DOH Issues New Directives on COVID-19 Return to Work and Cohorting of Residents
The Department of Health (DOH) issued two letters to nursing home administrators on April 29th extending the period of COVID-19-related exclusion from work for nursing home staff and requiring cohorting of residents with COVID-19. The work exclusion guidance requires nursing homes to exclude from work employees who test positive for COVID-19, but are asymptomatic, for 14 days from the "first positive test date." The guidance also requires exclusion from work of symptomatic employees until 14 days after symptom onset, provided that three days (72 hours) elapse since the resolution of fever without fever-reducing medications and respiratory symptoms are improving. The guidance acknowledges that these restrictions exceed the 10-day exclusion period set forth in the Centers for Disease Control and Prevention's (CDC) symptom-based and time-based return to work strategies. The DOH guidance does not reference the CDC's test-based strategy for determining eligibility for returning to work. According to DOH staff, the State’s extended exclusion period applies only to nursing home staff and not other health care facility or home care agency staff.
The work exclusion letter further directs nursing homes to the State’s health care workforce recruitment portal at Covidstaffingportal@exec.ny.gov. Nursing homes that request assistance through this portal will receive login credentials to access the database of recruits, along with a user manual and video. Facilities will have to screen and interview candidates and negotiate a compensation arrangement. Other workforce resources for LeadingAge NY members are available here.
The second of the two DOH letters to nursing home administrators includes a series of reminders of existing infection control requirements and adds a requirement to cohort residents into COVID-19-positive, negative, and unknown groups, with dedicated staff for the positive and "non-positive" residents. The letter instructs nursing homes to transfer residents within a facility, to another facility, or to a non-certified location if they are unable to successfully “separate out residents.” Nursing homes that are unable to find a transfer destination for residents are directed to call 518-474-2020. The letter further notes that facilities that are unable to meet infection control standards must suspend admissions. According to the letter, a failure to adhere to these requirements will result in civil monetary penalties and/or a license revocation.
In a related call on April 30th, DOH staff noted that nursing homes should accept and retain only residents whom they are able to care for in accordance with regulations. DOH staff stated that facilities should ensure that they have adequate personal protective equipment (PPE). Although DOH staff noted that facilities should make the PPE "accessible in common areas," this is contrary to CDC guidance on PPE conservation which recommends that "[a]ll facemasks...be placed in a secure and monitored site." In addition, DOH staff reminded facilities that focused infection control surveys of nursing homes are ongoing. These surveys will be expanded to include adult care facilities (ACFs). Facilities are reminded to refer to the Centers for Medicare and Medicaid Services (CMS) COVID-19 focused survey tool and DOH checklist to evaluate their infection control processes. More information on the focused surveys is available here.
Both of the April 29th letters leave important implementation questions unanswered, raise significant questions regarding interaction with other regulatory requirements, and generate feasibility concerns. LeadingAge NY has raised these questions and concerns with DOH and will keep members posted as answers are provided.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838