Long Term Care COVID-19 Plan
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Long-Term Care COVID-19 Plan
On March 10, Michigan recorded its first cases of COVID-19. By the first week in April the state was tallying about 1,500 cases and 100 deaths per day, and it became clear the state’s long-term care facilities were facing immense challenges.
In order to respond to those concerns and provide essential protections to both residents and staff in residential care facilities, the State of Michigan leveraged authority granted by Executive Order and the Michigan Public Health Code. By designated authority, the Michigan Department of Health and Human Services (MDHHS) has acted to prevent and control the spread of COVID-19 by implementing a variety of strategies in the areas of infection control, diagnostic testing, data collection and reporting, and emergency staffing response.
MDHHS and other state partners continue to address and adapt to the changing impact of COVID-19 across the state. Expand the titles below to learn more about each component of the MDHHS Long-Term Care COVID-19 Plan.
Long-Term Care COVID-19 Plan
Michigan law imposes on the Michigan Department of Health and Human Services (MDHHS) a duty to continually and diligently endeavor to "prevent disease, prolong life, and promote public health," and gives the Department "general supervision of the interests of health and life of people of this state." MCL 333.2221. Pursuant to the responsibility to protect vulnerable individuals and ensure the health care system can provide care for all health issues, MDHHS issued iterative emergency orders to continue mitigation techniques to restrict gatherings and require procedures in order to reduce the spread of the virus within Michigan's residential care facilities.
The current emergency order dated May 21, 2021 provides criteria for permitting idoor visitiation within nursing homes and other residential facilities in Michigan. MDHHS provides additional guidance through resources linked below to support facilities in implementing procedures to be followed during the COVID-19 epidemic to insure continuation of essential public health services and enforcement of health laws.
Resources:
Residential Care Facilities May 21, 2021 Order Guidance (NEW 6.15.2021)
Mom's Vaccinated: When can I visit her nursing home (cms.gov)
Given the significant risk of COVID-19 outbreaks in long-term care facilities, MDHHS has issued an Emergency Order requiring that nursing facilities, homes for the aged, and adult foster care facilities licensed to care for 13 or more individuals conduct diagnostic testing in certain circumstances, to the best of their ability. Under the current testing order, revised May 5, 2021, testing is required under the following circumstances:
- Initial testing of all new or returning residents to a facility covered by the Order and newly hired staff when the individual is unvaccinated and has not been tested in the 72 hours prior to intake or start date.
- Testing any resident or staff member with symptoms of COVID-19 or suspected exposure to COVID-19, regardless of that individual's vaccination status.
- Weekly testing of all residents and staff in facilities experiencing an outbreak (any facility acquired positive cases among residents or staff) until 14 days after the last new positive case, regardless of vaccination status.
- Weekly testing of all unvaccinated staff.
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Please see the following resources for more details and guidance on testing requirements, implementation, and reimbursement:
MDHHS Testing Implementation Guidance
MDHHS LTCF Testing - Financial Implications
LTCF Testing Reimbursement Form
Use the online Antigen Supply Request Form to request test supplies two weeks in advance of testing.
Use the online Antigen Reporting Form to report completion of individual tests.
Standing Order for Testing dated February 2, 2021
On May 21, 2020 the Michigan Department of Health and Human Services (MDHHS) released guidance detailing Federal and State COVID-19 reporting requirements for Skilled Nursing Facilities. Data received as part of this requirement has ensured that MDHHS has had the information necessary to respond to the COVID-19 outbreak, providing an understanding of the impact on residents and facilities, and identified resource needs and supported prioritization of public health action.
Following the recommendations from Governor Whitmer's appointed Nursing Home COVID-19 Preparedness Task Force, MDHHS issued updated guidance to maintain effective reporting on an ongoing basis. Effective October 28, 2020, all skilled nursing facilities, home for the aged and adult foster care facilities licensed for 13 or more individuals are required to report weekly COVID-19 surveillance data to the state, including information on resident and staff cases and deaths. To enhance the quality of this reporting, MDHHS conducts ongoing data validation in collaboration with the Michigan State University Institute for Health Policy and other partners. Data and more information on this project are located on the MDHHS Coronavirus Long-Term Care Data web page.
Please see the following resources for more details and guidance on reporting requirements and implementation:
Skilled Nursing Facilities
- Provider Letter L 21-33 dated 04/29/21
- EMResource NHSN Module Quick Guide
- 2021 Annual COVID Survellance Data Audit
- 2021 COVID Surveillance Data Audit Overview
- Phase I Resources - NHSN Data Review & Correction
- Phase II Resources - EMResource Historical Data Review & Correction
Home for the Aged and Adult Foster Care Facilities
Skilled Nursing Facility EMResource Office Hour Sessions
MDHHS hosts regular office hour sessions for skilled nursing facilities and state partners to review technical components of the required COVID-19 surveillance reporting process and platform. Recordings of recent sessions are provided below:
- 07/15/2021 - EMResource Audit Process and Upcoming NHSN Changes
- 07/01/2021 - Annual COVID-19 Surveillance Data Audit Phase I & II Review
- 06/17/2021 - NHSN Vaccine Module Reports
- 06/03/2021 - Overview of Supply Board and NHSN Vaccine Status
- 05/20/2021 - Updated Reporting Requirements
- 04/22/2021 - Point of Care Reporting Tool Introduction
- 04/08/2021 - Fire Marshal Discussion
- 03/04/2021 - Lab and Sequencing Discussion
Surge Staffing
As additional COVID-19 testing takes place in long-term care facilities, some facilities will experience a need for surge staffing if staff test positive. To meet this need, MDHHS will facilitate the establishment of Rapid Response Staffing Resources that offer:
Rapid Response Staffing resources are being expanded statewide and will include new categories of staffing available in addition to a longer duration of staff availability. Facilities requiring staffing assistance will need to meet specific criteria and demonstrate they have exhausted all other options. Staffing resources available will include registered nurses, licensed practical nurses, social workers, certified nursing assistants, personal care aides or resident care assistants, direct care workers, dietary aid, dietary cook, and environmental services staff.
Direct Care Worker Resources
AFC/HFA Provider Direct Care Worker Wage Increase FAQ
AFC/HFA Direct Care Worker Pass-Through Reimbursement Form
Skilled Nursing Facility COVID-19 Response: Direct Care Worker Wage Increase FAQ
Direct Care Worker Wage Pass-Through Reimbursement Form (Updated March 2021)
Direct Care Worker Premium Pay Provider L Letter 20-52 dated August 25, 2020
Nursing Facilities Premium Pay Update Provider L Letter 21-08 dated January 21, 2021
CHRT NH COVID Response Presentation
In April, MDHHS launched the COVID-19 Regional Hub strategy. These facilities are dedicated to caring for COVID-affected long-term care facility residents who no longer need hospitalization, or to individuals who have not been hospitalized and cannot be safely isolated or cared for in the nursing facility where they live. More information about Regional Hubs is located on the Nursing Facilities page.
Through this strategy, MDHHS created partnerships with nursing facilities that had the capacity to contribute to local need for services, proximity to acute care facilities experiencing high COVID-19-related demand and ability to effectively quarantine COVID-19-affected residents. To facilitate these partnerships, MDHHS worked alongside Licensing and Regulatory Affairs to ensure all facilities had adequate physical space planning, and met safety and infection control protocols to perform in this enhanced role.
MDHHS has enhanced Regional Hub reporting requirements in alignment with national nursing facility reporting efforts. Additionally, to augment self-reported data from facilities, MDHHS has prioritized Regional Hub facilities for review and support with the Infection Prevention Resource and Assessment Team (IPRAT). This effort ensures Hub facilities have all resources and necessary support to maintain infection control protocols as they continue operations. Regional Hubs are also subject to weekly monitoring and oversight audits conducted by MDHHS staff.
The information gathered from these efforts is used to inform how MDHHS identifies the changing landscape, the need for new Regional Hub locations and when to begin reducing capacity in areas where the need no longer exists. MDHHS has established a process for facilities to begin decommissioning some Regional Hub space in light of the reduced regional needs at this time.
The MDHHS Infection Prevention Resource and Assessment Team (IPRAT) is providing both remote and onsite technical assistance, education and training to long-term care facilities and other congregate care settings. Facilities or local health departments can request assistance at mdhhs-iprat@michigan.gov. Additionally, Michigan.gov/iprat contains guidance and information for LTC facilities. The IPRAT team, in partnership with local health departments, has been using the CDC Infection Control and Assessment Response (ICAR) Tool to assist congregate care settings in mitigating the risk of infection from COVID-19 and other special pathogens.
Resources:
Guidance to Protect Residents of Long-Term Care Facilities: Quarantine and Testing
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Past Meetings & ResourcesThursday, July 23, 2020Thursday, July 30, 2020Thursday, August 6, 2020Thursday, August 13, 2020Thursday, August 20, 2020Thursday, August 27, 2020Please note that these recommendations are being further developed and revised by workgroups. Everything on this list may not appear in the final recommendation report to the governor.
If you have any questions please contact us at: MDHHS-MSA-COVID19@michigan.gov
The Center for Health & Research Transformation at the University of Michigan was engaged to conduct an evaluation of the state’s regional nursing home hub COVID-19 strategy, comparing Michigan’s approach and outcomes to those in other states. In addition, they conducted extensive research to provide recommendations for preparedness in the event of another COVID-19 surge and further considerations to minimize infections, morbidity, and mortality across the continuum of long-term care services. They have compiled their findings and recommendations in a detailed report and presentation. The State of Michigan is leveraging this report in conjunction with the Nursing Homes Preparedness COVID-19 Task Force recommendations to enhance the strategies they currently use support and protect residents across the long-term care continuum.
CHRT Keeping Nursing Home Residents Safe and Advancing Health in Light of COVID-19 - August 31, 2020
Keeping Nursing Home Residents Safe Summary Report - September 8, 2020
Keeping Nursing Home Residents Safe Summary Report - Updated December 3,2020
Keeping Nursing Home Residents Safe Appendices - December 3, 2020
