providers to gain extended prior authorizations through the termination of the emergency declaration.
Emergency Order Granting Temporary Blanket Waivers
Pursuant to the “Declaration of Public Health Emergency for Coronavirus Disease 2019 Outbreak” issued by Governor Eric Holcomb on March 6, 2020 and IC4-21.5-4-1, and as authorized by IC 16-28-1-10 and the September 18, 1991 resolution of the Executive Board of the Indiana State Department of Health (ISDH), the Indiana Health Commissioner hereby ORDERs as follows:
Tuberculosis screening for employees and nonpaid personnel of facilities:
CMS – 1135 Authority – Immediate Jeopardy Duties Only and LTC Strike Teams
With CMS using 1135 authority to require nursing home surveyors to limit their duties to immediate jeopardy only, we will be using this workforce to form LTC strike teams. These teams will go to facilities (those with a presumed case will be prioritized) to do PPE training and communicate risk mitigation strategies with essential staff (those who provide healthcare to patients with presumed or confirmed COVID-19 cases). These teams will also do targeted test collection. We hope to fully utilize this workforce and their expertise to assure that the facilities that care for our most vulnerable residents are as prepared as possible to continue to do so safe and effectively. This is not a regulatory visit and there will be no report given to the facility. The team will rely upon the facility’s screening of the residents to prioritize testing. Please have a nurse available to assist with the resident during the testing. Your staff will be appreciated by both the resident and the strike team staff to comfort the resident.
See complete ISDH Newsletter HERE
MARCH 18, 2020
MARCH 17, 2020
MARCH 16, 2020
MARCH 14, 2020
ISDH is updating its recommended visitation guidelines which mirror’s CMS for nursing facilities and also includes
  • Residential care facilities
  • Assisted-living facilities
  • Residential care & assistance program providers
  • Housing with services establishments
  • Intermediate care facilities for IDD, including group homes
  • Rehabilitation hospitals
  • State psychiatric hospitals
  • Free standing psychiatric hospitals
MARCH 13, 2020
CMS Makes Third Revision to Guidance to Infection Control and Visitations to Nursing Facilities QSO-20-14-NH Follow this visitation guidance.
MARCH 12, 2020

 Prepare Now 

1.  Review infection prevention and control policies and procedures from the CDC

2. Review emergency preparedness plan with staff and expect ISDH survey's to be more narrowly focused on infection preparedness.  Read more from CMS.

3.  Have a Communication Plan for all stakeholders.  Download The World Health Organization Communications Package

 Resource Directory 

CMS UPDATES
Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes

COVID-19 Response News Alert: CMS Issues Frequently Asked Questions to Assist Medicare Providers

CMS Develops Additional Code for Coronavirus Lab Tests


CDC INFORMATION
About COVID-19

EPA Releases List of Disinfectants to Use Against COVID-19

EPA’s Emerging Viral Pathogen Guidance was developed and finalized in 2016 to allow for a rapid response in the event of an emerging viral pathogen outbreak. It was triggered for the first time ever for SARS-CoV-2 on January 29, 2020. The guidance outlines a voluntary, pre-approval process for making emerging viral pathogens claims. In the event of an outbreak, companies with pre-approved products can make off-label claims (for example in technical literature, non-label-related websites, and social media) for use against the outbreak virus.

VIEW THE LIST HERE

REVISED ** CMS Guidance for Nursing Homes  VIEW HERE

ISDH Long Term Care Newsletter / Special Issue:  COVID-19 / Coronavirus

The Indiana State Department of Health (ISDH) Division of Long Term Care is providing facilities with information related to COVID-19.  It is recommended that facilities review this information and use it to educate staff and visitors.

Additional questions please contact LTC Deputy Director Tammy Alley at talley@isdh.in.gov or 317.233.7441, or LTC Director Brenda Buroker at bburoker@isdh.in.gov or 317.234.7340.

CMS Announces Actions to Address Spread of Coronovirus

CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect facilities affected by Coronavirus.    READ MORE

Additional Resources

Strategies to Prevent Spread in LTC Facilities

Getting your workplace ready for COVID-19