The LeadingAge Nursing Home Network met on September 27 to review recent nursing home policy updates and share feedback among members. The network was joined by Alice Bonner, Senior Advisor for Aging at the Institute for Healthcare Improvement and Chair of the Moving Forward Nursing Home Quality Coalition. Register for the Nursing Home Network here. Check out the Nursing Homes page on the LeadingAge website here.

Moving Forward Nursing Home Quality Coalition

Dr. Alice Bonner, Senior Advisor for Aging at the Institute for Healthcare Improvement and Chair of the Moving Forward Nursing Home Quality Coalition, joined the Nursing Home Network to discuss the work of the Moving Forward Nursing Home Quality Coalition. The coalition is funded by a grant from the John A. Hartford Foundation to improve the quality of nursing home life. The coalition seeks to advance recommendations made by the National Academies of Sciences, Engineering, and Medicine (NASEM) in the April 2022 report The National Imperative to Improve Nursing Home Quality Honoring our Commitment to Residents, Families, and Staff.

Over a 2-year period that began in summer 2022, the coalition, driven by the steering committee and 7 subcommittees, will prioritize recommendations under each of the 7 goals outlined in the NASEM report; engage policy makers, advocates, nursing home leaders, residents, and other subject matter experts to create action plans; and organize policy makers, nursing home staff, and other leaders to test and promote the plans. The goal of the initiative is to drive specific improvements in nursing home quality in the short-term while creating a sustainable collaborative to continue the work in the future.

Learn more and stay up to date with the work of the coalition here.

Policy Updates

CDC Recommendations for Healthcare Settings The Centers for Disease Control & Prevention (CDC) updated COVID-19 recommendations on September 23. The latest round of updates streamlined recommendations for healthcare settings, including retiring previous nursing home-specific recommendations. Under the new recommendations, healthcare settings continue to utilize community transmission rates for determining prevention and mitigation strategies, but will no longer differentiate individual strategies based on vaccination status. Recommendations included changes to screening processes, source control, quarantine and work restrictions of asymptomatic residents and staff who have experienced close contact or high-risk exposures, and removal of recommendations for routine screening testing of asymptomatic staff. Learn more about the changes here.

NHSN Reporting NHSN reporting on COVID vaccination status changed on September 26 with adoption of the updated definition of “up to date” for the reporting period September 26 – December 25. Beginning September 26, individuals will be reported as “not up to date” if more than 2 months have passed since their last COVID shot, including completion of the primary series or the last COVID (monovalent) booster. Individuals must receive the updated bivalent booster to be considered up to date with COVID-19 vaccination.

Nursing homes will also begin reporting on flu vaccination coverage among staff beginning with this flu season. The reporting is required as part of the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and data must be reported at least once by final data submission deadlines following the conclusion of flu season. Flu season, as defined for this quality measure, runs October 1 – March 31 each year. As with all SNF QRP measures, providers will have 45 days following the end of the quarter to submit data. Data must be submitted through the Healthcare Personnel Safety component of NHSN, rather than the Long-Term Care Facility component through which COVID-19 data is reported. More information is available here.

Flu Vaccines for Ages 65+ Public health experts are predicting an early and more severe flu season this year than as seen in years past. For this reason, the CDC is recommending that individuals aged 65 years and older receive higher-dose flu vaccines or adjuvanted flu vaccines, which appear to be more effective than the standard-dose unadjuvanted vaccines for this age group. Learn more here.

Critical Element Pathways CMS released updated critical element pathways in mid-September. These tools guide surveyors in investigating and citing noncompliance during surveys and have been updated to reflect the changes to the Requirements of Participation interpretive guidance released in June 2022. The critical element pathways are available in a zip file located in the Downloads section of CMS memo QSO-22-19-NH.

Public Reporting of Nursing Home Ownership Data CMS continues to update nursing home ownership data. First publicly reported in April 2022, the data now allows for the identification of common ownership across nursing home locations. This move comes as part of the Biden Administration’s drive to increase transparency and accountability of nursing homes. The data is available on the CMS data site and will be updated monthly. Read the CMS press release here.

GAO Report on Nursing Home Infection Control The Government Accountability Office released a report on September 14 describing data on resident changes in health and examining the role of infection prevention and control measures taken by CMS and CDC before and during the pandemic. The report made 3 recommendations for CMS action: 1) establish minimum infection preventionist training standards, 2) collect infection preventionist staffing data and use data to determine whether current requirements are sufficient, and 3) provide additional guidance to surveyors on determining scope and severity when citing infection control deficiencies. HHS agreed with the GAO’s first recommendation but neither agreed nor disagreed with the other 2 recommendations. Access highlights and the full report here.

LeadingAge Voting Resources September 20 was National Voter Registration Day. LeadingAge is passionate about ensuring that older adults have access to voting and the ability to register to vote and encourages members to work with the older adults in their communities to develop voting plans. Check out this easy-to-use website to assist. The website allows individuals to look up their registration status, register to vote, request a mail-in ballot, find their polling place and even look up local candidates.

Member Feedback

Members had many questions about the newly updated CDC recommendations. In particular, the decision to eliminate vaccination status-specific recommendations has many concerned that this will inadvertently miscommunicate that COVID-19 boosters are unnecessary. Similarly, members wondered how the new recommendations impact the vaccine mandate. For example, with CDC no longer recommending routine testing of staff who are not up to date, many providers wondered if they can continue to use screening testing as an additional precaution for those who have been granted exemptions from vaccination requirements.

The LeadingAge Nursing Home Network call takes place on the last Tuesday of every month. If you are a LeadingAge nursing home member and would like to join this group, you can register here. Your LeadingAge login is required to register. If you do not have a LeadingAge login, you can create one here using your work email address. Our next monthly call will take place Tuesday, October 26 at 2pm ET.