CMS Call Recap: Lessons from COVID-19 in Nursing Homes

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS held a brief call for Nursing Homes yesterday afternoon.  I attended the 30-minute call which was quite different from other such COVID-19 calls.  Here are my take-aways from that call:

  • The call was chaired by the Interim Director of the Clinical Division of NHs within CMS. They had 2 guest speakers – Dr. John W. Mielke, a physician from MN and the other was Crystal Larson, Administrator of a hospital based LTC facility in Front Royal, VA.
  • The call included a pep talk of sorts from the Director on what CMS is working on to support LTC facilities and staff including testing, screening, focused survey, restricting visitation, etc. Her presentation could be summed up in this statement: “CMS wants to meet the needs of nursing homes and will get resources to you as quickly as possible.”

Both guest presenters spoke to some of their best practices with COVID-19 in LTCFs.  These included:

  • Networking internally and externally – create coalitions within communities including your competitors
  • Staying informed and communicating…education is key
  • Moving COVID+ patients to another facility or at least a designated wing
    • Solely dedicated caregivers for COVID-positive as well as COVID-negative residents – consistent staffing
    • Quarantine/isolate new admissions without a negative COVID test
  • Therapists dedicated to only 1 facility rather than travelling between facilities
  • Conducting morning or daily meeting with staff & providers and including discussion of difficult patient cases
  • Providers checking in with facilities to see how things are going
  • Ways to conserve PPE supplies & monitoring of same
    • Use homemade masks for staff who do not have direct contact with residents
  • Utilizing telehealth options
  • Activity programs
    • Room service carts for resident activities
    • 6’ Bingo games (from doorways of resident rooms)
  • Staff support
    • Chair massages
    • Treats
    • 24-hour hotline
    • Bi-weekly calls to staff to reduce staff, increase mental health, promote self-care
  • BREATHE – staff/caregivers to personally identify 5 things each day to be grateful for

The remainder of the 30 minutes was devoted to questions – CMS allowed 3.

  • The 1st question was about managing therapy in COVID+ as well as COVID- facilities.

Dr. Mielke responded by urging facilities to stop allowing therapists to serve more than 1 facility – therapists should be dedicated to only one facility to mitigate the spread of the virus.  Dr. Mielke also spoke to MN therapists conducting all therapy in individual resident rooms and not the therapy gym.

  • The 2nd question was about the waiver for MDS completion and submission. The 1135 waiver issued March 13, 2020 was quite vague about not requiring current regulations/guidelines for timely completion and submission. Accepted practice and regulation prior to the COVID-19 emergency required the PPS MDS to be submitted and accepted before the facility can bill for skilled reimbursement. The answer from CMS was that they will be providing additional guidance soon.
  • The 3rd question involved advanced payments to providers, but CMS had no one on the call that could answer that yesterday. [Note that the April 7, 2020 Dear Clinician Letter provides some additional information.]

In conclusion, the Director again pointed listeners to attend COVID-19 Office Hours twice weekly from 4-5pm.  There’s one every Tuesday & Thursday with the next being today, Thursday, April 9, 2020.   Information on this call as well as registration is found here.  She also provided this email address for questions regarding COVID-19:

This interactive Office Hours session will feature special guest speakers, Dr. Joseph G. Ouslander and Dr. William Russell. Dr. Ouslander recently published a COVID-19 special article and editorial in the Journal of the American Geriatrics Society. He and Dr. Russell will review these publications and will share key updates, actionable guidance, and resources to assist long-term care providers in their COVID-19 prevention and preparedness efforts.

Dr. Ouslander’s distinguished career and lifelong achievements in clinical geriatrics include the creation and dissemination of Interventions to Reduce Acute Care Transfers (INTERACT), a quality improvement program that assists long-term and post-acute care organizations in improving care and reducing unnecessary hospitalizations and their related complications and costs.

Dr. Russell is an internist and geriatrician focused on value-based care for seniors in the ambulatory setting. He serves as the medical lead for Conviva Care Centers in Palm Beach County Florida, responsible for the care of over 25,000 older patients. He was a technical lead at the Office of the National Coordinator for Health IT for the Transitions of Care Challenge Grants.

Dr. Christine LaRocca, a fellowship-trained, board-certified geriatrician and Medical Director for Telligen, will serve as the facilitator for this office hours call.