UPDATES RELATED TO ALL HANDS ON DECK AND COVID VACCINES/BIVALENT BOOSTERS 

CDC Posts Agreement for Long-Term Care Providers Seeking to be Enrolled as Vaccinators 
Late December 16th, CDC posted the Sub-Provider Agreement for Long-Term Care Facilities Enrolling in CDC COVID-19 Vaccination Program 90 Day Initiative. To qualify, long-term care providers must partner with a pharmacy that is enrolled as a COVID-19 vaccine provider. There are a number of other criteria LTC providers must meet, including that all staff who receive, handle, manage, prepare or administer vaccine must be fully trained. The LTC organization must have the capability of storing and handling the vaccine properly and administrative requirements. The LTC provider must still follow all state requirements. There are details at the CDC link on the criteria and links to the forms that allow a 90-day period, until March 15, 2023, for LTC providers to be vaccinators.  Katie Smith-Sloan released a comment to the media praising the CDC move as an “advocacy success.” LeadingAge agreed to promote bivalent boosters for residents and asked HHS to find ways for providers to be vaccinators in exchange. HHS moved swiftly to make this happen.   

LeadingAge Weekly Report to HHS on Progress on the All Hands On Deck Project 
Here is LeadingAge’s report to HHS on Bivalent booster uptake and LeadingAge activities to support increases.  LeadingAge nursing home members surpass all nursing homes in terms of the percentage of residents who are  up to date with their COVID vaccines – i.e., have accepted bivalent boosters. The national number is 45.5; 59.36% of residents in LeadingAge nursing homes are up to date. 

State by State Data on Resident Vaccines/Bivalent Boosters 
Here is a table showing vaccines and boosters by state, comparing all nursing homes in the state with LeadingAge member nursing homes, using the most recent data available (covering the week of December 4th), 

LPC Pulse Check on Bivalent Booster Uptake 
A brief pulse check on the monthly LPC member network call, led by Todd Adams, Director of Health Legislative Affairs, revealed some interesting stats on how LPC members are doing with getting residents – especially SNF residents – boosted with the bivalent vaccine. When asked how many SNF residents had already received the vaccine, most members who responded to the call survey gave uptake rates ranging from 85-99%. Quite encouragingly, members also reported experiencing “no challenges” with access to vaccines, and several credited partnerships with pharmacies for the ease of access. Reasons for why a minority of SNF residents are not getting the bivalent booster included religious and medical reasons, complacency, and vaccine fatigue. To increase participation in the bivalent vaccine, LPC members said that they were offering clinics, ongoing education and outreach, and leadership examples to motivate participation. When Todd asked what else LeadingAge or the federal government could do to help increase the percentage of SNF residents who receive the bivalent boosters, there was a notable silence in the chat responses. Although the call attendees numbered 59 members, those members on the call represented organizations across the U.S. and both single and multi-site organizations. Any LPC members who wish to add to the pulse check, or have information to share related to SNF resident bivalent booster uptake, please email Todd (tadams@leadingage.org) or Dee (dpekruhn@leadingage.org). 

Winter Playbook for Nursing Homes and Other Long-term Care Facilities to Manage COVID-19 and Protect Residents, Staff, and Visitor 
Following the press release yesterday, the White House released this playbook specifically for long-term care providers. and calling on all long-term care facility leaders to step up this winter and help residents and staff access updated COVID-19 vaccines, ensure that residents and staff are testing if they are symptomatic, and know how to access COVID-19 treatment options (such as oral antiviral pills) if they test positive and improve indoor air quality across facilities.  

CDC’s Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19 associated with Emergency Department 
 CDC just released a report sharing the “Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19 associated with Emergency Department visits. The report gathered data from nine states.  It concludes that the “Bivalent booster doses provided additional protection against COVID-19–associated emergency department/urgent care encounters and hospitalizations in persons who previously received 2, 3, or 4 monovalent vaccine doses. Because of the waning of monovalent vaccine-conferred immunity, the relative effectiveness of bivalent vaccines was higher with increased time since the previous monovalent dose. The full report can be accessed HERE. 

CDC’s Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years 
CDC just released a report sharing the hospitalization of  Immunocompetent Adults Aged ≥65 Years who have received the Bivalent mRNA Vaccine. They gathered data from 18 States. The report concludes, that among immunocompetent adults aged ≥65 years hospitalized in the multistate IVY Network, a bivalent booster dose provided 73% additional protection against COVID-19 hospitalization compared with past monovalent mRNA vaccination only. The full report can be accessed HERE .  

FEDERAL NEWS 

Measure Applications Partnership PAC/LTC Work Group Debated 2022 Measures Under Consideration As we noted at the beginning of December, the National Quality Forum published its latest Measures Under Consideration list, affectionately called the MUC list. These measures are then referred to their respective provider or setting work groups for input and consideration. The work groups vote on whether to accept NQFs recommendation related to the measure. LeadingAge is a voting member of the Post-Acute Care/Long-Term Care Work Group, which met Monday, Dec. 12 to review 2 Home Health Quality Reporting Program(QRP) Measures. Two SNF QRP measures and 5 SNF Value-Based Purchasing Program measures. Three MUC measures were proposed across multiple post-acute care settings – Cross Setting Discharge Function Score, COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date; and COVID-19 Vaccination Coverage among healthcare personnel. Each of these thee measures garnered considerable discussion and debate among the public and work group members. While the function measure, received enough support for rulemaking once the measure receives endorsement from a consensus-based entity (such as NQF), provider organization work group members expressed concern about the appropriateness of including a resident/patient’s COVID-19 vaccination status as a QRP reporting measure. No one thought it wasn’t important information but the way the measure is written it is not recording action or inaction taken by providers but merely whether the resident/patient is up to date on their vaccination. LeadingAge also noted that SNFs already collect this information and report weekly into NHSN on both short and long-stay residents. CMS was not offering to have this MDS reporting replace the NHSN reporting. In addition, the proposed SNF reporting would only be for short stay FFS residents, which was incomplete information if the goal is to provide consumers with actionable information to help them make decisions about where they receive care. LeadingAge had also submitted public comments on these measures. Ultimately, the required 60% threshold of work group members was not met to support a recommendation on the measure for it to move forward for home health, long-term care hospitals, and intermediate rehabilitation facilities. For SNFs, the work group was unable to meet the 60% threshold on: conditional support for rulemaking, do not support rulemaking under any conditions, and to not support with mitigation. Unfortunately, the meeting was running over time and so some voting members had to leave. Work group members are unclear what the final determination was on the SNF measure related to resident’s up to date COVID-19 status. CMS is steadfast in its commitment to reporting on COVID-19 vaccinations in residents/patients and healthcare personnel and no arguments could dissuade them from this position even though their proposed measure is less inclusive than what is reported into NHSN today. Ultimately, these votes are non-binding on CMS who can still move ahead with these measures. LeadingAge will continue to advocate to CMS about our concerns with these measures and their inclusion in the QRP and VBP programs.  

HRSA Begins Issuing Final Repayment Notices for Non-Compliance with PRF Terms and Conditions 
 HRSA is currently issuing its first batch of final repayment request notices to providers who are required to return Provider Relief Fund payments. Batches of these letters are expected to be issued to providers over the next 4 months, all who will have 60 calendar days to either r submit repayment or appeal the notice via a decision review request.  The good news is, according to HRSA, 99% of providers are compliant with their reporting requirements. Members who need assistance or have questions about this process can reach out to Nicole (NFallon@leadingage.org). A LeadingAge article on this was included in the Friday edition of LeadingAge Need to Know but is also available here. 

LEADINGAGE KANSAS NEWS 

No Friday Webinar This Week 
Join us each Friday for an update on what is going on pertaining to COVID, updates on the association front, and much more.  

If you haven’t registered already, you can do so here. You can also see archived webinars and get handouts here.  

LEADINGAGE NATIONAL NEWS 

Upcoming LeadingAge Coronavirus Call. On Monday, December 19th at 2:30 PM CT 
Dr. Barbara Mahon Acting Director of, Coronavirus and Other Respiratory Viruses Division (CORVD) in CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) will join us to talk about vaccines, tests, and treatments. Dr. Mahon led part of the COVID response with CDC and has a great deal to share on the clinical evidence on boosters and treatments. They’ll also explain Nowcast,  a model that estimates the most current estimates of circulating variants. It is a tool that LeadingAge members can use to track the most current information about COVID in their community, by variant, in order to determine if any actions need to be considered. We’ll talk with these CDC experts about how aging services providers can use Nowcast. 

On December 21st, Dr. Pingting Karen Nie, Geriatrician and Associate Chief of the Healthcare Outreach Unit at the Los Angeles County Department of Public Health will join us to talk about LA plans on moving towards mandating masks in public spaces and what that means for long term care providers. Will we see this in other states and jurisdictions? Are you ready? 

 If you haven’t registered for LeadingAge Update Calls, you can do so here. You can also find previous call recordings here. Note that to access recordings of the calls you need a LeadingAge password. Any staff member of any LeadingAge member organization can set up a password to access previous calls and other “members only” content. 

RESOURCES 

GAO Finds Nursing Homes in Communities with High COVID Had Longer Outbreaks 
The Government Accountability Office (GAO) released a report on December 15 on COVID-19 in Nursing Homes. Specifically, GAO studied outbreaks in nursing homes in four states between June 2020 and December 2021. They found that nursing home outbreaks lasted an average of four weeks. Further, they identified factors that increased the likelihood that a nursing home would have a longer outbreak, including: higher transmission in the surrounding community, more than 100 beds, those experiencing staffing shortages, and those that are government owned. None of these findings will be surprising to LeadingAge members and most are beyond the control of providers.    

NIC Releases the Wave 48 Survey Results 
The National Investment Center has released its latest round of executive survey results, called the Wave 48; the review period for this report is November 14 – December 11 2022. With this survey, NIC introduced questions on organizations’ ability to service debt from current organizational activities, and how interest rates have influenced the ability to service debt. The majority of operators of IL, AL and memory care indicated that the current operational environment had a “moderate impact” on their ability to service debt; the majority of nursing homes indicated that the same had “no impact” on servicing debt. Regarding the rise of interest rates, similarly, 89% of nursing homes said this had “no impact” on servicing debt, followed by proportionate majorities of AL (64%,) memory support (63%,) and IL (58%.) While the survey did not explore reasons for the lack or marginal impact of these two factors on debt service, generally, this indicated that most organizations have been able to continue to service debt while faced with an on-going, challenging operational and financial landscape.  

In terms of move-ins and lead volumes, generally speaking, operators reported a steady increase in the pace of move-ins, despite facing the “tripledemic” of COVID, flu, and RSV. Encouragingly, too, lead volumes were reported higher in Wave 48 than in most prior surveys, although not fully commensurate with the lesser-inclined pace of move-ins. The interpretation here was that leads are not as quickly being converted into move-ins as they are being accumulated; effectively, people are still waiting a little longer to move in despite an increased overall interest to do so. Also in this survey, operators showed a trend away from offering rent or monthly fee concessions to incentivize moves; compared to previous surveys, more operators in this survey reported that only up to 25% of their properties were offering such concessions, and no organizations were offering concessions in all of their properties.  

Finally, this survey also took a comparative look at full time position vacancies and staffing shortages. Encouragingly, as compared to the Wave 42 survey, the percentages of unfilled full-time positions have dropped; in Wave 48, the majority of organizations reported at 6-10% vacancy rate of full time positions, whereas in Wave 42, the majority of organizations reported a 11-15% vacancy rate, followed closely by a large minority of organizations with 25% or more full time positions vacant. Still, 90% of all organizations reported some staffing shortages, and of that, 33% indicated that those shortages spanned across their entire portfolio of properties and service organizations. NIC is always looking for more organizations to participate in this survey; your organization can participate in Wave 49 by clicking here.  

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