ASSISTED LIVING/SENIOR HOUSING | Updated September 24, 2020 This compilation of frequently asked questions is provided to support assisted living providers as they navigate the challenges, requirements, regulations, recommendations, guidance, and other facets of the global COVID-19 pandemic. The information contained is a guide and resource. If you still have questions or need additional information after reviewing the resources and information contained in this document, please reach out to Vicki McNealley, Director of Assisted Living, via email or by calling (800) 562-6170, extension 107. The WHCA team continues to post updated information and resources on our website here. We encourage you to check back often for updates. WHCA will continue to send COVID-19 updates to share breaking information. QUESTIONS

How can I best prepare my facility and staff for a resident with COVID-19 and hopefully prevent it from coming into the facility? How is an outbreak defined? What are reporting requirements for COVID-19? What personal protective equipment do we need? What if my facility cannot care for a resident with COVID-19? What about independent living residents? Who should be tested for COVID-19? If an employee tests positive for COVID-19, when should they return to work? What are the legalities when a staff member is exposed at work? How do we safely reopen our facility? Can the local health jurisdiction impose more stringent expectations? Can facilities admit/re-admit residents now? Can residents leave the facility? Can we continue communal dining? Is DSHS doing onsite visits? What laws and regulations have been repealed? How does this affect direct care workers and administrators: background checks, training, licensing, and certification?

HOW CAN I BEST PREPARE MY FACILITY AND STAFF FOR A RESIDENT WITH COVID-19, AND HOPEFULLY PREVENT IT FROM COMING INTO THE FACILITY?

There are several ways to work to prevent COVID-19 from entering your facility and to prepare your facility for one or more residents having this infection. Because of the possible surge in COVID-19 cases in the community, it is imperative to determine how to best operate your building should residents testing positive remain in and/or return to your facility.

PREVENTION PREPARATION

There are many steps to take to minimize the likelihood of COVID-19 from entering the facility. Developing strong, effective policies, combined with consistent and frequent training, will minimize COVID-19’s stronghold and spread in the facility.

Infection Control: Policies and Training Ensure all staff have the following training from a qualified person, with return demonstration. All training should be documented as completed, with topic, name of attendee, and date.

Hand hygiene (including proper handwashing and use of hand sanitizer). An instructional video is available.

Donning and doffing PPE, including gloves, gowns, masks (medical-grade and N95), and eye protection. Instructional videos for donning and doffing are available.

Proper disposal of used PPE

Cleaning and disinfecting shared medical equipment (example: oximeters, blood pressure cuffs, stethoscopes, thermometers) and environmental surfaces

Methods to minimize cross-contamination

Policies and procedures related to COVID-19 and infection control (location of P&P and contents)

Signs/symptoms to watch for; how to report those findings, when, and to whom

Designate an Infection Control Specialist in the facility/company o This person should have additional training. Consider the CDC

training sessions.

Monitoring Residents

All residents should be monitored at least daily for signs and symptoms of COVID-19. This should be documented, and staff should follow up with any symptoms indicating possible infection. Symptoms to monitor include, but might not be limited to:

o Fever o New or worsening cough o Difficulty breathing

● DELINEATE AN INFECTION WING. This can be a cluster of rooms down a hallway–nothing special. This newly-formed area can serve several residents experiencing symptoms of COVID-19, all the while keeping distance from healthy residents and staff in other areas of the facility. Consider serving these residents in the same room/apartment, even if previously the room was meant for one resident only, in order to conserve staff efforts and improve care efficiencies. Ensure consistent staffing for this area as well, to minimize spread of infection. Each room should have gowns, goggles, masks, and gloves outside the door, along with hand sanitizer. If the resident’s cognitive status allows, alcohol-based hand sanitizer should be inside the room as well. A disposal box/trash can for used PPE should be placed just inside the room.

● PHARMACY SERVICES. Work with your long term care pharmacy to get a dedicated medication cart/box for the COVID-19 wing. This will minimize the need for staff to move from this wing to the remainder of the building for commonlyused medication items.

● COORDINATE AND COMBINE RESIDENT SERVICES. To save PPE and minimize staff exposure and possible spread of the infection, limit entry to COVID-19 rooms to identified staff only. By combining services, the PPE-donned staff member can tidy a room, serve a meal, provide resident care, gather laundry, and deliver medications/ treatments all in one visit.

● REVIEW POLST, ADVANCE DIRECTIVES. During these uncertain times, it is necessary to revisit each resident’s wishes regarding end-of-life decisions. These discussions, while difficult, are necessary to ensure the resident receives the level of care s/he prefers.

● REACH OUT TO OTHER PROVIDERS. Before you have a COVID-19 case in your building, reach out to your local hospital(s), hospice and home health agency(ies), and other long term care facilities. Discuss their expectations of you should a resident show signs of, or be diagnosed with, COVID-19. Discover other buildings around you that are currently serving COVID-19 cases.

o Chills o Repeated shaking with chills o Muscle pain o Sore throat o New loss of taste or smell o Decrease in oxygen saturation levels (SaO2)

Residents leaving their apartment should: o Wear a cloth face covering or a medical-grade mask o Practice hand hygiene o Distance oneself from others by at least six feet

Residents leaving the community should: o Participate in a risk assessment before leaving, to determine

steps to take upon the resident’s return o Be reminded to wear a face covering, practice hand hygiene

and social distancing while away

Monitoring Staff All staff, whether employed, contracted, or from outside agencies, must be screened upon entry to the building. This must be documented and documentation retained. Staff should be aware of immediate steps to take should they show signs of COVID-19.

All staff in the building must wear PPE; the type and amount depend on the exact job duties and potential exposure to COVID-19.

Staff should report to management immediately if they have been exposed to someone with a known case of COVID-19; these staff members should quarantine at home and get tested as soon as possible, returning to work when the LHJ advises that it is safe to do so. The CDC’s Preparedness Checklist will guide you in planning for COVID-19 infection in your building.

● Ensure you have enough PPE in the case of COVID-19 outbreak. Identify several reliable sources where you can gain access to items should the need arise.

● Develop and implement a Respiratory Protection Program in your facility.

If, due to limited staffing, lack of PPE, inability to delineate a section of your building for dedicated Covid-19 care, and/or resident condition, you are unable to care for a resident with COVID-19, you should consider reaching out to the resident’s case manager to determine alternate temporary placement for treatment. For residents who are privately paying for care and do not have a Medicaid case manager, you can email Geri-Lyn McNeill, Program Manager, DSHS Home and Community Services.

RESOURCES

Dear Provider Letter ALF #2020-024 Respiratory Protection Program Template CDC Coronavirus Disease 2019 (COVID-19) Preparedness Checklist for Nursing Homes and Other LTC Settings Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19 RCS Community Program Infection Prevention Assessment Tool for COVID-19

HOW IS AN OUTBREAK DEFINED?

An outbreak is defined as at least one resident or healthcare worker with confirmed COVID-19, or one resident with severe respiratory infection resulting in hospitalization or death, or two or more residents or healthcare workers with new-onset respiratory symptoms consistent with COIVD-19 within 72 hours of each other. An outbreak ends 28 days from the date of the last onset of symptoms or from the last positive test of an asymptomatic person, whichever is longer.

RESOURCES

Interim COVID-19 Outbreak Definition for LTC and Residential Facilities (DOH)

WHAT ARE REPORTING REQUIREMENTS FOR COVID-19?

REPORTING TO LOCAL HEALTH JURISDICTIONS REPORTING TO DSHS

Healthcare providers and healthcare facilities must report suspected or confirmed resident and staff cases of COVID-19 to their local health jurisdiction.

● Information on how to report to your local health jurisdiction ● Washington State Local Health Jurisdictions

Your local health jurisdiction is not just a reporting center, but a resource to you. They direct and provide guidance on determining when sick staff can return to work and how to best quarantine a sick resident. When you first report an issue to your local health jurisdiction, be sure to get a point of contact’s name and telephone number/email for follow-up questions and reporting needs.

It is also recommended that you notify all residents and their family members, along with all employees, for the initial positive case. Subsequent cases should include notification to staff as well, to implement transmission-based precautions and minimize any inadvertent nonessential contact. AHCA/NCAL has provided sample template letters for residents and families.

Suspected or confirmed resident cases must also be reported to the Residential Care Services Complaint Resolution Unit (CRU). AHCA/NCAL suggests reporting positive staff cases to the CRU as well.

● Residential Care Services CRU at (800) 562-6078 or online: Online Incident Reporting

In an April 20, 2020, Dear Provider letter, DSHS requested that providers and agencies update COVID-19 data using an online tool. (This does not replace the regulatory obligation to notify RCS CRU as noted in the previous paragraph.) Two additional data fields to report the number of COVID-19 deaths and hospitalizations have been added to the online tool. These two new data points support statewide level data collection and analysis to assess COVID-19 impacts for long term care facilities and agencies. Please be prepared to provide this information when completing bi-weekly updates. Click here for additional instructions and field definitions.

RESOURCES

AHCA/NCAL Notification Letter

WHAT PERSONAL PROTECTIVE EQUIPMENT DO WE NEED?

ALL COUNTY INFORMATION ADDITIONAL KING COUNTY-SPECIFIC INFORMATION

Personal Protective Equipment (PPE) including masks, gloves, eye protection, and gowns are essential for mitigating the spread of COVID-19 in long term care facilities. Due to the unprecedented national shortage of PPE, it has been difficult for long term care facilities (LTCFs) to secure the PPE they need.

The State Department of Health released guidelines for PPE allocation. These guidelines elevate LTCFs without a case to the Tier #1 category and define LTCFs as including nursing facilities, assisted living facilities, adult family homes and supportive living providers.

Cloth masks should not be worn for patient care unless you are in a crisis standards of care situation.

All long term care facilities are instructed by DSHS to purchase necessary personal protective equipment. In the event of an urgent shortage, facilities should notify their local emergency management agency (EMA) or local health jurisdiction. If these backup sources cannot fulfill the request, facilities may notify DSHS and request an emergency 7-day supply.

DSHS has limited supplies of PPE. You can order them through the online store; although, there is no guarantee that you will receive the items ordered.

It is recommended that assisted living communities secure private means to obtain PPE to ensure you have consistent delivery of necessary items.

To request PPE from the King County Office of Emergency Management, please fill out the form attached and send your request via email to rcecc.logs@kingcounty.gov. The deadline for weekly submission is each Wednesday at 12:00 p.m.

RESOURCES

CDC guidelines on cloth masks Local Health Jurisdictions L & I Instructions on Use of PPE DOSH Guidance on fit-testing for N95 Filtering Face Pieces

WHAT IF MY FACILITY CANNOT CARE FOR A RESIDENT WITH COVID-19?

If you are unable to isolate a resident who has tested positive, or the resident’s condition is not stable or predictable, or you do not have enough PPE or are experiencing staffing limitations, you may be unable to keep the infection contained and meet the needs of the resident(s). If that is the case, you can consider reaching out to a COVID-19 dedicated skilled nursing facility for temporary placement and care of a resident with COVID-19. The following facilities have contracts with DSHS to provide COVID-19 care in dedicated units. Avalon Health & Rehabilitation Center – Pasco | ADM Mark Weerasinghe | Tel (509) 547-8811 Avamere Transitional Care of Puget Sound | ADM Allyson Jenkins | Tel (253) 671-7300 Ballard Care and Rehabilitation | ADM Kayla McDaniel | Tel (206) 782-0100 Richmond Beach Rehab | ADM Rosie Velasco | Tel (206) 546-2666

WHAT ABOUT INDEPENDENT LIVING RESIDENTS?

Residents living in assisted living communities who receive no services, or “independent living residents,” should be screened daily for COVID-19 symptoms, just like assisted living residents are screened. This is to ensure the building as a whole is effectively managed and infection transmission minimized.

WHO SHOULD BE TESTED FOR COVID-19?

COVID-19 testing must be ordered by a doctor, nurse practitioner, or physician’s assistant and administered correctly in order to obtain accurate results. It is important to vet laboratory services to ensure the testing is authentic, being analyzed by a certified lab, and to determine how test results are communicated to the patient (or facility) and to Department of Health officials. If you have questions regarding COVID-19 testing for residents and/or staff, please contact the prescribing practitioner and/or your local health department for information and further direction.

Nurses in the assisted living facility can perform COVID-19 tests in house via swabbing; qualified nursing assistants can also do this under the general direction and supervision of a registered nurse. Home care aides can perform swab testing via nurse delegation. It is highly recommended that the assisted living facility secure standing orders for COVID-19 testing for all residents, in the event a resident shows symptoms or is otherwise exposed.

Questions regarding the statewide testing can be referred directly to the Department of Health via their email contact line doh-cbts.imt@doh.wa.gov. Questions that cannot be answered by the Department of Health staff will be referred to the RCS Policy Unit. Questions are being compiled and updated on a DOH FAQ document.

In the event that your facility has an outbreak, you will follow the testing directions of your local health jurisdiction representative.

The federal government is planning to send antigen testing kits to all assisted living facilities in the nation. WHCA will update members with details as more information becomes available.

RESOURCES

Department of Health Guidance on Testing Dear Provider Letter DOH FAQ Document on Statewide Testing

IF AN EMPLOYEE TESTS POSITIVE FOR COVID-19, WHEN SHOULD THEY RETURN TO WORK?

CDC has guidance on best practices for staff who have tested positive (both symptomatic and asymptomatic). This guidance offers directions on when staff can return to work. While this guidance does not address every situation, it is a recommended guide to assisted living facilities. Your local public health department is your resource for guidance and direction if you have questions regarding employee exposure and restrictions.

RESOURCES

CDC Return to Work Guidance for Health Care Workers Local Public Health Jurisdictions

WHAT ARE THE LEGALITIES WHEN A STAFF MEMBER IS EXPOSED AT WORK?

Many thanks to Lane Powell for this guidance.

When one of your staff is exposed to a COVID-positive fellow employee, there are some suggestions and considerations under this scenario: Follow CDC and Local Guidelines It is important to follow CDC and local health department guidelines. This can be a challenge in a high-risk work environment where guidance can change rapidly. The CDC has guidance for risk assessments for health care providers here and advice on returning health care providers to work after COVID exposure here. Inform Other Employees of Potential Exposure but Maintain Confidentiality Employers should inform employees of any known COVID-19 cases in the work environment (while keeping the identity of the infected employee confidential) so that employees can obtain testing and a diagnosis if they think they have been exposed. Use of Paid Time Off Health care professionals who have possibly been exposed should be allowed to use sick or personal time off to obtain a diagnosis from a provider, and also use that sick or personal time off to fully recover from the virus if the diagnosis is positive. In general, the use of sick or personal leave should be strongly encouraged among staff to keep patients and staff healthy. In addition to employer-provided sick leave and personal time off, the Families First Coronavirus Response Act (FFCRA) provides 14 days of emergency paid sick leave for six different qualifying events. Qualifying events for FFCRA Paid Sick Leave include where an employee has been advised by a health care provider to self-quarantine and where an employee is experiencing symptoms of COVID-19 and seeking a medical diagnosis. The FFCRA does allow for health care providers to be exempted from utilizing FFCRA emergency paid sick leave. However, the government has encouraged employers to be “judicious” when exempting health care providers from the FFCRA paid emergency sick leave in order to minimize the spread of COVID-19. The Department of Labor has noted that, “For example, an employer may decide to exempt these employees from leave for caring for a family member but choose to provide them paid sick leave in the case of their own COVID-19 illness.” More information on FFCRA Emergency Paid Sick Leave can be found here. Also, please note that if employees are working in Seattle and want to use Seattle Paid Sick and Safe Time leave, there has been a change to the verification requirement. Previously, an employee was required to have a health care provider verify the need for sick leave. The new temporary rule essentially suspends this process by declaring that requiring health care provider verifications is a per se unreasonable burden to both the employee and the health care system during the COVID-19 public health emergency. Under the new rule, an employee remains free to choose to provide a health care provider’s note, if it is available to them. Potential Return to Work Testing CDC and DOH recommend time as opposed to testing in order to return to work. Employers may require an employee who has been exposed to take a COVID-19 test prior to returning to work, but the employer should pay for the cost of the test and compensate the employee for the time necessary to obtain the test. Additional Questions If you have additional questions, Lane Powell has a list of questions and answers to various scenarios that may happen in members’ facilities here.

HOW DO WE SAFELY REOPEN OUR FACILITY?

HOW DO I FIND WHAT PHASE MY FACILITY IS IN? WHAT ARE THE RESTRICTIONS ON VISITORS?

There are several factors you must address before determining your facility’s phase for the Long Term Care Safe Start plan. The following must be in order before determining your phase:

Access to adequate testing for residents and staff should the need arise; that includes access to a commercial laboratory for processing the tests. The facility must have the capacity to conduct ongoing testing; and

A response plan, including cohorting (or, if not possible, temporarily transferring residents to another care setting) and other infection control standards, should COVID-19 enter the building; and

Active screening of all staff and visitors per DOH guidelines; and

A plan to promptly identify and isolate potentially infected residents; and

Secure enough PPE to last at least 14 days.

Once all of these issues have been addressed, you may determine the phase in which your facility is situated. Please note that your facility might not be in the same phase as the greater county due to an increase in county-wide infections. Also, your facility cannot be in a phase beyond your county’s current phase. Follow the Safe Start for Long Term Care plan based on the phase your facility is in.

Should the county infection rate increase, you will be expected to “pause” your advancement towards the next phase; you will not be expected to move “backwards” to a previous phase. Additionally, should an outbreak occur in your facility, you will follow the guidance of the local health jurisdiction representative.

Depending on the phase in which your building is currently situated, visitors may be allowed inside the facility. All residents without symptoms or currently diagnosed COVID-19 may have up to two visitors each day when certain criteria are met for outside visits no matter the facility’s current phase. Click here for to access “What is Allowed for Long Term Care Facilities Visitation” guidance.

Compassionate care visits are made on a case-by-case basis and available in all phases. All visitors except EMS staff should be screened for symptoms (including temperature) upon entry, and facilities should require appropriate hand hygiene and require that PPE be worn.

Facilities should communicate through multiple means to inform individuals of visitation restrictions, such as through signage at entrances/exits, letters, emails, phone calls, and recorded messages for receiving calls.

RCS licensors and/or complaint investigators may enter your building to conduct investigations; local ombuds may also enter your facility. They must sign in and go through the same screening as other visitors; they must also bring their own PPE as necessary, based on the situation.

WHAT OUTSIDE HEALTHCARE SERVICES PROVIDERS SHOULD BE CONSIDERED “ESSENTIAL HEALTH CARE PROVIDERS”?

WHAT IS AN ESSENTIAL SUPPORT PERSON?

If your facility is in Phase 1 of the Safe Start for Long Term Care, only essential health care providers may enter the building. The identification of “essential health care providers” is determined on a case-by-case basis. The goal of restricting visits in long term care facilities is to limit exposure, particularly given the high mortality rate for seniors and those with complicating conditions. The risk-benefit analysis should consider whether the health care service is necessary, and/or related to compassionate care at end-of-life.

In the event that a resident is unable to visit in an outside setting, and only for buildings situated in Phases 2 or 3, an essential support person (ESP) can be designated for the resident. Each facility must establish policies and procedures for how to designate and utilize an ESP. The resident must be consulted to determine who their ESP shall be. In order to ensure limited indoor visits at any given time, the facility can outline the number of ESPs it shall allow in the building at any given time, as well as establish time limits on individual ESP visits to keep residents safe. The ESP must wear all necessary

PPE when in the facility. Of note, ESPs may not visit residents who are experiencing symptoms of COVID-19, are COVID-19 positive, or during a resident’s 14-day quarantine unless the visit is a compassionate care visit.

SHOULD I RESTRICT ENTRY BY THE LTC OMBUDS? HOW DO WE MANAGE STAFF ENTERING/LEAVING THE BUILDING?

Residents still have the right to access the Ombuds program. Their access to in-person visits should not be restricted unless there is a COVID-19 outbreak in the facility. If in-person access is not available due to an outbreak, facilities need to facilitate resident communication (by phone or other format) with the Ombuds program or any other entity identified in RCW 70.129.090.

You must screen all staff for fever and other symptoms of COVID-19 at the beginning of the work shift. Should any staff person show symptoms, they should be given a mask to put on and sent directly home. Staff should also perform “self checks” throughout their shift and report any symptoms to a designated manager, don a mask, and immediately go home.

You may want to consider requiring symptom checks to be conducted again, and documented if a staff person leaves the building at any time during their shift and returns to the building.

HOW DO WE LIMIT ENTRY DOORS?

For buildings with multiple entrances, it is encouraged that you secure all entries except the main entry; this will allow you to better track all people who enter and leave your community. Instruct staff and residents to use only one entry/exit point. Post signs on all entrances, directing the reader to the appropriate method of entry and alternate ways to communicate with staff and residents. This includes state agency staff and other regulatory bodies.

RESOURCES

CDC guidelines for LTC Facilities Safe Start for Long Term Care Visitor “What is Allowed for LTC Facilities” Form Outdoor Visitation for LTCF (DOH) Visitor log (DOH) LTC Ombuds Re-Entry Notification

CAN THE LOCAL HEALTH JURISDICTION IMPOSE A MORE STRINGENT EXPECTATIONS?

Your local health jurisdiction can impose additional criteria for the facility in an effort to minimize the spread of COVID-19. Examples of enhanced limitations may include strict isolation of all residents to their rooms/apartments, additional vital sign monitoring, and/or daily phone contact with the local health department.

CAN FACILITIES ADMIT/RE-ADMIT RESIDENTS NOW?

CAN WE/SHOULD WE CONTINUE TO ADMIT RESIDENTS NOW?

Providers should conduct an internal risk assessment to determine the policy for admitting new residents. In the event of an outbreak, a representative from your local health jurisdiction may limit your ability to move in residents. Providers should consider several factors when considering move-ins. First, if you would have admitted or readmitted that person prior to the COVID-19 outbreak, there is no reason not to admit/readmit now. The pre-admission assessment will determine whether the prospective resident is stable and predictable. Current symptoms for COVID-19 should be considered as part of that assessment. If the resident is exhibiting signs of COVID-19, you may want to ensure the individual is tested for the virus and you have testing results prior to agreeing to admission. While the AHCA guidance below is focused on skilled nursing facilities, the admission considerations may apply to assisted living facilities. DOH and DSHS expects providers to quarantine newly-admitted/re-admitted residents for 14 days; this practice is beneficial in limiting the spread of the infection, particularly since individuals may be asymptomatic for a time before testing positive. If you are implementing this precautionary practice, ensure residents and their families are aware and agree to this standard.

Before admitting a resident, the provider must also consider staffing and the amount of PPE on hand, should the prospective resident’s condition warrant droplet precautions.

RESOURCES

Chapter 388-78A-2050 – Resident Characteristics

CAN RESIDENTS LEAVE THE FACILITY?

While visitors may be limited, there are no limitations on residents, whether they be AL or IL residents, leaving the facility. It is recommended that management explain the possible risks of leaving the community, including exposing oneself, all other residents, family and staff. Alternatives to family visits can be accomplished through facilitating telephone or video chat methods. Likewise, should a resident need something at a local pharmacy or grocery store, management may consider running errands or working with the resident’s family to run errands to minimize the resident’s need to leave.

If a resident chooses to leave, it is recommended that a risk assessment be completed before they leave to determine the potential level of exposure, and that they be screened upon return, and continually screened for symptoms following the facility’s protocol.

Residential Care Services has issued a Dear Administrator Letter with additional guidelines regarding residents leaving the facility.

RESOURCES

Risk Assessment Template to Assess COVID-19 Exposure Risk for Residents/Clients After Community Visits

CAN WE CONTINUE COMMUNAL DINING?

HOW DO WE MANAGE COMMUNAL DINING/MEALS?

The ability to offer communal dining depends on the Safe Start for Long Term Care phased re-entry requirements. If your facility currently has a COVID-19 outbreak, you will want to follow the instructions of your local health jurisdiction representative; guidance might include cancelling communal dining.

Communal dining should feature social distancing, cleaning and disinfecting strategies, staff wearing masks, and residents wearing masks/face coverings unless eating or drinking.

RESOURCES

Safe Start for Long Term Care

IS DSHS DOING ONSITE VISITS?

DSHS is conducting onsite infection control visits in response to facility and community reports of COVID-19 cases in the facility. DSHS has also begun investigating complaints and has stated they plan to return to routine inspections in October.

WHAT LAWS AND REGULATIONS HAVE BEEN REPEALED?

In an effort to allow maximum flexibility in responding to this outbreak, state agencies are working tirelessly to repeal laws and regulations that will make it difficult for providers to meet the needs of their residents during this national emergency, including:

● Repeal of caregiver training and certification requirements in Chapter 388-112A ● Repeal of certain administrator training requirements in Chapter 388-78A ● Repeal of TB testing of staff upon hire; WAC 388-78A-2480 and WAC 388-78A-248(1) are waived ● Elimination of certain Resident’s Rights provisions (related to visitors, etc.), particularly during an outbreak and increased community infection rates ● Relaxed resident eligibility and financial screening requirements ● Repeals of continuing education requirements for licensed and certified staff members

RESOURCES

Click here for a synopsis of laws and rules that are rescinded through October 1, 2020.

HOW DOES THIS AFFECT DIRECT CARE WORKERS AND ADMINISTRATORS: BACKGROUND CHECKS, TRAINING, LICENSING, AND CERTIFICATION?

REPEALED WAC 388-112A NURSE DELEGATION

The Legislature has waived all of WAC 388-112A until October 1, 2020. This includes home care aide training and certification, orientation/safety training, specialty training (dementia, mental health, and developmental disabilities), CPR/First Aid, and continuing education requirements. It is expected that any staff hired during this time will receive orientation to the building and to their job, and a state background check. As classes resume, it is important to register students for required classes in an effort to minimize backlog once the waivers are lifted.

Caregivers who have not yet started or completed nursing assistant or home care aide training can apply for a nursing assistant registered (NAR) through the Washington State Department of Health, complete the nine hour nurse delegation core self-study and pass the exam in order to perform delegated tasks taught by a RN. If the nursing assistant will be administering insulin, the three-hour Focus on Diabetes delegation class must also be successfully completed. Temporarily during the outbreak, DSHS has extended the nurse delegation visits from 90 days to 120 days, with the allowance for remote and/or video-based assessments and competency evaluations based on the RN delegator’s judgment.

EMERGENCY INTERIM PERMITS TEMPORARY PRACTICE PERMITS

When a nursing student has graduated from a nursing program and before they take the national exam (for LPNs, RNs and ARNPs), they can apply for licensure following the online process. After the college/university sends the certificate of completion confirming completion of the program, the licensing unit has received the official transcripts, and the applicant has registered for the national examination, licensing staff can issue an emergency interim permit allowing the applicant to work as a nurse during the declared emergency. When testing is available again, nurse applicants are required to take the national exam to complete the process for permanent licensing.

At this time, the Nursing Commission recommends applying for nurse licensure through the online license application process. Please submit a complete packet of required information to ensure no unnecessary delay. If you are endorsing your license from another state, please complete licensure verification online. We encourage the submission of electronic transcripts; please have your college or university return the transcript to nurselicensing@doh.wa.gov. A temporary practice permit is valid for 180 days, or until the Nursing Commission issues a permanent license. If the emergency extends beyond 180 days, the Commission may grant extensions. The Commission is making it a priority to process temporary permit applications in King, Pierce and Snohomish Counties. Click here for information.

FINGERPRINTS AND FBI CRIMINAL BACKGROUND CHECKS UNIFORM EMERGENCY VOLUNTEER HEALTH PRACTITIONER ACT

The state of Washington is resuming fingerprint background check operations, and while the standard is currently waived, we strongly recommend that workers register and schedule appointments to have fingerprints taken. The requirement for fingerprints for out-of-state applicants is temporarily waived during the emergency and will be required when the emergency ends. Applicants will receive directions on fingerprinting. State Patrol background checks through the BCCU are still required. There is a process for priority checks. Fingerprint checks for administrators, caregivers, and nurses have been waived during this time; state background checks are still required upon hire and every 24 months. Click here for information on scheduling required fingerprint background checks.

Also commonly referred to as RCW 70.15. Licensed nurses from Washington or other states with no prior disciplinary history may apply to work in Washington without further licensing requirements. Find information, including FAQs, and the application on the Emergency Volunteer Health Practitioners webpage.

The DOH Office of Emergency Preparedness and Response manages the placement of nurses based on need. Nurses may accept voluntary or paid assignments. This is not a substitute for Washington licensure and is available only during the time of the Governor’s emergency proclamation.