COVID-19 FAQs

We at MHCA know you are all working hard to keep everyone in your communities safe and healthy during the current COVID19 emergency. We have developed this FAQ to share some of the guidance we have been able to seek out for members in the hopes it will help with questions as they arise. Questions originated from MHCA member facilities with responses generated from Maine CDC HAI Coordinator, AHCA and CMS Guidance Documents. If you have questions, please contact Danielle Watford, Director of Quality Improvement & Regulatory Affairs (207.623.1146, ext. 221).

MHCA Member Generated FAQs
CDC Agency Updates

What is the call-in information for the weekly ‘Big Tent’ all provider call with the ME CDC on Mondays at 1:00 p.m. EST?

What is the call-in information for the weekly LTC specific provider call with the ME CDC on Wednesday at 1:00 p.m. EST?

I’m a small facility where do I start to prepare my building for COVID-19?

This is not an all inclusive list but some things to begin thinking about:

  1. Review the CDC and CMS guidance documents which can be found on https://www.mehca.org/covid
  2. Have a process in place for screening of staff and essential visitors. Who does it, what happens if someone meets criteria to be sent home and who monitors the return to work status of those folks.
  3. Send out communication to your residents and families regarding exactly what your COVID-19 plan is regarding contact such as bringing in items for love ones, mail, video conferencing etc. Some facilities have allowed for drop off of items but have limited the times for drop off to a few hours in the morning to best handle the deliveries.
  4. Inventory your current PPE equipment. Be thinking about how much you might need if you have a resident test positive. How many staff would need to interact with the resident  on a daily basis. Keep in mind there is CDC guidance for reuse or extending use (up to 1 shift) of PPE.
  5. Look at your physical plant and how you might isolate a resident in a single room. Look and see what the logistics might be for storing PPE supplies for donning and doffing. In a perfect situation there would be a room outside the isolation room for this process but most buildings are not designed for isolation precautions. So be looking for how that would work in your building.
  6. Reach out to your district MEMA liaison and fill out the MEMA form I’ve attached here. If you are unable to get PPE supplies from your normal supply chain this is how you would do it.
  7. Listen in on the Maine CDC calls dedicated to long term care providers, Wednesdays from 1-2 p.m. This will give you an up to date look at the information coming directly from the CDC. I’ve attached the link for log in here:

https://zoom.us/j/570558574 
Call in for audio by phone: 1.646.558.8656 
Meeting ID: 570 558 574

Staff Symptoms

If a staff person screens with signs and symptoms of COVID-19 when can they return to work?
 
Screen for these symptoms: 

  • Fever >100.0°F
  • New of Worsening Cough
  • Shortness of Breath
  • Sore Throat

Exclude from work until: 

  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever- reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

  • At least 7 days have passed since symptoms first appeared

If the staff member were never tested for COVID-19 but have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.

What do I do if one of my staff members develops signs and symptoms of COVID-19 during their shift?

Staff should immediately put on a mask, be instructed to leave the building and self-quarantine at home. They should call their healthcare provider and explain their symptoms and that they work in a LTC facility. If tested refer to the above return to work criteria.

What if a staff member has a cough but none of the other symptoms?

Think of screening as A …or… B…or…C…or…D….
Cough alone meets criteria for being sent home and not allowed to work. In the case the symptom is a cough, you should follow that screening question up with: Is this new or changed?

PPE Procedures

Do I need to wear a mask while working in my facility?

If you are healthy, you only need to wear a mask if you are taking care of a person with suspected COVID-19 infection. Practice good infection prevention hygiene. Preserve your PPE supply for the event it is needed.

How do I request additional PPE supplies if my current in house vendor is not able to deliver what I need?

Requests for PPE should be made through the Maine district liaison of MEMA (Maine Emergency Management Agency). A request form (ICS FORM 213 RR) can be found on the MHCA webpage at www.mehca.org/COVID.

Who can Work?

If a staff person screens with signs and symptoms of COVID-19 when can they return to work?
 
Screen for these symptoms: 

  • Fever >100.0°F
  • New of Worsening Cough
  • Shortness of Breath
  • Sore Throat

Exclude from work until: 

  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever- reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

  • At least 7 days have passed since symptoms first appeared 

If the staff member were never tested for COVID-19 but have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.

My staff member had direct contact with someone who is currently being tested for COVID-19, but the results are not back. Can they come to work?

Yes, they can work. Screening should occur as normal prior to shift and they do not need to wear a mask.

A resident came down with symptoms this afternoon, prior to that he had 4 staff take care of him. Do the 4 staff members need to quarantine at home?

Staff should continue to self-monitor and may continue to work if they remain asymptomatic.

Can a staff member work in a nursing facility if they have worked in another health care facility (hospital or other) where they took care of a COVID-19 positive patient? They were wearing PPE per protocols.

The recommendation is to minimize staff working in more than one facility as much as possible. However, this may not always be practical.

If a staff member took care of a positive patient at a facility and worn PPE there are no restrictions on working in another facility. No additional prevention measures recommended. All staff should be self-monitoring every day for symptoms.

Facility Operations

Should staff be allowed to leave during their shifts? They’re entitled to a break obviously but many leave and come back.

Yes. Recommend social distancing, hand hygiene.

How is Maximus handling the process of NF/PNMI eligibility and PASRR Level 2 assessments to avoid additional "visitors" to the facilities?

DHHS has suspended all in-person, face-to-face MED or PASRR assessments required under 10-144 Maine Care Benefits Manual, 10-149 Ch. 5 Office of Aging and Disabilities Policy Manual Part 1 and 14-197 Office of Aging and Disabilities Policy Manual Part 2.

Effective immediately, all face-to-face initial and re- assessments shall be conducted telephonically. As clinically appropriate, initial MED assessments may be authorized for a period of up to six (6) months and MED re-assessments are to be authorized for up to one (1) year.

The suspension of face-to-face assessments is effective for a period of 30 days. On or before April 17, 2020, guidance will be given to resume face-to-face assessments or to extend the practice of telephonic assessments.

If we take the most recent COVID-19 guidance and add that into our infection control plans is that enough during this time? We don’t want to rewrite our IP policies but just want to make sure we are complying with the requirements for up to date IP plans.

Yes, that is an efficient solution.

CMS waived the requirement for 3 hospital midnights for new skilled admissions. What does this mean?

AHCA’s FAQ can be found here.

Briefly, CMS has not limited the waiver to types of admissions. Therefore, skilled stays may be admitted from:

  1. Hospitals with less than three days;
  2. Hospitals with only observation stay days;
  3. Emergency Rooms;
  4. Direct from Community;
  5. Direct from Community where they were receiving home health or outpatient services; and
  6. Long-Stay patients current in residence with a change in status that now requires a skilled level of care (See 3-Day FAQ #6 below) may be skilled in place without a hospital admission.
Families 'dropping things off'

Our families want to send mail, flowers and newspapers into the facilities for their loved ones. Is it ok to accept these?

Items arriving in the mail, directly to the facility are likely at low risk. Newspapers, if new, and arriving in the mail are ok. The CDC would not recommend that the papers be passed around the facility.

Since having a newspaper available to residents is a CMS requirement purchasing additional newspapers for all who want them is highly recommended.

Families would like to drop off food items for our residents is this ok?

This is not recommended. As long as contact precautions remain in the transmission-based precautions recommendation, the CDC does not recommend allowing it/ It is not the food itself that is the concern, the issue is the containers.

Residents Who Test Positive

A resident has tested positive for COVID-19. How long should they be isolated from the rest of the facility?

Residents who test positive for COVID-19 or who are suspected of COVID-19 should immediately be on precautions. The resident should remain on precautions for 14 days from onset before discontinuing.

Essential Personnel

Are therapy services considered essential personnel? 

When deciding if a therapist needs to enter a building (regardless of their being an employee or outside contractor), LTC facilities and therapy personnel should consider the intent of the federal and state guidance. The intent is to restrict entry of as many people as possible, as each additional person entering increases the risk of COVID-19 entering. Of course, this also needs to be balanced against trying to meet the needs of the resident. That risk-benefit trade off needs to be made on a case-by-case basis but should incorporate the high morbidity and mortality associated with contracting this virus in the elderly over 80 (estimated at 15-20% or more). As result, you may need to make therapy-specific changes to the individual care plan.

Who are the exceptions to the visitor restriction guidance from CDC?

Exceptions to restrictions:

  • Health care workers: Facilities should follow CDC guidelines for restricting access to health care workers. This also applies to other health care workers, such as hospice workers, EMS personnel, or dialysis technicians, that provide care to residents. They should be permitted to come into the facility as long as they meet the CDC guidelines for health care workers. Facilities should contact their local health department for questions, and frequently review the CDC website dedicated to COVID-19 for health care professionals.

  • Surveyors: CMS and state survey agencies are constantly evaluating their surveyors to ensure they don’t pose a transmission risk when entering a facility. For example, surveyors may have been in a facility with COVID-19 cases in the previous 14 days, but because they were wearing PPE effectively per CDC guidelines, they pose a low risk to transmission in the next facility, and must be allowed to enter. However, there are circumstances under which surveyors should still not enter, such as if they have a fever.