The LeadingAge Nursing Home Network met on December 27 to review recent nursing home policy updates and share feedback among members. Register for the Nursing Home Network here. Check out the Nursing Homes page on the LeadingAge website here.

Policy Updates

All Hands On Deck LeadingAge, working in collaboration with American Health Care Association (AHCA) and the Department of Health & Human Services (HHS), has launched the All Hands on Deck campaign to increase COVID-19 bivalent booster uptake among the older adults served in our member communities. Providing weekly reports to HHS, we see that 46% of nursing home residents nationwide are up to date with COVID-19 vaccination as of December 11 while 60% of residents of LeadingAge member nursing homes are up to date. Our hard-working, mission-driven member nursing homes are also increasing rates of acceptance at a higher rate than the national average. LeadingAge is working with HHS to address barriers to bivalent booster uptake including education and information dissemination, vaccination prior to hospital discharge, and increased flexibilities for nursing homes acting as vaccination administration sites. Keep up to date with our activities and access tools and resources to assist with bivalent booster uptake here.

QIO Assistance for Vaccines and Therapeutics During the December 8 Skilled Nursing Facility (SNF) Open Door Forum, the Centers for Medicare & Medicaid Services (CMS) announced that the Quality Improvement Organizations (QIOs) have been tasked to assist nursing homes with improving bivalent booster uptake and timely access to therapeutics for residents. CMS stated that the QIOs are available to provide technical assistance including helping to organize vaccine clinics, provide information and answer questions about vaccines and therapeutics, and help nursing homes identify and access supplies. While QIOs have begun reaching out to some nursing homes, CMS urges nursing homes not to wait for outreach and to initiate contact for any needed assistance. Nursing homes can identify and contact their QIOs by using the “Locate Your QIO” function here.

Winter Playbook The White House has released the Winter Playbook for Nursing Homes and Other Long-Term Care Facilities to Manage COVID-19 and Protect Residents, Staff, and Visitors. The Playbook focuses on 3 key areas: improving bivalent booster uptake, increasing access to COVID-19 testing and treatment, and improving indoor air quality. Practical strategies include offering both in-person and virtual information sessions and following up directly with residents and staff who have not received updated boosters; evaluating all who test positive for appropriateness for COVID-19 therapeutics and working with the long-term care pharmacy to have a small stockpile of doses on hand; and scheduling inspection of and promptly addressing issues identified with the nursing home’s HVAC system. For more information and strategies, check out the Playbook here.

CDC Core Infection Prevention and Control Practices The Centers for Disease Control & Prevention (CDC) updated Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings on December 7.  This guidance document outlines core infection prevention and control practices that can be incorporated into the infection prevention and control program at any time and are not specific to COVID-19. The information in this document was first compiled in 2014 and recent updates include recommendation for a designated, clean medication preparation site away from sinks and other water sources; a system for early detection and management of infections at patient access points and upon admission; and considerations for broader use of source control during periods of high respiratory virus transmission, including respiratory viruses other than COVID-19. Metrics for measuring high transmission could include cases, outbreaks, or increased healthcare system access. Review the recommendations here.

GAO Report on Nursing Home Outbreaks The Government Accountability Office (GAO) released a report on December 15 that examined the duration of COVID-19 outbreaks in nursing homes from June 2020 – December 2021. Utilizing CDC data, the GAO found that during this period, nursing homes experienced an average of 7.6 separate outbreaks with the average outbreak lasting 4 weeks. Additionally, 91% of nursing homes experienced at least one outbreak lasting 5 weeks or longer and the winter surges during both years showed the longest average duration of outbreaks, with outbreaks averaging 7 weeks. Examining factors impacting outbreaks, GAO found that the transmission of COVID in the surrounding community (i.e. community spread) had the strongest association with outbreak duration and most outbreaks, approximately 75%, started with a reported staff case as opposed to a reported resident case. Other factors impacting outbreak duration included nursing home size, staffing shortages, and ownership type. Read the report and access report highlights here.

OSHA Final Rule Filing / ETS Update The Occupational Safety and Health Administration (OSHA) sent a final rule to the Office of Management and Budget (OMB) on December 7 that is thought to involve the Emergency Temporary Standard (ETS) that was mostly withdrawn in December 2021. At the time, the ETS was withdrawn with the understanding that the provisions would be put into rulemaking. While the rule has not been released in the federal register yet, we know that OMB is the last stop in that process. LeadingAge will be keeping an eye out and updating members when the final rule is released. Read here for a refresher on the ETS.

Moving Forward Coalition Update The Moving Forward Nursing Home Quality Coalition has entered phase 3 of its work. The seven committees have identified the initial set of priorities on which they will focus work, with both short-term and long-term priorities selected. The coalition sought public feedback on the priorities during 2 listening sessions in December and will continue accepting online submissions of feedback through the end of December. In January, Chair Alice Bonner will convene a public discussion to review feedback received and share a vision for the committees’ future work. The committees are scheduled to work through phase 3, Action Plan Development, from December 2022 – April 2023. Go here to review the priorities, submit feedback, and register for the January 11 conversation with Chair Alice Bonner.

MDS Updates and Timelines The Draft Minimum Data Set (MDS) v1.18.11 is now available for download. The Nursing Home Comprehensive (NC) Set was previously made available and both can be accessed in the Downloads section here. CMS anticipates releasing a draft update to the Resident Assessment Instrument (RAI) manual in the second quarter of 2023, with online training and resources available in May and live training and workshops slated for June. A LeadingAge webinar on the new MDS is available to purchase here, with a discount for LeadingAge members. CMS continues the onboarding process for the new Internet Quality Improvement and Evaluation System (iQIES), with onboarding of general users beginning back in November. The Provider Security Official is responsible for onboarding the nursing home’s general users and information for this process is available here. Information for onboarding the Provider Security Official is available here.

Member Feedback

During December’s call, members discussed barriers to bivalent booster uptake. Many reported that residents readily accept boosters while staff continue to show reluctance. Reasons for hesitation include continued concerns and misconceptions about vaccine health risks such as atrial fibrillation and fertility issues; and questions about the necessity of vaccination for healthy, low-risk staff. Staff note that while boosters are associated with lower rates of serious illness, so are factors such as age and health status and since a booster is not 100% effective at preventing COVID transmission, there is less incentive for low-risk staff to stay up to date with vaccination.

Members further report that when CDC updated healthcare setting guidance to remove distinctions in mitigation measures between those who were up to date and those who were not up to date, this confused staff and inadvertently sent the message that vaccination was no longer important. Similarly, members reported that because CMS took no further steps after mandating the primary series, some staff believe that CMS and CDC have determined the initial mandate and vaccination efforts to be a mistake.

Feedback on COVID-19 therapeutics was more promising, with members reporting no issues accessing therapeutics for residents and one member reporting that staff who tested positive were also readily prescribed therapeutics because of their status as healthcare workers in a nursing home. Members reported that additional information and resources would be beneficial for increasing physician awareness of and comfort with prescribing therapeutics.

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, January 31 at 2pm ET.