This week, The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC) updated nursing home guidance on visitation. With roughly 80% of residents and 55% of staff fully vaccinated¹, they have okayed visitation unless nursing homes fall into these COVID-19 categories:

• County positive is greater than 10% and less than 70% of residents vaccinated
• There are confirmed resident infections
• There are residents in quarantine

CMS also stressed the reminder to follow the Core Principles of COVID-19 Infection Control. Finally, CMS reiterated compassionate care visits should continue to be allowed under any circumstance.

What Constitutes Compassionate Care?

It is not just when a resident is in the last stages of life and can include situations where the resident is showing deterioration in mental health.

• Resident was living with family before recent admission and struggling with the change.
• Resident is grieving after a recently passed friend or family member.
• Resident needs help and encouragement with eating or drinking and is experiencing weight loss or dehydration.
• When a resident who used to talk to others, is experiencing emotional distress, seldom speaking, and crying frequently.

Just keep contact as limited as you can, and again, try to adhere to the Core Principles of COVID-19 Infection Control.

Resources to Assist Nursing Homes with Visitation

In case you missed them last week, again, here are resources to help:

• CMS Fact Sheet on Updated Nursing Home Guidance
• CMS County Positivity Rate Reports
• Core Principles of COVID-19 Infection Prevention [Shareable Flyer]
• Core Principle #1-4 Flyers: Screening | Hand Hygiene | Mask Dos/Donts | Social Distancing
• Delaware's Best Practices in Visitation

Source: 1) NIC.org, Executive Survey - Wave 23 Summary of Insights and Findings (February 22 to March 7, 2021)

With the majority of nursing home residents now vaccinated, families are naturally asking 'When can we visit?' Though CMS has not updated requirements since September, vaccinations now put nursing homes in a better position to meet them. 

CMS Requirements for Visitation

[With the exception of compassionate care visitation]

• No COVID-19 cases in last two weeks
• No outbreak testing currently underway
• COVID-19 county positivity rate less than 10 percent
• Adherence to the core principles of COVID-19 infection prevention (printable PDF)

CMS further stipulated:

• Visitors adhere to core principles with staff monitoring
• Visitors are limited per resident and by facility size with recommendations:
  • Scheduled
  • Maximum must not exceed 20% facility residents
• Visitor movement is limited and kept to designated spaces, with outdoor preferred

States Reopening This Week

These recommendations reconsidered, we've seen states like Delaware, Ohio, Michigan, New York and Tennessee opening nursing homes this week. Delaware's policies seemed carefully thought out and perhaps offer a good starting point for others.

New York also added the requirement of testing within 72-hours of visit for those in counties with a 5-10% positivity rate. CMS also encourages testing in this scenario, as well as among those who visit as often as weekly.

Pressures from AARP

AARP joins families in pressing for visitation decisions from nursing homes, asking facilities to provide clear, advanced guidance to loved ones. Further, they ask virtual visits to be made a priority. 

Resources to Assist Nursing Homes with Visitation

Understanding your plates remain full, we've collected the following resources as quick reference or help.

• CMS County Positivity Rate Reports
• Core Principles of COVID-19 Infection Prevention [Shareable Flyer]
• Core Principle #1-4 Flyers: Screening | Hand Hygiene | Mask Dos/Donts | Social Distancing

The news this week is good. Various sources are reporting drastic declines in nursing home cases of COVID-19. The New York Times reports, "From late December to early February, new cases among nursing home residents fell by more than 80 percent, nearly double the rate of improvement in the general population." This decline syncs with the arrival and prioritization of vaccines for nursing homes. 

According to February 8-21 responses to NIC's Skilled Nursing COVID-19 Tracker, the majority of residents and staff have taken the COVID-19 vaccines. 

• Dose #1 received by 84% of residents and 59% of staff
• Dose #2 received by 76% of residents and 55% of staff 

Some staff are still reluctant, but NIC's survey also provides data on the top nine tactics nursing homes are using to achieve vaccination acceptance among residents and staff. 

AHCA and LeadingAge, with the help of the Centers for Disease Control and Prevention (CDC), have committed to the nationwide goal of getting 75 percent of approximately 1.5 million nursing home staff vaccinated by June 30, 2021. So, expect more vaccine success tips to assist with this effort.

Meanwhile, senior care inches back toward a more normal mode of operation. Operators are finding time to focus on what is now promising to be an even more competitive market and we're here to help. Our March 4 webinar will offer leading experts discussing post-pandemic repositioning strategies.

In addition to expert advice from Health Dimensions Group (HDG) CEO/Principal, Erin Shvetzoff Hennessey (MA, NHA, CPG), we'll talk about how multi-facility operators like HDG are using our primeVIEW decision dashboard to their strategic advantage.

Until then, keep up the great work out there and celebrate this wave of good news on the COVID-19 front. As always, thank you for your many months of tireless care across senior care communities. 

In researching the link between social and mental health among long-term care (LTC) residents, The Journal of Post-Acute and Long-Term Medicine (JAMDA) identified 12 ways to maintain social connections during COVID-19. The full research is available on their site.

[Click for PDF version]

We hope these strategies might help families, and staff build and maintain social connection for LTC residents during this challenging time. For additional COVID-19 resources, see our COVID-19 Partner Resources library.

Throughout January, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) co-hosted a series of fireside chats on COVID-19 vaccine safety. Below are highlights from these sessions.

What is the difference between the two COVID-19 vaccines?
The major difference is the cold storage requirement (minus 75 degrees Celsius) of the Pfizer vaccine and its expiration after five days of refrigeration. There are minor differences in dosage and timing – with Moderna's administered as two 100-microgram doses given 28 days apart and Pfizer's administered as two 30-microgram doses given 21 days apart. 

Do the COVID-19 vaccines contain the virus?
No, the virus acts like an avatar. It makes the virus seem as if it is already in the body.

How can we be sure the COVID-19 vaccines are safe?
Multiple U.S. partners are working together to ensure the safety of these vaccines, imploring measures to include expedited clinical trials and extensive vaccine safety monitoring. Learn more via the CDC.gov website, Ensuring the Safety of COVID-19 Vaccines in the United States.

Can the COVID-19 vaccines cause infertility?
No.

Will the COVID-19 vaccines alter my DNA?
No.

Were the COVID-19 vaccines tested on individuals of different races?
Black, Hispanic, Asian, and American Indian representatives were included in trials. According to Newsday.com, they were represented as follows:

* Black (13% U.S. population): 10% U.S. Pfizer participants; 10% Moderna participants
* Hispanic (<19% U.S. population): 13% U.S. Pfizer participants; 20% Moderna participants
* Asian (6% U.S. population): About 6% Pfizer participants; 4% Moderna participants
* American Indian: Pfizer participation similar to U.S. population; Moderna information not provided.

Source: Minority numbers up in clinical trials (December 7, 2020)

If you have had COVID-19 do you still need to be vaccinated? 
Yes, studies are in the works to determine how long you might be immune to the virus.

Does the vaccine contain any fetal cells?
No.

If you already tested positive is there a timeline for getting vaccinated? 
No, but it is recommended you get vaccinated.

How long do you need to be monitored after getting the shot? 
For most people, 15 minutes. If you've had allergic reactions in the past, wait 30 minutes.

Should you continue to wear a mask after both shots?
Yes, you could be a carrier. But, if you are exposed after both shots, you shouldn't have to quarantine.

Does the vaccine contain aspirin in it?
No, nor does it have aluminum or preservatives.

How often will people need to get vaccinated? 
It is too early to tell.

Why are children not receiving the vaccinations? 
The vaccines were fully-trialed on those age 18 and up. Trials began in October in children as young as 12, but trials are expected to continue for several more months.

How can we answer general concerns about staff getting vaccinated?
We are seeing more staff getting vaccinated after they see others receive it with no issues. The CDC developed a toolkit to help facilities address myths and get all healthcare workers vaccinated. 

How can we address safety concerns based on vaccine reactions?
The CDC has no safety concerns based on current vaccine reactions. There is a smartphone app (V-Safe) to text with the CDC after you've received your first and second dose.  

How can we address concerns about the speed of COVID-19 vaccine development?
The technology used to develop the vaccine has been around for 10 years. It was developed for another virus and continues to reduce the timeframes for other vaccine development. Both Pfizer and Moderna trials had at least 30K participants.

When will COVID-19 vaccination distribution improve?
In mid-February, the CDC will begin working with 21 different pharmacy chains/groups to dispense the vaccine.  

Will the states be taking some COVID-19 vaccines back from facilities?
The CDC has tried to provide the correct quantities for each facility. If there are extra doses after all staff and residents are vaccinated, the state may take the overage to use elsewhere.

What can you tell us about the development of new COVID-19 vaccines?
Two new vaccines are close to approval. The AstraZeneca vaccine has a very high efficacy rate. Johnson & Johnson's one-dose vaccine is still in the trial phase with hopes of test completion by mid-February. 

Do people need a second dose of the existing vaccines?
There is not enough data at this time to determine if the second dose is needed.

How can we address timing concerns about getting the second dose within recommended timeframes?
The CDC says you can get the second dose up to 42 days after the first dose. 

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This concluded the series of sessions, but you may find these additional resources helpful:

• 8 Things to Know about the U.S. COVID-19 Vaccination Program

• AMDA COVID-19 Vaccine Q&A Summary