Vaccines prioritized for healthcare workers and long-term care facility residents: Your COVID-19 Briefing
In this edition
Use the links listed below to jump between sections.
NEWS
Biden administration health appointments
Legislation introduced to delay Medicare sequestration
New CDC guidance
Medicare and home health: Taking stock in the COVID-19 era
COMPLIANCE
IRS indicates heightened focus on expense deductions
Hospices may charge fundraising losses against provider relief funds
Nursing home discharges
CLINICAL
ADMINISTRATIVE
Can COVID-19 vaccination be mandated for employees?
HHS distributing funds to more than 9,000 nursing homes
Please note
The views, information, and guidance in this resource are provided by the author and do not necessarily reflect those of WellSky. The content provided herein is intended for informational purposes only. The information may be incomplete, and WellSky undertakes no duty to update the information. It is shared with the understanding that WellSky is not rendering medical, legal, financial, accounting, or other professional advice. WellSky disclaims any and all liability to all third parties arising out of or related to this content. WellSky does not make any guarantees or warranties concerning the information contained in this resource. If expert assistance is required, please seek the services of an experienced, competent practitioner in the relevant field. WellSky resources are not substitutes for the official information sources on COVID-19. Providers should continue to track developments on official CMS and CDC pages, including:
Current cases & maps
Last week, COVID-19 was the leading cause of death in the United States, displacing both heart disease and other serious respiratory illness. Every two minutes, someone in the United States is now dying of the disease. On December 6, White House Coronavirus Task Force coordinator Dr. Deborah Birx characterized the COVID-19 pandemic as the worst disaster (of any kind) that the U.S. has ever experienced.
The prognostications for the next few weeks suggest that things are going to get much worse before they get better — especially because the expected Thanksgiving surge (on top of the ongoing fall surge) won’t materialize until mid-December. If a picture is worth a thousand words, the New York Times hot spots map from December 7 tells the story: there is virtually no place in the United States that is not severely affected by COVID-19 right now. Even more alarming is the fact that many epidemiological projections suggest that daily mortality counts will rise from the current level of about 2,000 per day, to 3,000 per day by early January.
With most of the current discussion centering on the availability and prioritization of vaccines against COVID-19, many public health officials are cautioning against assuming that vaccination is a quick fix. Even though vaccinations will likely start to be available in the next few days for frontline workers (including home health, hospice, and skilled nursing facility (SNF) staff members) and residents of long-term care facilities, it’s clear that some workers won’t have access to vaccines due to state allotments. With others in the community unable to acquire the vaccine, community spread will likely continue.
The upward curve of newly reported cases by day has gotten much steeper in the last month, as shown by the New York Times graph below.
As with new cases, mortalities are now climbing much more precipitously than in the preceding months. If the predictions are true, this slope will be much steeper next month.
A key indicator for post-acute providers is the growth in hospitalization rates, because many of these patients will likely be discharged to another health setting for a continuation of care — especially as hospitals continue to fill up. We have heard, albeit anecdotally, from many providers, including hospices, that they are now seeing a resurgence in admissions of patients who have been hospitalized with the disease. Every day, the news is packed with stories of how stretched hospitals are becoming, both from the standpoint of available beds — including ICU beds — and staff. As one commentator so aptly put it, all the hospital beds in the world won’t do much good if there are no nurses or physicians to provide needed care.
Nursing home cases also continue to rise. More than 28,000 nursing homes and long-term care facilities have reported that a total of 787,000 residents and employees have become infected with COVID-19. That amounts to about 5% of all reported cases. According to the New York Times, more than 106,000 residents and employees of nursing homes have died — 35% of all deaths across the nation. In 13 states, long-term care facility mortalities constitute half of all deaths linked to COVID-19.
Finally, one more map shows the status of mask mandates across the country. Only nine states — Idaho, Wyoming, South Dakota, Missouri, Oklahoma, Tennessee, Georgia, Florida, and Alaska — have no mask restrictions. In Nebraska, Kansas, Arizona, Arkansas, Mississippi, and South Carolina, masks are required in certain situations. Everywhere else, masks have been mandated either at the state or local level or both.
To wrap up the statistics, here is where we are now:
- As of our last briefing, the U.S. had recorded just over 10 million cases of COVID-19. In one month, we added another 4.8 million to the tally, bringing the total number of cases in the U.S. to nearly 15 million as of this writing. Right now, we are adding just under 200,000 cases a day on average. Even so, it is estimated that only 15% of the population has been infected thus far.
- We reported in our last briefing that on November 7, the U.S. saw more than 127,000 new cases of COVID-19 — the record at that time, which has now been eclipsed by the December 4 total of more than 229,000 new cases.
- In our last briefing, we reported that the national ensemble projection predicted a total of as many as 266,000 deaths by the end of November. I thought that seemed too high at the time, but the projection was essentially true. The next prediction we should pay attention to comes from the Institute of Health Metrics and Evaluation at the University of Washington, suggesting that we could see as many as 539,000 mortalities from COVID-19 by April 1, 2021. As of December 7, there have been 283,800 mortalities from COVID-19 in the U.S. Doing some back of the envelope math, that means that mortalities could conceivably just about double in the next four months.
December will be a hard month — especially with upcoming holidays and decisions to be made about gathering with friends and family. With care and perseverance, we will see light at the end of the tunnel — soon, I hope. But until then, vigilance will be the name of the game for all of us.
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News
Biden administration health appointments
President-elect Biden announced several appointments for key posts over the weekend, including Xavier Becerra as the new Secretary of the Department of Health and Human Services. If confirmed, he will replace Alex Azar. Beccera is the current Attorney General of California and a former member of Congress.
Dr. Rochelle Walensky, currently the chief of infectious diseases at Massachusetts General Hospital, has been selected to lead the CDC. She is an expert on AIDS and HIV and a professor at Harvard Medical School. She will replace Dr. Robert Redfield.
Dr. Vivek Murthy, who served as the Surgeon General in the Obama administration, will again take that post, if confirmed.
Finally, Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases (NIAID) will become a key advisor to the new administration.
Legislation introduced to delay Medicare sequestration
Last week, bipartisan legislation was introduced in the House of Representatives that would delay the reimposition of the 2% Medicare sequestration deductions from reimbursement for the remainder of the public health emergency. The Coronavirus Aid, Relief, and Economic Security (CARES) Act waived sequestration, but only through December 31, 2020. This bill, if passed, would preserve the action initiated through the CARES Act for the remainder of the public health emergency.
New CDC guidance
The CDC has released more than 40 updates to guidance documents in the last couple of weeks, four of which have significance for post-acute providers:
- Strategies for Optimizing Supply of Facemasks and N95 Respirators
- These are two separate documents
- Preparing for COVID-19 in Nursing Homes
- Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19
Facemasks and N95 respirators
Updated guidance has been posted concerning returns to conventional capacity practices along with contingency and crisis capacity considerations. The guidance can be found at the following links:
For the most part, there is nothing very new here beyond the contingency and crisis capacity considerations, but it’s worth a read to make sure your agency processes are up to date in terms of supply inventory and maintenance.
COVID-19 in nursing homes
This update has two components: 1) Centers for Medicare & Medicaid Services (CMS) guidance on holiday celebrations and 2) CDC guidance on testing.
The holiday guidance alert from CMS is provided below:
The coronavirus disease 2019 (COVID-19) public health emergency (PHE) has been one of our nation’s greatest challenges and has especially taken a toll on the nation’s nursing home residents. CMS is committed to protecting the health and safety of nursing home residents at all times and especially during the challenges presented by the spread of COVID-19. We understand the emotional impact that separation from loved ones has caused. In September, CMS provided revised guidance for how residents can safely receive visitors in the nursing home. With the holiday season fast approaching, we understand that residents and their families will want to spend more time together. During the holidays, facilities, residents, and visitors should continue to follow the guidelines for visitation and adhere to the core principles of infection prevention, such as remaining six feet or more apart, wearing a face covering, and limiting the number of visitors in the nursing home at any one time. We also recommend that facilities find innovative ways of celebrating the holidays without having parties or gatherings that could increase the risk of COVID-19 transmission (e.g., virtual parties or visits, provide seasonal music, movies, decorations, etc.).
We also know that some residents may want to leave the nursing home temporarily to visit family and friends for the holidays or other outings. While CMS supports family engagement and a resident’s right to leave the nursing home, everyone needs to work together to take extra precautions to help reduce the spread of COVID–19, which can pose an elevated danger to the health of nursing home residents. Therefore, CMS recommends against residents leaving the nursing home during this PHE. With the potential for a safe and effective vaccine on the immediate horizon, extra precautions now are essential to protect nursing home residents until a vaccine becomes available. Leaving the nursing home could increase a resident’s risk for exposure to COVID-19. The risk may be further increased by factors such as a resident’s health status, the spread of COVID-19 in the community (e.g., cases or positivity rate), or attendance at large gatherings. We encourage residents to discuss these and other risks with their families and nursing home staff. Nursing homes should educate residents and families of the risks of leaving the facility, the steps they should take to reduce the risk of contracting COVID–19, and encourage residents to stay connected with loved ones through alternative means of communication, such as phone and video communication. For examples of ways to connect with residents, refer to memorandum QSO-20-28-NH. Should a resident ultimately choose to leave the nursing home, CMS is providing the following recommendations:
- Limit close contact (maintain physical distancing of six feet or more), keep gatherings as small as possible, and use technology to engage with others remotely;
- Wear facemasks or cloth face covering at all times (including in cars, homes, restaurants, etc.);
- Limit contact with commonly touched surfaces or shared items;
- Keep safe around food and drinks. Avoid communal serving utensils, passing of food, potluck or buffet style food service, and instead opt for individually prepared plates by a single server;
- Perform hand hygiene often (e.g., wash hands with soap and water or alcohol-based hand sanitizer);
- Avoid large gatherings, crowded areas, and high-risk activities such as singing;
- For those attending a gathering, avoid contact with individuals outside of their household for 14 days prior to the gathering;
- Ask anyone who has signs or symptoms of COVID-19, or has been exposed to someone diagnosed with COVID-19, to not attend the gathering;
- If possible, conduct gatherings outdoors. Indoor gatherings should have good ventilation, open windows and doors if possible;
- Verbally greet others instead of shaking hands or giving hugs. Think ahead about how you will manage to prevent physical interactions with loved ones of different ages such as young children; and
- Check local conditions and state requirements for precautions and restrictions, including positivity rates and quarantine requirements, before crossing state lines.
CMS has collaborated with the Centers for Disease Control and Prevention (CDC) on these recommendations, and we encourage you to review CDC’s webpage on holiday celebrations, which has more suggestions for preventing the spread of COVID-19.
Note to nursing home staff: Staff should also use extra caution, especially during the holidays. Staff should follow the same recommendations for residents and families regarding gathering with their families and friends outside of work to protect the vulnerable residents they care for.
Additionally, while the above actions can greatly reduce the risk of spreading COVID-19, due to the highly contagious nature of the virus, we recommend nursing homes take the following actions when residents return to the nursing home:
- Screen and increase monitoring for signs and symptoms.
- Test a resident for COVID-19 if signs or symptoms are present or if a resident or their family reports possible exposure to COVID-19 while outside the nursing home. A nursing home may also opt to test residents without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time, such as over 24 hours. For more information on testing guidelines see CMS memorandum QSO-20-38-NH.
- Place the resident on transmission-based precautions (TBP) if the resident or family member reports possible exposure to COVID-19 while outside of the nursing home, or if the resident has signs or symptoms of COVID-19 upon return. Please note that residents and loved ones should report to the nursing home staff if they have had any exposure to COVID-19 while outside of the nursing home.
- Consider placing residents on TBP if they were away from the nursing homes for more than 24 hours.
Testing guidance can be found at the same link and includes the following recommendations:
- Residents with symptoms should be on transmission-based precautions using all recommended personal protective equipment (PPE) for care of a resident with suspected COVID-19 infection.
- Residents with symptoms of COVID-19 or the flu should be tested for both.
- Infected residents should be moved to a dedicated COVID-19 care unit. Those with the flu should be in single rooms or housed with other residents with the flu. If moving the patient is not possible, they should remain in the same room with measures in place to reduce transmission to others. Residents with symptoms of acute respiratory illness who have neither the flu nor COVID-19 should be cared for using standard precautions and any additional transmission-based precautions based on the patient’s suspected or confirmed diagnosis.
Work restrictions for healthcare personnel with potential exposure to COVID-19
An update was made to prior guidance to clarify that the time period of 15 minutes or more which is used to define a “prolonged” close contact, refers to the cumulative amount of time a person is exposed to one or more infected individuals during a 24-hour period. Thus, the guidance does not relate to multiple periods of contact, but rather total exposure time that exceeds 15 minutes.
Quarantine changes
The CDC also issued new quarantine guidelines last week. Here is what the new guidance has to say:
- People who have been in close contact with someone who has COVID-19, excluding people who have had COVID-19 within the past 3 months, DO need to quarantine.
- People who have tested positive for COVID-19 DO NOT need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again.
- Close contact means:
- The person was within six feet of someone who has COVID-19 for a total of 15 minutes or more.
- Providing care to someone who is sick with COVID-19.
- Having physical contact (such as hugging) with a person who has COVID-19.
- Sharing a drink or eating utensils with an infected person.
- Being close enough to encounter respiratory droplets when an infected person sneezed or coughed.
- Steps to take include:
- Staying home for 14 days after the last contact with a person who has COVID-19.
- Watch for symptoms.
- If possible, stay away from others, especially those at high risk for getting very ill from COVID-19.
Reducing the length of quarantine may make it easier for people to quarantine by reducing the time they cannot work. A shorter quarantine time can also lessen stress on the public health system, especially when new infections are rapidly rising. Local health authorities make final decisions about quarantine periods based on local conditions. Options that may be considered include:
- Stopping quarantine on day 10 without testing.
- Stopping quarantine on day seven after receiving a negative test result (as of day five or later).
After stopping quarantine, the CDC recommends that exposed persons watch for symptoms until day 14 and, if symptoms appear, begin self-isolating. Also, after quarantining, masks should be worn and social distancing together with regular hand hygiene should be consistently practiced.
The updated guidance states, “CDC continues to endorse quarantine for 14 days and recognizes that any quarantine shorter than 14 days balances reduced burden against a small possibility of spreading the virus.”
Medicare and home health: Taking stock in the COVID-19 era
At the end of October, on the heels of new CMS focus on hospital care at home, a new study was released by the Commonwealth Fund suggesting that home health providers are well positioned to provide these services, but the current design of Medicare benefits is insufficient to meet overall needs. The study asserts that policy changes could increase the value of the benefit, but “questions also remain about the relative quality of services, particularly among home health agencies working with Medicare Advantage plans.” Much of the publication is devoted to information already well known to home health providers. However, there are several policy implications that are of interest:
Expand opportunities for care at home
- Home healthcare should be better integrated with social care programs and non-medical benefits to address all individual needs.
- A more robust benefit for post-acute care at home is needed, as current coverage is inadequate for many patients. For example, many patients need more than one visit per day to close the gap between home health and SNF care (even though home health benefits are typically limited to intermittent services).
- Family caregivers should be paid for supporting COVID-19 patient services to accelerate the recovery process and prevent costly, negative outcomes. Medicare could also support family caregivers by providing PPE to protect them from infection while they are caring for others.
Bolster the home health workforce
- Increase the pay of home health aides to improve the quality of care. CMS should add a wage and benefit increase to payments for aide services. The wage premium would address extra hazards involved in providing direct care during a pandemic. Other benefits such as paid sick leave could also promote greater safety and could help to alleviate worker shortages.
- Expand the scope of practice for nurse practitioners, clinical nurse specialists, and physician assistants to help support and enhance the quality of the home health workforce.
Enhance quality and oversight
- Expand the regulatory oversight of home health agencies for the purpose of motivating them to adopt best practices.
- Reduce knowledge gaps. Based on data showing the use of home health by Medicare Advantage (MA) enrollees, home health agencies included in MA plans “are of poorer quality compared with those in traditional Medicare.” Expanding MA plans to cover non-health benefits, such as palliative care or in-home support, could change the quality of home healthcare overall for these enrollees.
- Home health agencies should be required to report COVID-19 data to evaluate the number and rate of infections among home health patients.
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Compliance highlights
IRS indicates heightened focus on expense deductions
The Internal Revenue Service (IRS) Revenue Ruling 2020-27 was issued in November, and the ruling essentially establishes the agency’s intent to double down on the deductibility of expenses — such as rent, salaries, wages, and employee benefits associated with Paycheck Protection Loans received in 2020 but not forgiven until 2021. Another document — Revenue Procedure 2020-51 — creates a safe harbor for Paycheck Protection Program (PPP) borrowers that have their loan forgiveness denied or who choose not to pursue forgiveness.
The ruling discusses two types of situations in which a taxpayer receives a PPP loan in 2020 and pays expenses associated with rent and wages that are eligible expenses under Section 1106(a) of the CARES Act. In one example, the entity applies for forgiveness of the loan and knew the actual amount of expenses that qualified, even though the lender has not advised the entity of whether the loan will be fully or partially forgiven. In the second scenario, the entity has not yet applied for loan forgiveness but knows the amount of qualified expenses.
In both situations, according to the IRS, the business would have a reasonable expectation of loan forgiveness at the end of 2020 and, as a result, deduction of the expenses that offset the loan is inappropriate.
As we have reported in the past, all organizations should have been accounting for PPP loan offsets in a way that will make tax reporting easier and more accurate next year.
Hospices may charge fundraising losses against provider relief funds
In a November 17 letter to the National Hospice and Palliative Care Organization (NHPCO), Thomas Engels, administrator of the Health Resources and Services Administration of the Department of Health and Human Services (HHS), opined that lost fundraising and thrift store revenues for hospices “may” qualify as lost revenue under the Provider Relief Fund (PRF) program.
“PRF funds may be used to reimburse lost revenue attributable to coronavirus, and lost fundraising and thrift store revenue may qualify as reimbursable lost revenue. To calculate lost revenues attributable to coronavirus, providers are required to report revenues received from Medicare, Medicaid, commercial insurance and other sources for patient care services. Providers should report fundraising and thrift store revenue in 2019 and 2020 as a revenue source if it was raised to fund patient care services.”
The question is whether “may” equates to “can” in terms of offsetting Provider Relief Funds with these sources of lost/reduced revenue.
Nursing home discharges
Transfers or unexpected discharges of nursing home residents can be an unsafe and traumatic experience according to the HHS Office of the Inspector General (OIG). Accordingly, the OIG has identified Facility-Initiated Discharges in Nursing Homes as an investigational topic. The decision is based on data from the National Ombudsman Program and recent media reports highlighting the rise in nursing home evictions in 2020. CMS estimates that as many as a third of nursing home residents may experience a facility-initiated transfer or discharge. The investigatory work will examine the extent to which nursing homes meet CMS requirements for facility–initiated discharges and the involvement of state long-term care ombudsmen and survey agencies in addressing the concern.
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Clinical highlights
HHS/ASPR miniseries on outpatient COVID-19 therapeutics
This week, HHS and the Assistant Secretary for Preparedness and Response (ASPR) are providing a miniseries on FDA–approved therapies for COVID-19. The series will air from 11 a.m. to 12 p.m. CT on Wednesday, December 9.
According to the announcement, the series will provide a deep–dive on new and emerging COVID-19 outpatient therapeutics, including monoclonal antibodies. The goal of the series is to equip clinicians with appropriate knowledge, resources, and tools needed to initiate and scale administration of these therapies and reduce strain on the U.S. healthcare system.
Covered topics will include:
- Clinical trials and drug efficacy
- Best practices from the field
- Priority settings, i.e. nursing homes, Federally Qualified Health Centers (FQHCs)
- Ethical issues
- Considerations for use of vaccine and therapeutics
Readers can register for the presentation here. Please note that, from my inspection of the link, it appears that there will be additional sessions available on December 16 as well as January 6, 13, and 20.
Reusing PPE
The Association for Professionals in Infection Control and Epidemiology recently conducted an online survey of 1,083 infection preventionists. Two-thirds of survey respondents reported extended use or reuse of surgical masks, with 73% citing a similar policy for respirators. About 44% said that gowns and gloves were also being used more than once.
Breaking the numbers down a little more, we learn that 37% of those surveyed indicated that respirators were being used for five days, while another 38% indicated that respirators were being used for as many days as possible as long as they showed no signs of breakdown. For masks, 13% indicated that masks were being changed out daily, 17% at five days, and 57% were reusing masks for as many days as possible.
Clearly, a good bit of the strategy around reuse of PPE, especially masks and respirators, is to ensure an ongoing available supply. Many organizations are still experiencing supply chain difficulties and are also anticipating that the next three to four months will bring greater demand for PPE resources, even though safety of care for both patient and provider is of significant concern.
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Administrative highlights
Can COVID-19 vaccination be mandated for employees?
New COVID-19 vaccines are being developed and released by Pfizer/BioNTech and Moderna in the coming days, with more brands to follow. On December 2, the CDC indicated that it would prioritize frontline healthcare workers and residents of long–term care facilities for vaccination. For many providers, the next big question will be whether immunization should be voluntary or required.
Many have, for some time, required healthcare workers to be immunized against the flu. That includes post-acute providers, but with the COVID-19 vaccine, there is a whole host of questions that must be considered as a way of assessing risk associated with any vaccine mandate. Most expect that healthcare organizations, both large and small, will not mandate that their employees be vaccinated even though they have the right to require vaccination as a condition of employment. The underlying reason is simple — the inherent risk associated with several unknowns, including vaccine effectiveness and potential side effects. I reached out to my friend Robert Markette, an attorney at Hall, Render, Killian Heath & Lyman, for words of wisdom and guidance. Here is what Robert had to say:
There is no clear legal guidance surrounding an employer’s decision to require vaccination or leave the decision up to individual employees. It is true that many post-acute providers require their employees to be vaccinated for the flu. However, unlike flu vaccines that have been tested and on the market for many years, here we have a new set of vaccines that have been subjected to an accelerated development and validation timetable. There is data to support expectations of their effectiveness, but there are no guarantees. That circumstance puts employers in a delicate position when it comes to establishing policy aimed at COVID-19 vaccination requirements.
For an employer mandating that each employee accepts the COVID-19 vaccine, there is risk that the employer could be held liable for injuries sustained by an employee if something goes wrong later. This risk arises from the fact that, like many other issues we have faced in 2020, there is no clear legal guidance on the issue of employer liability arising out of a mandate that employees take the vaccine. This makes it difficult to assess the potential outcome of an employee lawsuit against an employer that was based upon the employer requiring the employee to take the vaccine. It is also difficult to assess what steps the employer might take to limit its liability in the event of an adverse outcome. This means that the employer could be held liable for a future adverse event related to the vaccine if vaccination was made mandatory. On the other hand, if accepting the vaccine is left to personal choice, the organization would be able to argue that it was not liable for any adverse outcome because it did not require employees to be vaccinated. The fact that the decision to take the vaccine was solely the employee’s decision could result in the employer avoiding liability in the event an employee encounters a later health problem that can be associated with the vaccine. Consequently, employers will be well advised to allow employees to choose whether or not to be vaccinated.
Employers should also be cautious about “encouraging” employees to take the vaccine, as the encouragement could be viewed as influencing the employee’s decision to be vaccinated. For example, an employer that makes the vaccination voluntary but then offers a bonus to those who agree to be vaccinated as an inducement to become a part of a COVID-19 team with higher compensation. An employer that takes this route may still be in harm’s way in the event of a future adverse event, because the employee could argue that the financial inducement significantly influenced their decision to be vaccinated. This may still be a defensible position, but agencies should consult with counsel to evaluate any policy that might undermine the argument that the employee’s decision remains completely voluntary.
Employers will also want to monitor developments in the coming months. As more and more people are vaccinated, this may change the risk profile. Furthermore, there may be developments in terms of case law, legislation, or government mandates that alter the employer’s obligations and risk. As an added benefit of vaccination, many post-acute providers — especially those visiting patients at home — will be able to assemble COVID-19 teams made up of individuals who have been voluntarily vaccinated. These individuals will be able to visit patients with a reduced level of potential risk.
Every provider organization must make its own determination of what makes the most sense in terms of its workforce and operations, but a bit of caution is recommended — at least for the near term.
HHS distributing funds to more than 9,000 nursing homes
On December 7, HHS announced that it would be distributing another $523 million to more than 9,000 nursing homes across the country for their performance related to COVID-19 and, specifically, reductions in mortalities from September to October. This is the second distribution in the five-phase Nursing Home Quality Incentive Program. HHS has expressed its hope that payments for November will be just as high, noting that $333 million was sent to more than 10,000 nursing homes for their September infection control and mortality reduction results.
“As we approach the rollout of safe and effective vaccines for our most vulnerable, we continue the innovative program we created this year to incentivize and assist nursing homes in battling COVID-19 and applying the right infection control practices. This half a billion dollars in incentive payments will reward nursing homes that have shown results in their tireless work to keep their residents safe from the virus.”
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In closing
How a home health aide spends her Sundays
Multiple showers, multiple buses, multiple patients, multiple masks and gloves, according to a New York Times article published December 4. The article chronicles a Sunday for Keisha Gourdet — a wife, working mother of three children, and home health aide in Brooklyn. Her day begins at 4 a.m. and ends 21 hours later.
Gourdet is with her first patient of the day by 6:30 a.m., and during her shift she gets his breakfast ready, gets him showered, cleans the apartment, and takes him for a walk before leaving for her next patients shortly after noon. This time she is off to a nursing home in Queens where she arrives a couple of hours later to don a new mask, new gloves, and a new set of protective gear. Here, she cares for 10 elderly residents with dementia. After putting everyone to bed at 9:30 p.m., she completes clinical notes for another 90 minutes before leaving for home. By this time, its 11 p.m. After a train and another bus, she arrives home just after 1 a.m. to go to sleep and start all over again.
Of her work, Gourdet shares the obvious — “not everyone can do this” — and I suspect a truer statement has never been made. She also notes that “my patients need my help. I would feel I’m neglecting them if I didn’t show up.” She is the personification of quality that we should love about those who work so hard for the patients they serve. I tip my hat to you, Keisha Gourdet.
In the meantime, in the spirit of the holidays, I wish each and every reader a joyous holiday season and much needed renewal in the new year. This year, things will undoubtedly be different for many of us as we consider the difficult events of 2020, but I continue to have faith that 2021 will bring better days.