Information for Providers and Long-Term Care Professionals

Information for Providers and Long-Term Care Professionals

* Accuracy and currency are paramount to us. Please contact james.kopriva@dshs.wa.gov with suggested revisions to this page. *


    Safe Start for Long-Term Care

    On Aug. 6, Governor Inslee announced the Safe Start for Long-Term Care plan. Effective Aug. 12, the plan establishes criteria for long-term care facilities to safely conduct visitation. The plan also prescribes policy related to trips outside the facility, communal dining and group activities, testing and screening, source control and PPE, and staffing.

    A summary is available here.

    Important Documents

    Frequently Asked Questions

    How do LTC Phases work?

    LTC Phase status is based upon the general Safe Start plan, but takes additional factors into account.

    Those additional factors include local virus activity, facility access to testing and personal protective equipment, and virus activity within the facility.

    Facilities will be held to LTC Phase 1 if the local COVID case rate per 100,000 residents exceeds 75.

    To reach LTC Phase 2, the local COVID case rate threshold is 25-75 per 100,000 residents. 28 days must have passed since the last positive or suspected client was identified within the facility. A plan for responding to new infections must be prepared. Adequate staffing, PPE, cleaning supplies, local hospital capacity are also required.

    To reach LTC Phase 3, the local COVID case rate threshold is 10-25 per 100,000 residents. 28 days must have passed since the last positive or suspected client was identified within the facility. A plan for responding to new infections must be prepared. Adequate staffing, PPE, cleaning supplies, local hospital capacity are also required.

    To reach LTC Phase 4, the local COVID case rate must not exceed 10 per 100,000 residents. 28 days must have passed since the last positive or suspected client was identified within the facility. A plan for responding to new infections must be prepared. Adequate staffing, PPE, cleaning supplies, local hospital capacity are also required.

    Facilities may not move beyond their county's Safe Start Phase.

    Do residents that leave facilities for community visits need to be quarantined?

    Facilities will complete an exposure risk assessment for each resident who leaves the facility for community visits. The risk assessment will inform how the facility manages residents upon their return. Residents that leave the facility, as well as those accompanying them (family members, etc.), should be educated on infection prevention. "Low-risk" resident activity will prompt a safety briefing and screening. "Medium-risk" resident activity prompts a 14-day refrain from group activity. "High-risk" resident activity should be quarantined for 14 days. The facility will work with the Local Health Jurisdiction (LHJ) in determining the best approach after completing the exposure risk assessment.

    How are "end-of-life" and "psychosocial need" circumstances defined for early LTC Phase visits?

    "End-of-life" circumstances are generally considered to be defined by a sharp decline in health status.

    "Psychosocial need" circumstances are generally considered to encompass situations of acute distress or trauma. Examples include the death of a friend or loved one or distress over sudden lifestyle changes.

    All compassionate care circumstances are considered by facilities on a case-by-cases basis. In Phases 1 and 2, these visits are to be conducted sparingly.


    COVID-19 Reporting Requirements

    You must report suspected or confirmed cases of COVID-19 to the following parties (see list of notifiable conditions)

    ALTSA requests that all long-term care facilities report COVID status twice per week. (See Instructions)

    THE SEMIWEEKLY REPORTING DOES NOT REPLACE CRU REPORTING FOR FACILITIES AND AGENCIES


    Long-Term Care Advisory Group

    An advisory group has been formed to address pandemic-related issues affecting long-term care providers. The group is comprised of members of state government, industry representatives, labor representatives, and other stakeholders.

    Advisory Group Purpose Statement

    The purpose of this Long-Term Care Facilities COVID-19 Advisory Group is to:

    • Communicate across agencies and across advisory group representation what is needed to fully support residents, families, providers and facility staff in response to the COVID-19. 
    • Share information that has been captured from other groups and sources with the goal of coordinating the many channels of information that are occurring as a result of COVID-19 response.
    • Advise agencies and local jurisdictions on policy decisions and practices related to COVID-19 response in long-term care facilities and home and community-based programs.
    • The activities of this group are specific to COVID-19 related needs.  Unless the group decides to adjourn earlier, once the threat of the pandemic is past, activities of this advisory group will terminate.
    Represented long-term care facilities include adult family homes, skilled nursing facilities, supported living agencies, and assisted living facilities.

    Resources:

    Meeting Agendas:

    Meeting Minutes:


    Personal Protective Equipment (PPE)

    Pay close attention to our "Provider/Administrator Letters" for the latest guidance. Refer procedural questions to your local health department.

    Conservation and Re-Use of PPE

    The Centers for Disease Control and Prevention has published strategies for the conservation of PPE. The Centers for Disease Control and Prevention has published a checklist specific to the conservation of N95 respirators. This ALTSA Flyer discusses the conservation of PPE, re-use of PPE and alternatives when facing a shortage.

    Use of Cloth Face Coverings - Residents and Clients

    The CDC and CMS recommends the adoption of cloth face coverings by long-term care residents when in the presence of others, even if no symptoms are present. The face covering should cover the nose and mouth. It is important to properly use and sanitize the covering.

    Protocol for Donning (Putting On) and Doffing (Taking Off) PPE

    The effectiveness of PPE depends on its proper use. Putting on or removing PPE inappropriately can negate its protective properties. Adhere to CDC guidelines for use of PPE and refer to CDC instructions for properly donning (video) and doffing (video) PPE.

    How to Acquire PPE

    All long-term care facilities are instructed to purchase necessary personal protective equipment. In the event of an urgent shortage, facilities should notify their local emergency management agency (EMA) or local health jurisdiction (LHJ). If these backup sources cannot fulfill the request, facilities may notify DSHS and request an emergency 7-day supply.

    Individual Providers and Adult Family Homes are eligible to receive a one-time, 31-day supply of PPE from the state.


    COVID-19 Testing    

    Who should get tested?

    The Washington State Department of Health recommends prompt testing for anyone with symptoms of COVID-19. If a resident, client, or staff member at a long-term care facility tests positive for COVID-19, contact your local health jurisdiction for immediate instruction on broader testing.   

    Training Staff to Administer COVID-19 Testing

    The Department of Health and local health jurisdictions are leading the training of facility staff in performing COVID-19 testing. Contact your local health jurisdiction to inquire about training for viral testing, specimen collection, and reporting.  


    Infection Control and Prevention

    COVID-19 Guidance for Home Care Workers

    This document details important safety measures for home care workers to protect themselves and their clients. It is also available in a variety of languages:

    Amharic

    Arabic

    Cambodian

    Chinese

    English

    Spanish

    Korean

    Laotian

    Russian

    Samoan

    Somali

    Tagalog

    Ukrainian

    Vietnamese


    Appendix K Waivers

    Appendix K waivers have been filed in response to the COVID-19 outbreak. These waivers temporarily modify some processes of care, provider qualifications, service limitations, and other guidelines. Providers should stay current with these waivers to optimally respond to COVID-19.


    Provider Rate Enhancements

    The outbreak of COVID-19 has burdened providers with increased costs. Emergency rate enhancements have been extended to providers to offset some of these increased expenses.

    Home and Community Services (HCS) Rate Enhancements

    Home Care Agencies will receive a vendor rate of $35.68 per hour, or $8.92 per quarter hour, through September 30, 2020.

    Individual Providers will receive an additional $2.56 per hour for hours worked through September 30, 2020.

    • H20-068 details temporary rate changes for Home Care Agencies, training class time and the Family Caregiver Support Program.
    • H20-070 details rate add-ons for Medicaid service providers, including assisted living facilities, enhanced services facilities, adult family homes, community choice guides, supportive housing, behavior support agencies, nurse delegators, private duty nursing and skilled nursing during the COVID-19 outbreak.
    • H20-077 details rate enhancements for Individual Providers.

    Residential Care Services (RCS) Rate Enhancements

    The Centers for Medicaid and Medicare Services have increased Federal Match Assistance Percentages (FMAP), resulting in an effective 12-15% rate increase for facilities.

    Admitting nursing home facilities will receive an exceptional rate of $100 per client per day atop regular rates for admitting a hospitalized client who transitions to their facility during the surge period.

    DSHS has also begun establishing contracts with providers that can establish buildings or wings that can provide services dedicated to COVID+ residents. These COVID+ facilities will receive an enhanced daily rate of $450/day.

    ALTSA issued a “Dear Provider” letter on May 4 that details rate increases for Assisted Living Facilities and Adult Family Homes.


    Additional Guidance for Providers

    Guidance for Individual Providers

    The work performed by Individual Providers is considered essential under the Governors Proclamation 20-25. See our Guide for Individual Providers top strategies to limit close contact and protect yourself and others.


      ALTSA Response to COVID-19

      The Aging and Long-Term Support Administration (ALTSA) has reacted to the COVID-19 outbreak by securing federal waivers to afford providers much-needed flexibility in care delivery, and by delivering timely guidance to providers and facilities. Our guidance consolidates input from Governor Jay Inslee, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and other authoritative bodies.


      Help, Hotlines, and Guidelines

      Washington State Department of Health Coronavirus Call Center

      • 1-800-525-0127 and press #.

      Washington State Department of Health Web Resources

      Centers for Medicare and Medicaid Services

      Applicable to federally certified programs such as nursing facilities and ICF/IIDs

      Centers for Disease Control and Prevention

      Washington State Coronavirus Response Website

      DSHS Aging and Long-Term Support Administration