Long-Term Care Professionals & Providers

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.

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 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 effectiveness of cloth face coverings relies upon the proper use and sanitation of the covering. The Centers for Medicare and Medicaid Services (CMS) further recommend that clients cover the nose and mouth when caretakers or staff enter the room, whether by mask or tissue.

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.

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.

• Long-Term Care Advisory Group - Member Roster

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.

Meeting Agendas:

• September 2, 2020
• September 9, 2020

Meeting Minutes:

• August 12, 2020
• September 2, 2020

HCS has issued a statewide plan to surge activities at acute care hospitals to determine eligibility, plan services, and find viable community alternatives.

• HCS Surge Plan Overview and FAQ
  • What is HCS doing to address current capacity issues in acute care hospitals?
  • What is the process for HCS Case Managers to conduct telephonic assessment?
  • What additional information/assistance is needed due to COVID-19 emergency?
  • How do we escalate cases?
• Hospital Escalation Contacts
• Acute Care Hospital Transitions - FAQs for SNFs
  • Guidance supporting expedited transitions from inpatient to nursing facility care through June 2020.
  • Outline of policies, process, and key contacts in FAQ format.

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 20% rate increase for May and June. HCAs that serve clients with suspected or confirmed cases of COVID-19 will receive an additional $1 per hour.

Individual Providers will receive an additional $3 per hour for hours worked during May and June. They will also receive a one-time $100 stipend, per client, for cleaning supplies. DSHS will make additional contributions towards health benefits and increased training sessions to support social distancing within classrooms.

• H20-047 details rate enhancements for Home Care Agencies.
• H20-037 details a rate add-on for Home Care Agencies committed to serving clients suspected or confirmed of COVID-19 infection.
• H20-043 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.

Guidance for Individual Providers

The work performed by Individual Providers is considered essential under the Governors Proclamation 20-25. Your clients may need you more than ever during this outbreak, but we encourage steps to reduce close contact and require that you contact your client and case manager in the event you feel ill yourself. See our Guide for Individual Providers for more information.