National Nursing Home Training Series: Week 6 Recap

COVID-19 Transparency: Resident and Family Notification

You probably didn’t go into health care to practice crisis communication. But make no mistake: as a long term care practitioner, you are already a seasoned crisis communicator. You have guided residents and families through life-changing decisions and accompanied them through their most important moments. Now you have an opportunity to display these skills to a larger audience in the COVID-19 era. Gayle Atherton, BSN, RN, CPHQ, CDP, a healthcare quality improvement specialist with TMF Health Quality Institute, and TMF Patient & Family Engagement Coordinator Nanci Newberry, MEd, BSN, RN, CPHQ, CPPS, described how to develop and manage a long term care stakeholder communications plan in their July 2, 2020 presentation for the Centers for Medicare & Medicaid Services (CMS) National Nursing Home Training Series. TMF is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Arkansas, Mississippi, Texas, Puerto Rico and the Virgin Islands.

Federal Requirements

Two entities are driving federal COVID-19 data collection and reporting requirements, including the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). Data reported to NHSN on resident impact, facility capacity, staff and personnel, supplies and personal protective equipment (PPE) and ventilator capacity and supplies are also available to anyone on Nursing Home Compare. Atherton summarized today’s federal requirements as follows:

  • Nursing homes must inform residents, their families and representatives of COVID-19 cases in their facilities by 5 p.m. the next calendar day if there is a single, confirmed COVID-19 infection among residents or staff or if three or more residents or staff display new-onset respiratory symptoms consistent with COVID-19 within a 72-hour period
  • Nursing homes are required to provide weekly cumulative updates to residents and resident representatives. Any notifications for COVID-19 incidence or symptoms must also include a weekly cumulative update
  • Updates should not include personally identifiable information (PII), but should describe efforts to prevent or reduce COVID-19 infections and any changes to normal operations
  • Nursing homes are expected to make reasonable efforts to make it easy for residents and their representatives to obtain this information.

The Communications Plan: A New Tool for Compassionate Care

It may be natural for communication to falter in the midst of staff and PPE shortages, testing availability challenges and visitor restrictions. And with examples of COVID-19 sensationalism in the media, your facility leadership may be wary to go beyond the minimum requirements for disclosure.

But Atherton noted that state surveyors are conducting interviews of residents and their representatives to confirm that they are receiving timely COVID-19 updates. It is also prudent to maintain proactive communication with local, state and federal governments, your state’s long term care ombudsman, local hospitals, emergency medical services, other long term care and residential facilities, community organizations – including those involved with disaster preparedness – and the media. Proactive communication with these audiences may mean a quicker resolution to PPE shortages later, or connections to valuable resources to help your residents and staff members stay safe and well cared for during the pandemic. Check out the Facility Communications section of the CDC Nursing Home Preparedness Checklist and the CMS Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes for ideas on how to structure a COVID-19 communications plan. 

The Tools

CMS guidance to nursing homes on reasonable efforts to keep residents and their representatives informed are important. Nursing homes are not expected to make individual phone calls to residents and families to inform them of new COVID-19 infections within the facility. Group emails, website postings, mailings and recorded telephone messages are valid options to keep these important stakeholders informed.

Mandated notifications may be general, but should become more detailed and customized for COVID-19-positive residents and their families. Newberry and the TMF team can recommend a variety of tools that help support patients and families during this time, whether it’s reducing isolation, learning what matters to the resident, tips on what to say and how to say it or initiating advance care planning conversations. A complete list of resources is available on www.QIOProgram.org.

Other valuable communication tips that Newberry has collected from nursing homes working with the TMF QIN-QIO include:

  • Customize your communication. Use the phone if the resident’s family does not have access to broadband internet. Engage interpreters when needed
  • Stay positive. For example, you can encourage staff members to call quarantined meals room service”
  • Offer options. Offer a greeting card to visitors who cannot see their family member in person, which can be delivered to the resident’s room
  • Facilitate video calls via FaceTime, Skype, Zoom and Google Duo (which allows multiple people to participate)

To Learn More

Download the TMF QIN-QIO slides and resources from the National Nursing Home Training Series page, visit www.QIOProgram.org to connect with the QIN-QIO serving your state or territory and sign up for updates about the CMS National Nursing Home Training Series.