The Iowa Department of Public Health (IDPH) and the Iowa Department of Inspections and Appeals (DIA) began implementing guidance from the Centers for Medicare and Medicaid Services (CMS) for the phased reopening of Iowa’s long-term care facilities on March 13, 2020. On June 4, 2020, IDPH and IDA issued the Iowa Guidance on Phased Easing of Restrictions for Long-Term Care Facilities (Iowa LTC Guidance) which supports the CMS guidance. In attempting to return to normal operations, the state seeks to balance restrictions necessary to mitigate the spread of COVID-19 and the quality of life and dignity of the residents that reside in these facilities. Below is a brief summary of the phased plan. Long-term care facilities should thoroughly review the guidelines and work with DIA to ensure compliance.
Each Phase provides mitigation steps for the following considerations:
- Essential/Non-Essential Healthcare Personnel
- Non-Medically Necessary Trips
- Communal Dining
- Universal Source Control & Personal Protective Equipment (PPE)
- Cohorting & Dedicated Staff
- Group Activities
- Phase Regression
- Survey Activity
Phase 1 is designed for vigilant infection control and includes measures such as generally prohibiting visitors with certain exceptions; restricting entry of non-essential healthcare personnel; utilizing telemedicine whenever possible; limiting communal dining; routine staff and resident screening; requiring face masks; cohorting residents who are symptomatic or test positive for COVID-19; restricting group activities; routine testing in accordance with testing guidance; and limiting investigations to complaints alleging threats to residents’ health and safety.
Facilities must meet certain metrics before initiating Phase 2. These metrics include the following: 14 days since last positive or suspected case identified; adequate staffing levels; adequate supply of PPE; ability of local hospital to accept referrals/transfers; capable of cohorting residents; and a downward trend in number of cases over past 14 days in the county. Phase 2 involves an easing of some of the restrictions imposed in Phase 1, such as limiting but not completely prohibiting entry of visitors and non-essential healthcare personnel. Phase 2 also adds a new focus of Phase Regression to monitor the presence of COVID-19 in the building to determine if a return to Phase 1 is necessary.
Facilities must meet the same metrics described in Phase 2 before initiating Phase 3. In Phase 3, all residents should have the ability to have limited visitation; modified communal dining is allowed, and salons may open with some restrictions.
DIA plans to issue similar guidance for Iowa’s assisted living facilities on or around June 11th. Facilities should also expect additional guidance and information to be provided by DIA and/or IDPH as facilities begin to move through these Phases.
If you have any questions about how this guidance affects and/or should be applied to your long term care facility, please do not hesitate to contact one of the BrownWinick Health Law attorneys.