Nursing Home 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.
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Given the significant risk of COVID-19 outbreaks in long-term care facilities, MDHHS has issued an 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. The following testing is required:
- Initial testing of all residents and staff;
- Testing any resident or staff member with symptoms of COVID-19 or suspected exposure;
- Weekly testing of all residents and staff in facilities with any positive cases among residents or staff, until 14 days after the last new positive;
- Weekly testing of all staff in counties of risk levels A through E on the MI Safe Start Map;
- Testing of all new or returning residents during intake unless tested in the 72 hours prior to intake;
- Testing of all newly hired staff on their start date or in the 72 hours prior to start date.
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Please see MDHHS guidance and associated FAQ (Updated November 23, 2020) for more details on requirements and implementation.
MDHHS has also published a testing assistance request form for skilled nursing facilities, homes for the aged, and adult foster care facilities to request state assistance to complete testing, if needed. For facilities applying for a CLIA waiver to use rapid antigen tests, this guide shows step-by-step how to fill in the CLIA waiver.
Additionally, MDHHS has published SNF COVID-19 Testing Financial Guidance (updated November 2,2020), and associated Testing Reimbursement Form to support facilities in implementing their testing plans.
Finally, MDHHS has published HFA and AFC COVID-19 Testing Financial Guidance (Updated November 2, 2020), and associated Testing Reimbursement Form to support facilities in implementing their testing plans.
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On May 21, 2020 the Michigan Department of Health and Human Services (MDHHS) released policy 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 policy to maintain effective reporting on an ongoing basis. Effective October 28, 20202, all nursing facilities are required to report weekly data into the state’s EMResource portal, 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 Long-Term Care Facilities web page. MDHHS provides additional guidance through Reporting FAQs (update in process) to provide ongoing support to facilities to meet the reporting requirements.
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
Skilled Nursing Facility COVID-19 Response: Direct Care Worker Wage Increase FAQ (Updated October 2, 2020)
Direct Care Worker Wage Pass-Through Reimbursement Form
Direct Care Worker Premium Pay Provider L Letter 20-52 dated August 25, 2020
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.
MDHHS is working in coordination with Doctors Without Borders to help identify long-term care facilities in need of assistance with their infection prevention and control (IPC) practices to prevent the spread of COVID-19.
Doctors Without Borders is applying its infection control expertise to long-term care facilities in Europe and the United States through small mobile teams sent to assess IPC practices and provide tailored recommendations to best safeguard residents and staff. Teams train staff on infection prevention and control, correct use of PPE and provide on-site support. Recognizing the emotional toll that COVID-19 has brought on frontline staff working in nursing home facilities, Doctors Without Borders also offers workshops on stress management.
Additionally, the Infection Prevention Resource and Assessment Team (IPRAT) is providing remote technical assistance, education and training to long-term care facilities. 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, in partnership with local health departments, has been using the CDC Infection Control and Assessment Response (ICAR) Tool. Nearly 300 long-term care facilities have completed an ICAR to date. The IPRAT in the future is planning to conduct more proactive outreach and technical assistance with facilities based on data, LARA infection control surveys and results of 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-COVID-19NursingHomeTF@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
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 an emergency order on October 21 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.
This order provides for continued protection of resident rights and visitation guidance to nursing homes and other residential facilities in Michigan. MDHHS provides additional guidance through Visitation FAQs (updated 11/09/2020) to support to 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.
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