Facility Implementation Plan for Reopening Meadows Nursing and Rehabilitation Center (Subject to Change based on CDC Guidelines & Orders of the Secretary of the Department of Health and Governor Wolf)
As per the Department of Health requirements Meadows Nursing and Rehabilitation Center has developed the following plan in order to reopen our Skilled Nursing and Rehabilitation Center, based on Center for Medicare and Medicaid Guidelines.
As a prerequisite, baseline testing must be completed as per the Order. Our facility conducted Universal Baseline Testing on residents and staff 7/6 through 7/8/2020. Initial testing results were completed by Geisinger Lab in Danville, PA. Baseline testing included all full-time, part-time, contracted and active employees. All 94 residents and actively working staff tested negative during baseline testing.
Please note for Staff refusing initial baseline testing: asymptomatic staff may refuse to be tested. However, based on their risk of exposure, community spread, and staffing needs, in general, staff persons refusing testing shall not care for residents in unexposed (Green) Zones. If these staff develop symptoms consistent with COVID-19 testing is mandatory as per the Return to Work Policy and the staff person shall be excluded from work.
Please note for Resident refusing testing: occasionally asymptomatic residents or resident representatives of an asymptomatic resident may refuse testing for the resident. These residents, if potentially exposed to COVID-19, shall be transferred to the potentially exposed (Yellow) zone until at least 14 days after known exposure. If these residents develop symptoms consistent with COVID-19, testing is recommended; therefore, testing requests will be revisited with the resident and/or resident representative.
- Any resident displaying signs or symptoms of COVID-19 are transferred into the Yellow Zone and tested for the virus. We utilize Commonwealth Lab for resident testing.
- In the case of an outbreak, (“An outbreak of most communicable diseases can be defined as one of the following: One case of an infection that is highly communicable”), all staff, residents, non-essential workers and active volunteers would be tested weekly until there are no more cases as per the recommendations. If there are positive cases of COVID19 in the facility, there will be mandatory weekly testing for all staff as per the guidance of CDC as a condition of employment. Additionally, healthcare personnel shall participate in testing based on county positivity rate as a condition of employment beginning October 1, 2020.
In order to complete this undertaking, facility has an agreement with multiple labs:
- Geisinger, Commonwealth Lab, Vikor Scientific and Chemysis, and the Regional Response Health Collaboration Program (RRHCP) may assist with additional testing. Additionally, facility has access to a RAPID Point of Care Antigen Test which has been authorized by FDA under an EUA only for the detection of proteins from SARS-CoV-2. Facility has been approved for COVID-19 Testing Waived by Emergency Use Authorization (EUA) under our CLIA Permit.
- Additionally, the Interim Final Rule, CMS-3401-IFC, directs Facility to adhere to CMS Final Rule F866 in regards to Routine Testing based on county positivity rate, which recommends the following:
As per CMS, the Testing Frequency will be as follows based on three triggers for testing:
Symptomatic, Outbreak and Routine/Surveillance
Symptomatic Testing: Facility shall test any staff or residents who have signs or symptoms of COVID-19. Facility shall continue screening all staff, residents and other visitors.
Outbreak Testing: Facility shall test all active staff and residents in response to an outbreak (defined as any single new infection in staff or any nursing home onset infection in a resident). All staff and residents that tested negative will continue to be tested every three to seven days. This testing frequency will last until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least fourteen days since the most recent positive result.
Routine Testing: Facility shall test all staff based on the extent of the virus in the community, using CMS’ published county positivity rate in the prior week as the trigger for staff testing frequency (see table below):
|Community COVID-19 Activity||County Positivity Rate in the past week||Minimum Testing Frequency|
|Low||<5%||Once a month|
|Medium||5%-10%||Once a Week*|
|High||>10%||Twice a Week*|
*This frequency presumes availability of Point of Care testing on-site at the nursing home or where off-site testing turnaround time is within 48-hours
- Facility will adhere to Infection Prevention and Control Protocols for cohorting or isolating residents with CoronavirusDisease (COVID-19).
Facility will adhere to Screening Protocol for staff, visitors and residents. (Screening Protocol Procedures available upon request).
- Central Supply and Infection Preventionist Nurse monitors supply of personal protective equipment for staff. An inventory of PPE supplies is taken weekly to ensure adequate supply of gowns, masks, gloves and alcohol-based hand sanitizer. Additionally, supplies are ordered to maintain par level and allotment allocated from vendors are ordered. If needed, facility would reach out to RRHCP for assistance with PPE Supplies.
- In regards to adequate staffing, facility continues to hire for positions as needed. At the time of this plan, average staffing Per Patient Day is 3.3 nursing hours/patient day. (State Minimum is 2.7 PPD). If needed, facility would reach out to the National Guard and RRHCP for staffing needs in a crisis. Additionally, facility has agreements with staffing agencies.
- Facility will adhere to guidance for allowing communal dining and activities within CDC Guidelines to maintain social distancing, universal masking and hand hygiene and respiratory etiquette during communal dining and activities. It is the protocol to provide limited communal dining for COVID19 negative or asymptomatic residents only. Residents with respiratory or GI symptoms are not permitted to attend communal dining or communal activities. (Dining Protocol During COVID-19 available upon request).
Please note that If at any point during Step 1 of the reopening (14 consecutive days) there is a new facility onset of COVID-19 cases, the facility will cease Step 1 reopening and return to previous CDC guidance relating to the restriction of visitors and dining, respectively. After the new 14-day period, if there is no new facility onset of COVID-19 cases the facility may reinitiate Step 1 as described within the Facility Implementation Plan.
However, if from the date the facility enters Step 1, there is no new facility onset of COVID-19 cases for 14 consecutivedays the facility may move to Step 2.
Again, if at any point during Step 2 (14 consecutive days) there is a new facility onset of COVID-19 cases, the facility must cease Step 2 reopening and return to the previous CDC guidance restrictions relating to visitors and dining, respectively. Moving back to the guidance described restarts the 14-day period count. After the new 14-day period, if thereis no new facility onset of COVID-19 cases the facility may reinitiate Step 1.
From the date the facility enters Step 2, if there is no new facility onset of COVID-19 cases for 14 consecutive days the facility may move to Step 3.
- If at any point during Step 3 there is a new facility onset of COVID-19 cases, the facility must cease Step 1, 2, and 3 of reopening and return to the guidance as per CDC Guidelines to restrict visitors and dining, respectively. Moving back to the guidance restarts the 14-day period After the new 14-day period, if there is no new facility onset of COVID-19 cases the facility may reinitiate Step 1.
- If Luzerne county moves into the Red Phase, the SNF must return to the strict guidance in restricting visitors and communal dining, respec When the county moves back to the Yellow Phase, the facility may enter reopening again only when the prerequisites as discussed above as well as the absence of any new facility onset of COVID-19 case for 14 consecutive days since baseline COVID-19 testing.
Visitation Requirements- All Visitors Shall Adhere to Facility Screening Protocols
In order to safeguard the safety of our residents and the facility’s operations the following plan has been established for visitors:
- The schedule of visitation hours will be BY APPOINTMENT ONLY as follows during Step 2 & 3 of Reopening Skilled Nursing Facilities: Monday through Friday: 915am-430pm for visits in the NEUTRAL ZONE. Visits in the designated outside or inside neutral zone will be scheduled for up to 30 minutes.Saturday & Sunday: Virtual (Skype/Duo) Visits and/or Window Visits ONLY
-15 minute Virtual & Window Visits available on Weekends Only.
*Contact Laura Wingard, Activities Director at (570) 675-8600, ext 139
- Visitation will be available in designated neutral zone(s). Facility has determined the all-Purpose/Chapel Area for inside visitation and when weather permitting, the Pavilion will be utilized, as it provides coverage and shade.
- All Visitors will be screened, which will include COVID-19 screening questions and a pre- and post-temperature. Residents will be transported to the designated neutral zone for the limited visit, as visitors will NOT be permitted to enter resident care areas/ resident floor/room. Staff will monitor visitation to ensure compliance with social distancing, universal masking and hand hygiene. Visitor and resident must maintain social distancing of a six-feet distance during the entire visit.
- Designated staff will wipe down visitation areas after each visit. Staff will use an EPA-registered disinfectant to wipe down visitation area between visits and ensure proper wait time in between visits.
- There shall be no more than the allowable number of visitors per resident based on the facility’s capability to maintain social distancing and infection control protoc Facility has determined there shall be no more than six (6) resident visitations occurring simultaneously in a neutral zone.
- Facilities may leverage technology to use volunteers to perform scheduling activities rem
- Only residents residing in the unexposed (Green Zones) may safely accept visitors during Steps 2 and 3 of reopening.
- Visitation for residents with diseases that cause progressive cognitive decline (e.g., Alzheimer’s disease) and residents expressing feelings of loneliness will be given a priority.
- Each resident will be provided a facemask (if they can comply) to wear during the visit. Visitor MUST adhere with universal masking and observe social distancing during the entire visit.
- Children are permitted to visit when accompanied by an adult visitor, within the number of allowable visitors. Adult visitors must be able to manage children, and children older than 2 years of age must wear a facemask during the entire Children must also maintain strict social distancing. Facility will allow no more than two (2) adults to visit a resident OR 1 adult and 1 child. This will be strictly adhered to and visitors attempting to visit with more than the allowed number will not be permitted to visit.
- Visitors will NOT be permitted to access facility or facility grounds if they do not pass scree
- Alcohol-based hand rub will be provided to each visitor and demonstrated how to use it appropriately, if necessar
- Visitors must:
- Wear a face covering or facemask during the entire visit;
- Use alcohol-based hand rub before and after visit;
- Stay in designated facility locations;
- Sign in and provide contact information;
- Sign out upon departure; and
- Adhere to and pass screening protocols.
- In regards to Compassionate Caregiver Visitation, contact Social Services as to the protocol for limited visitation based on CMS Guidelines.
- Compassionate Care visitation is allowed in limited situations per CMS Guidelines. The Departmentrecognizes the connection between mental and emotional health and physical health, and that the effects of prolonged isolation may have such significant mental and emotional health impacts that a resident’s physical health becomes impair In these instances, facility shall work with the resident, family and staff to provide the resident with access to care needed to maintain or improve their health status.
- While CMS acknowledges that compassionate care situations may extend past end-of-life situations, these visits should not be routine, and allowed on a limited basis as an exception to restricting visitation.
Please note, during times of significant community transmission of COVID-19, Meadows Nursing and Rehabilitation Center will restrict visitation in order to protect residents and staff from outbreaks. TheDepartment has issued such guidance previously because of the direct connection between communitytransmission and outbreaks in facilities. There are times, however, when community transmission andfacility outbreak status allow for safe visitation, and at that time, safe visitation may resume based on Medical Director and Infection Preventionist RN guidance.
It is important to understand, facilities may still restrict visitation due to the COVID-19 county positivity rate, the facility’s COVID-19 status, a resident’s COVID-19 status, visitor symptoms, lack of adherence to proper infection control practices, or another relevant factor related to the COVID-19. However, facilities may not restrict visitation without a reasonable clinical or safety cause, consistent with §483.10(f)(4)(v). For example, if a facility has had no COVID-19 cases in the last 14 days and its county positivity rate is low or medium, a nursing home must facilitate in-person visitation consistent with the regulations
This implementation plan and protocols shall be in effect during Step 2 and Step 3 and through the duration of the Governor’s COVID-19 Disaster Declaration. The Department may update or supplement this guidance as needed.Please note our Implementation plan is subject to change based on CDC Guidelines & Orders of the Secretary of the Department of Health and Governor Wolf.