Office of Health Facility Licensure & Certification Nursing Home COVID-19 Reopening Plan As announced by Governor Jim Justice, beginning on June 17, 2020, visitation at nursing homes may resume at facilities that have had no cases of COVID-19 for the fourteen consecutive day period immediately preceding June 17, 2020 (i.e., since June 3, 2020), provided that the general framework outlined below is followed by such qualifying facilities. For facilities that will not qualify to open on June 17, 2020, such facilities may resume visitation upon achieving fourteen consecutive days with no COVID-19 cases at such facilities, provided, again, that the general framework outlined below is followed. Background for Nursing Home COVID-19 Reopening Plan On March 12, 2020, visitation at nursing homes in West Virginia was prohibited, recognizing the particularly vulnerable congregate populations at such facilities. On April 17, 2020, Governor Justice issued an Executive Order to test all residents and staff at every nursing home throughout the state. West Virginia was the first state to take this critical step to protect nursing home residents, and it has since been recommended by the Centers for Disease Control and Prevention (CDC) that all states follow suit and test these vulnerable populations. Under the leadership of Governor Justice, West Virginia has led the nation with an effective and proactive response to COVID-19, especially for the vulnerable nursing home population. On May 18, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a guidance memo to assist states in developing nursing home reopening plans. In response to this memo, the Office of Health Facility Licensure and Certification assembled a work group to develop a plan for the state. The West Virginia Nursing Home Advisory Council formed the basis for this group. This Work Group convened on May 26, 2020 and, again, on June 11, 2020, to review the CMS guidelines for reopening nursing homes and to provide input to the Office of Health Facility Licensure and Certification who, in turn, developed this reopening framework. The framework below suggests a general framework that nursing homes should utilize in determining how to facilitate safe visitation at their facilities. Each facility is unique in its layout, geography, resident population, and needs. Therefore, the recommended phases outlined below include recommendations designed to provide for the safety of residents, staff, and visitors alike, while allowing facilities the flexibility to determine the best implementation strategy for their specific operations. Additionally, many aspects of the virus and its properties remain unknown. This framework is based on current knowledge, and may be revisited from time to time as knowledge of the virus changes. Nursing Home COVID-19 Reopening Plan Phase Red is our current status to achieve mitigation of COVID-19 transmission regardless of community transmission. The Re-Opening Plan uses three phases to define reopening activities. These three phases are Phase Blue, Phase Yellow, and Phase Green. Phase Red: Active Covid-19 positive residents or positive residents within the last 14 days are in Phase Red. Screening • Screen 100% of all persons entering the facility • Screen 100% of residents at least daily Visitation • Compassionate care only Non-essential personnel • No non-essential personnel Trips outside the facility • Only medically necessary trips outside the facility Communal dining • No communal dining Group activities • No group activities Page 1 Phase Blue: At any time during Phase Yellow or Phase Green, if two or more residents test positive, or if it is determined that there is substantial community spread as defined by the Bureau for Public Health, the facility will enter Phase Blue. Screening • Remains the same as Phase Red Visitation • Compassionate care only Non-essential personnel • Non-essential healthcare personnel, including medical providers, allowed in the facility • Facilities may allow other non-essential personnel if they will not be entering any direct care areas Trips outside the facility • Only medically necessary trips outside the facility Limited communal dining • Limited communal dining based on medical necessity • 6 ft. social distancing must be maintained • Proper hand hygiene must be used by residents • Residents must wear face covering, as tolerated, to and from the dining area Limited group activities & • Limited group activities and therapy allowed if 6 ft. social distancing can be therapy maintained • Group activities and therapy must take place in a facility-designated location • Proper hand hygiene must be used by residents • Residents must wear face covering, as tolerated, to and from the activity or therapy Limited salon services • Beauticians and manicurists can provide services to residents on a limited basis if the safety guidelines required for hair salons, nail salons, and barber shops, as applicable, can be maintained. Phase Yellow: Facilities with no COVID-19 positives, and/or no substantial community spread for the immediately preceding 14 days, beginning no sooner than June 17, 2020, will enter Phase Yellow. Screening • Remains the same as Phase Red Limited Visitation • No more than two visitors allowed at the same time, by appointment only • Visits must take place in a facility-designated location • Time limitations may be imposed at facility’s reasonable discretion • No visitors under 12 years old • Visitors must wear face covering at a minimum, maintain 6 ft. social distancing, and use proper hand hygiene Non-essential personnel • Non-essential healthcare and other personnel and contractors may be allowed as determined necessary by the facility • Must maintain 6 ft. social distancing, use proper hand hygiene, and wear face covering Trips outside the facility • Only medically necessary trips outside the facility Communal dining • Communal dining allowed if 6 ft. social distancing can be maintained • Proper hand hygiene must be used by residents • Residents must wear face covering, as tolerated, to and from the dining area Group activities & therapy • Group activities and therapy allowed if 6 ft. social distancing can be maintained • No more than 10:1 ratio, resident to staff • Group activities and therapy must take place in a facility-designated location • Proper hand hygiene must be used by residents • Residents must wear face covering, as tolerated, to and from the activity or therapy Salon services • Beauticians and manicurists can provide services to residents if the safety guidelines required for hair salons, nail salons, and barber shops, as applicable, can be maintained. Page 2 Phase Green: Facilities that have progressed 14 consecutive days under Phase Yellow with no COVID-19 positives and no substantial community spread will enter Phase Green. Screening • Remains the same as Phase Red Visitation • Number and age of visitors allowed to be determined by facility • Visitation by appointment only • Visits must take place in a facility-designated location • Time limitations may be imposed at facility’s discretion • Visitors must wear face covering at minimum and use appropriate hand hygiene Non-essential personnel • Non-essential personnel and contractors allowed in the facility • Must maintain 6 ft. social distancing, use proper hand hygiene and wear face covering Trips outside the facility • Only medically necessary trips outside the facility Communal dining • Communal dining allowed if 6 ft. social distancing can be maintained • Proper hand hygiene must be used by residents • Residents must wear face covering, as tolerated, to and from the dining area Group activities • Group activities allowed if 6 ft. social distancing can be maintained • Proper hand hygiene must be used by residents • Residents must wear face covering, as tolerated, to and from the activity or therapy Salon services • Beauticians and manicurists can provide services to residents if the safety guidelines required by hair salons, nail salons, and barber shops, as applicable, can be maintained Alterations to the Reopening Plan OHFLAC will collaborate with the Work Group to address any revisions to the reopening plan as may become necessary based on ever-increasing knowledge of the virus. As facilities work through the reopening phases, if changes are identified to better meet the needs of residents, the Work Group will meet to recommend revisions as needed. Waiver or Variance Facilities may request a variance to move more quickly through the phases and/or to expand on visitation and services. Facilities would need to submit a waiver request to OHFLAC for such a variance. OHFLAC will issue guidance for what facilities should include in any such requests. OHFLAC will also consult with the Bureau for Public Health on such requests. Facility Self-Certification of Phases A facility shall notify OHFLAC as it enters each phase. New Admissions New facility admissions may not be eligible for visitation, communal dining, group activities, or salon services for, at least, 14 days. Testing Following the completion of facility-wide baseline testing, facilities should consider testing residents and/or staff under the following circumstances: • • There is substantial community spread; or Two or more residents are symptomatic. Personal Protective Equipment Proper use of PPE, as determined or recommended by CDC and CMS guidelines, must be maintained throughout all phases. Page 3