Begin Main Content Area

Protecting People in Long-Term Care Facilities in Pennsylvania

Background

Long-term care facility owners and administrators across the nation, and in Pennsylvania, often need to take extra precautions in controlling outbreaks of infectious diseases due to the nature of the close living environment, and because residents may have serious medical conditions that require near-constant care. These challenges have been especially difficult during the COVID-19 pandemic both nationally and in Pennsylvania. With this knowledge, the Wolf Administration took swift action to protect our vulnerable residents in long-term care facilities.

Pennsylvania's Approach

Since the start of the COVID-19 pandemic, the Commonwealth has focused on a plan with three major pillars to protect the vulnerable people living in long-term care facilities:

  • Ensuring resident safety through education, resources and testing;
  • Preventing and mitigating outbreaks; and
  • Working in partnership with state agencies, local health departments and long-term care facility operators.

This approach guides facilities on the cohorting of residents with COVID-19, universal screening and masking of all healthcare workers, and educates in clear terms how to provide residents access to the Department of Human Services' Long-Term Care Ombudsman Program.

Pennsylvania's Action

Pennsylvania has taken aggressive steps to prevent and mitigate outbreaks in long-term care facilities. In addition to its ongoing efforts, the Commonwealth will enhance its response to long-term care facilities by:

  • Implementing universal testing of staff and residents;
  • Increasing transparency through public reporting of outbreaks, deaths and testing; and
  • Providing ongoing direct support, including regulatory inspections, personal protection equipment and on-site staffing support.

Universal Testing of Staff and Residents

Testing is an essential element to ensuring resident safety. The Department is executing a robust universal testing strategy for staff and residents within long-term care settings as part of the Wolf Administration's statewide enhanced testing strategy. This statewide testing strategy focuses on: ensuring testing is accessible for all Pennsylvanians with symptoms of COVID-19; available by increasing supply and building community capacity and adaptable to the evolving landscape of the virus and emerging data.

Guidance issued to licensed hospitals and skilled nursing homes require that before a resident is discharged from a hospital to a long-term care facility, they are tested for COVID-19 if they were not hospitalized due to the virus. This provides valuable information to the facility to ensure they can cohort the patient properly, monitor their condition and take proper precautions to prevent the spread of the virus. This represents a significant step in identifying asymptomatic and pre-symptomatic residents so nursing facilities may properly isolate or cohort them. However, the Department anticipates it could increase challenges related to residents being admitted back into the nursing facility due to a lack of space or beds to properly accommodate these residents. The Department is actively analyzing options related to alternative care facilities to see how it can support the long-term care community in properly caring for those residents in a safe and clinically appropriate space.

Additionally, the Department issued clinical guidance, through a Health Alert, to provide direction to all long-term care facilities in Pennsylvania on universal testing strategies for skilled-nursing facilities and what steps to take after a positive test result.

The Department is committed to testing all patients and staff in Pennsylvania's long-term care facilities. To accomplish this, the Department is providing testing swabs to long-term care facilities that do not have an adequate supply based on what the Commonwealth receives from the federal government. For facilities that are not able to connect to testing laboratories, the Department's State Health Laboratory will process the tests.

Increased Transparency

To ensure Pennsylvania is in line with federal guidance recently released, the Secretary of Health issued an order that requires long-term care facilities report cases, deaths and tests performed to the Department of Health. A public report will be available on the Department website after May 18. The information in this report will be the same data collected by the Centers for Disease Control and Prevention (CDC) to provide consistent and comparable information.

Ongoing Direct Support

The Department has leveraged its existing resources to provide consultation to long-term care facilities to prevent or control existing outbreaks. This includes:

  • Quality Assurance licensure staff who do onsite visits to facilities to investigate complaints and concerns related to safety of the residents.

    The Infection Control and Outreach Team (ICOR)
    made up of members of the Department's Healthcare Acquired Infection program providing consultation and support to Department- licensed facilities. To date, this team has provided support to over 250 facilities.
  • The Educational Support and Clinical Consultation Program (ESCCP) created by DHS in partnership with the Jewish Healthcare Foundation and seven different healthcare systems across the state provides educational assistance and technical assistance to DHS and DOH licensed facilities including skilled nursing facilities. This assistance includes clinical guidance, advisement on infection control strategies and critical needs identification.
    • To date, this team has provided support to over 75% of the 1,200 personal care home/long-term care facilities in the Commonwealth;
    • To date, this team has provided support to 202 skilled nursing facilities; and
    • To date, this program held 10 educational webinars with total attendance of 1390 participants.
  • Post-Acute Staffing Team (PAST) leverages multiple state agencies' efforts, including the Pennsylvania Emergency Management Agency and the Pennsylvania National Guard to provide critically needed staffing support in long-term care facilities where staff have been impacted by their own illness or quarantine. To date, this team has prevented the evacuation of 10 long-term care facilities by supplementing their staffing.

To supplement these efforts, the Department:

  • Contracted with ECRI, Inc., to provide technical assistance to health care organizations and is tasked with conducting deeper infection control work with specific high-risk facilities. To date, this team has provided support to nearly 100 facilities.
  • Engaged the independent Patient Safety Authority (PSA) to track and analyzes risks to patients in healthcare settings and has also worked to provide technical assistance to these facility types. To date, this team has provided support to 89 facilities, mostly focusing on prevention work in facilities with no or limited cases.

    Waived Department of Health regulations to empower facilities to supplement staffing.

    Waived
    Department of State licensing regulations to temporarily alleviate barriers for health care practitioners during the pandemic.
  • Utilized the Commonwealth's existing staffing contract to provide nurses and other trained health care personnel to staff the facilities during this crisis.

All Hands-on Deck

The Wolf Administration has dedicated its resources to protect long-term care facility residents, health care providers and staff.

The DHS is in daily contact with the infection control teams at the Department, providing them with an up-to-date tracker of personal care homes, assisted living residences and skilled nursing facilities that ESCCP has contacted. When critical PPE needs are identified, DHS program offices, in consultation with the DHS-licensed facilities, give the requisite information to the Department to prioritize these sites for PPE allocation, staffing support, or additional infection control expertise.

The Department of Aging's Office of the State Long-Term Care Ombudsman (Office) has produced and distributed numerous guidance documents to assist consumers and their legal representatives understand their rights under CDC and CMS COVID-19 Interim Protocols. The Office also recently launched a statewide Virtual Family Council. Through a virtual platform, the Office "meets" twice monthly throughout the pandemic and beyond to support the needs of families during these extraordinary times. The meetings educate, support and gather information from

families. Additionally, this forum links people to their respective local ombudsman or other resources. More information on the Virtual Family Council and telecommunication project can be found on the Department of Aging website.

Additionally, this Office, in collaboration with AARP, will be providing telecommunication resources to a group of nursing home residents across the Commonwealth to increase access to communication with their loved ones.

The Pennsylvania Emergency Management Agency (PEMA) continues to work closely with the Department and other agencies to provide logistical support for staffing and resource allocation to long-term care facilities across the Commonwealth. Specifically, PEMA coordination at a statewide and local level is an essential component of the push model for PPE and other critical resources to long-term care facilities.

The Pennsylvania National Guard enhances multiple state agencies' efforts to provide critically needed staffing support in long-term care facilities where staff have been impacted by their own illness or quarantine. To date, this team has prevented the evacuation of 10 long-term care facilities by supplementing their staffing.

Resources for More Information

COVID-19 Information for Health Care Facilities: https://www.health.pa.gov/topics/disease/coronavirus/Pages/Health-Care-Facilities.aspx

COVID-19 Information for Nursing Homes: https://www.health.pa.gov/topics/disease/coronavirus/Pages/Nursing-Homes.aspx

COVID-19 Resource Guide for Older Adults: https://www.aging.pa.gov/Pages/covid-guide-for-older-adults.aspx

CDC's Coronavirus Guidance for Older Adults: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html

CDC'S Coronavirus Guidance on Shared and Congregate Housing: https://www.cdc.gov/coronavirus/2019-ncov/community/shared-congregate-house/index.html

Date created: 5/11/2020; Date updated: 5/12/2020