Senior-Living Advocates Call for HHS to 'Evolve' Its COVID-19 Guidance

Extend the Public Health Emergency, reinstate the nurse aide waiver, and loosen 'rigid' protocols, says letter from AHCA/NCAL.

With new COVID-19 variants emerging and flu season approaching, the U.S. Department of Health and Human Services (HHS) is being asked to extend the Public Health Emergency (PHE), reinstate the nurse aide waiver, and loosen “rigid” protocols.

Those requests were made by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) in a letter to Xavier Becerra, HHS secretary from Mark Parkinson, AHCA/NCAL president and CEO.

PHE Extension

Extending the PHE beyond its current October 13, 2022, expiration will ensure that long-term care facilities have the resources to protect their residents, the letter says.

“COVID-19 variants continue to emerge, and the latest BA.5 variant is causing an increase of cases among the general public across the country. The prevalence of COVID-19 in the broader community has an impact on long-term care residents and staff,” Parkinson writes.

“As we head into influenza season this fall, we need to ensure our healthcare infrastructure can quickly adapt, especially should a future variant elude the protection of our vaccines. Extending the PHE is critical to ensure states and healthcare providers, including long-term care providers, have the flexibilities and resources necessary to respond to this ever-evolving pandemic,” the letter says.

Nurse aide waiver reinstatement

AHCA/NCAL also asks for the reinstatement of the 1135 waiver on training and certification of nurse aides to support retaining temporary nurse aides (TNAs) “who have been a valuable member of the care team during this pandemic.”

The waiver ended June 6. TNAs who began the certification process then have the traditional four months’ time to become certified, meaning they must become certified before October 6, 2022, to continue working as a nurse aid.

Request to loosen 'rigid protocols'

Much like COVID has mutated and evolved into less-severe variants, HHS must evolve COVID protocols, to include long-term care facilities, the letter says.

For six months running, the rate of COVID-19 deaths among nursing home residents has been less than 1 per 1,000 residents, due in large part to the fact that nearly 85% of them have received at least one booster dose, which is higher than the percentage of Americans over the age of 65 who have done the same (70%), the letter says.

“Despite the progress we have made, nursing homes still must follow extremely stringent COVID-19 protocols in the areas of masking and personal protective equipment (PPE), testing, reporting, visitor screening, and isolation periods—or face harsh penalties,” the letter says. “Meanwhile, there are concerning reports that other healthcare settings are held to different standards with little to no consequences for failing to adhere to COVID protocols, even though the Centers for Disease Control and Prevention (CDC) guidance is applicable to all healthcare settings.”

Nursing homes are committed to protecting their residents and staff from COVID-19, but they also want to provide seniors and individuals with disabilities a high quality of life in a home-like environment, AHCA/NCAL says.

“These rigid protocols mean that nursing home residents have not seen the faces of their caregivers in more than two years, and families remark how the protocols make our facilities feel like a ‘sterile’ environment,” Parkinson wrote. “In September 2020, the Centers for Medicare and Medicaid Services (CMS) relaxed restrictions on visitations, group activities, and communal dining because officials recognized the need to balance protection from the virus with the overall quality of life for our residents. We are asking the agencies under HHS—CDC and CMS—to strike this balance once again.”

Extending the PHE and modifying COVID protocols for healthcare settings are not mutually exclusive, Parkinson writes. “Both are necessary,” the letter says, “to ensure that our public health systems are able to adapt to this evolving pandemic.”