Rural Caucus
office of the governor of the commonwealth of virginia
Slide 1
office of the governor of the commonwealth of virginia
GOVERNOR’S COVID-19 LONG-TERM CARE TASK FORCE
Dr. Laurie Forlano, Deputy Commissioner of Population Health, VDHGena Berger, Chief Deputy Commissioner, DSS
July 23, 2020
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 2
Welcome and Housekeeping Items• Please mute your phone (do NOT put us on hold) if you are not
speaking• We prefer to take questions/comments at the end of each agenda
item • Feel free to utilize the chat box
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 3
Overview of Agenda• Data Update• Medical Reserve Corps & Staffing Update• VHHA LTCF Support Update• Hurricane Season Planning• ALF & SNF Survey Recap• Testing Update
• Testing Advisory Council• Updated CDC Guidelines
• Financing • Discussion• Next Steps
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 4
COVID-19 Outbreaks in Virginia
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 5
Long-Term Care Facility PPS’: Between 4/21 & 7/21 Requests Received:
4 On Hold5 Received49 Scheduled 5 Specimen Collection22 Testing22 Withdrawn294 Closed
By LTCF Type:
Status ALF SNF
Received 3 2
Scheduled 10 38
Specimen Collection 2 3
Testing 5 17
Closed 55 227
On Hold 0 2
Withdrawn 9 13
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 6
Phased Reopening: Nursing Home StatusNumber of New LTCF Outbreaks Reported to VDH in the Last 7 Days (July 22)
● Central Region: 1● Eastern Region: 6 ● Northern Region: 0● Northwest Region: 1● Southwest Region: 1
Statewide (July 22) ● Nursing homes in Phase I: 84● Nursing homes in Phase II: 15
Note these data are not being posted publicly; for internal situational awareness.Data are considered incomplete, as nursing homes are not required to report phase changes.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 7
Medical Reserve Corps
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 8
VHEMP Long Term Care Facility SupportThe Virginia Healthcare Emergency Management Program (VHEMP), in partnership with Russell Phillips & Associates, conducted a statewide assessment of licensed Skilled Nursing Facilities (SNF) COVID-19 capabilities and needs from May 27, 2020 – June 8, 2020. The assessment was conducted by the Commonwealth’s six Regional Healthcare Coalitions and completed by 197 out of the 283 licensed SNFs- a completion rate of 70%.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 9
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 10
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 11
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 12
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 13
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 14
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 15
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 16
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 17
LTC Facilities and COVID-19
Prepared by Hannah Shadowen, MPH and Kurt Elward, MD on behalf of DMAS
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 18
Methods
• LTC facilities in Virginia (nursing homes, assisted living facilities, memory care, long term care) were invited to participate in a survey administered by RedCap.
• Survey created in partnership with DMAS, VDH, VALA, VHHA, and LeadingAge
• Survey focused on • Ability to perform technical COVID testing on site• Ability to increase testing frequency• Staffing and supply status
• Survey administered from May 29 through June 20
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 19
Response Rate
• 398 responses for Assisted Living Facilities survey – 76.2% response rate
• 72 responses for the Nursing home survey
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 20
Characteristics of Assisted Living Facilities with having at least one case in staff OR residents.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 21
Characteristics of Skilled Nursing Homes with having at least one case in residents*Data from the CMS COVID-19 in nursing homes, Nursing Home Compare, Census Bureau, and Minimum Data Set
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 22
Characteristics of Skilled Nursing Homes with at least one case in residents
*Data from the CMS COVID-19 in nursing homes, Nursing Home Compare, Census Bureau, and Minimum Data Set
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 23
Current Testing Capacity in Assisted Living Facilities
• 53.2% of facilities offer testing to residents OR staff.• Offering testing to residents and/or staff was significantly associated with having a
case, the size of the facility, the location of the facility, monitoring residents more frequently, providing a PPS, testing asymptomatic staff, being able to test 20% of residents weekly, having a staffing plan, and cohorting staff
• 31.6% have planned for or completed a PPS• Planning for or completing a PPS is significantly associated with having a case in the
facility, being larger in size, testing asymptomatic staff, having the ability to test 20% of residents weekly, having a staffing plan, and cohorting staff
• 68.2% of facilities reported that they COULD NOT perform testing on 20% of their residents weekly
• 87.5% of facilities COULD NOT perform testing on all staff weekly• Having the ability to test 20% of residents weekly and having the ability to test all staff
weekly was significantly associated with having a case in the facility but not with size of facility or location (Figure 4.1, 4.4, 4.5)
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 24
Staffing Shortages in Assisted Living Facilities
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 25
Characteristics of Skilled Nursing Homes with Staffing Shortage
*Data from the CMS COVID-19 in nursing homes, Nursing Home Compare, Census Bureau, and Minimum Data Set
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 26
Characteristics of Skilled Nursing Homes with Staffing Shortage
*Data from the CMS COVID-19 in nursing homes, Nursing Home Compare, Census Bureau, and Minimum Data Set
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 27
Virginia Testing Advisory Council
● Achieved the Governor’s initial testing goals of > 10,000 tests/day and a test positivity rate of < 10% statewide and regionally, however since late June testing challenges have returned including an extension of testing turnaround times (TAT) and increase in positivity rates in certain regions of the state.
● We are doing more testing, in more settings, but recognizing that PCR diagnostic testing is a finite resource, the question the TAC is focusing now on whether we are ensuring the highest priority individuals are receiving timely testing?
● Test volumes continue to grow, but turnaround times (TAT) – primarily from our commercial lab partners who perform 2/3 of the tests - now exceeds 6 days
● Test positivity rate is trending up statewide, and now exceeds the 10% positivity threshold in parts of Tidewater Region.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 28
Virginia Testing Advisory Council● TAT for CDC Priority 1 groups – hospitalized patients and symptomatic healthcare
workers – are still within a 2 day range at the moment.● But hospital testing capacity which had been growing steadily is now being constrained
by interruptions in reagent and other supplies:○ Making it a challenge to ensure pre-procedure test are available in time; and○ Limiting the capacity for post-discharge PCR testing for non-COVID, asymptomatic
transfers to post-acute settings.● Large commercial labs are being impacted by national trends and international supply
chain issues● Opportunities for remedy of delayed TAT and focus of the Testing Advisory Council
○ Pooled testing, Antigen Testing/Growing point of care options○ Refining of testing priority populations – outbreaks, congregate living, vulnerable
populations, etc.○ Increasing lab capacity (One Lab)
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 29
CDC Testing Recommendations Update
29
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 30
CDC Guidance Addressing Duration of Isolation and Precautions for Adults with COVID-19
Updated July 17, 2020
•Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
•Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html
•Summary of current evidence and rationale for these changes - Decision Memo
https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 31
Criteria for Return to Work for Healthcare Personnel (HCP) with SARS-CoV-2 Infection (Interim Guidance)Summary of recent changes:
● Except for rare situations, a test-based strategy is no longer recommended to determine when to allow HCP to return to work
● For HCP with severe to critical illness or who are severely immunocompromised, the recommended duration for work exclusion was extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised HCP, 20 days after their initial positive SARS-CoV-2 diagnostic test)
● Other symptom-based criteria were modified as follows:○ Changed from “at least 72 hours” to “at least 24 hours” have passed since last
fever without the use of fever-reducing medications○ Changed from “improvement in respiratory symptoms” to “improvement in
symptoms” to address expanding list of symptoms associated with COVID-19
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 32
Discontinuation of Transmission-Based Precautions (TBP) and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)Summary of recent changes:
● Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue TBP
● For patients with severe to critical illness or who are severely immunocompromised, the recommended duration for TBP was extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised patients, 20 days after their initial positive SARS-CoV-2 diagnostic test)
● Other symptom-based criteria were modified as follows:○ Changed from “at least 72 hours” to “at least 24 hours” have passed since last
fever without the use of fever-reducing medications○ Changed from “improvement in respiratory symptoms” to “improvement in
symptoms” to address expanding list of symptoms associated with COVID-19
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 33
Notes for Discontinuing TBP
● Review guidance document for complete description of discontinuation of TBP for patients with COVID-19
● Time period used depends on the patient’s severity of illness and if they are severely immunocompromised (*guidance document further defines)
● Decision Memo describes accumulating evidence supporting ending isolation and precautions for persons with COVID-19 using a symptom-based strategy
● VDH is updating LTC guidance documents and FAQs to reflect changes
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 34
Preparing for CARES Act Fund Reimbursement
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 35
Discussion
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 36
Next steps• Testing & Staffing Best Practices Webinars
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