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Version 2 of the Operational Guide for Appendix K: Emergency Preparedness and Response for the Community Living, Consolidated, and P/FDS Waivers

ODP Announcement 20-104 provides updated operational guidance to implement services through Appendix K flexibilities approved for the Community Living, Consolidated and Person/Family-Directed Support (P/FDS) Waivers during the COVID-19 pandemic.

ODP released the first Operational Guide on March 23, 2020 in ODP Announcement 20-027 to provide guidance regarding the first approved Appendix K. The Operational Guide has been updated in Version 2 to:

  • Add guidance regarding the flexibilities approved through the second and third Appendix K.
  • Elaborate on guidance based on current orders and updated recommendations issued by the Governor and the Secretary of Health.
  • Incorporate guidance based on stakeholder feedback and experiences regarding service provision during the COVID-19 pandemic.

The purpose of the Operational Guide is to provide guidance to providers (including services rendered under a participant-directed services model), Supports Coordination Organizations, Administrative Entities, and ODP to ensure adherence to the conditions of the emergency amendments approved in Appendix K and provide specific guidance on process, documentation, and health and safety measures.

The Operational Guide applies only to participants impacted by COVID-19 or who need services when hospitalized as outlined in the second approved Appendix K. Examples of participants impacted by COVID-19 include participants impacted due to staffing shortages, a COVID-19 diagnosis for the participant or a participant’s housemate or caregiver, and closures of service locations (residential homes, Community Participation Support service locations, etc.).

For any requirement not listed in the Operational Guide for Appendix K, refer to the current approved ODP waivers. ODP is finalizing Version 2 of the Operational Guide for the Adult Autism Waiver and will publish it soon.

CONTACT:
Please direct any questions about this announcement to your respective regional Office of Developmental Programs.

From NADSP:

In March of 2020, many businesses and schools followed safety protocols, closed their doors, and began working and participating remotely. For the vast majority of direct support professionals (DSPs), this was not an option. As we learned from friends and colleagues across the country of the mounting challenges in providing supports safely to individuals with disabilities during the COVID-19 pandemic, we knew it was important to hear directly from DSPs about their experiences.

In response to this need, the University of Minnesota’s Institute on Community Integration quickly developed a 27-question survey and collaborated with the National Alliance for Direct Support Professionals to reach a large sample of DSPs from across the country. Almost 9,000 direct support workers from the U.S. completed the survey between April 23-May 27, 2020 with at least one survey received from every state.

This survey, completed by direct support professionals, was intended to gather evidence about their experiences and lead to effective policy and practice decisions about what is needed and to better prepare for future waves of this pandemic.

 

The report concludes with a section “Moving Forward- What is Needed?” that includes the following recommendations:

Comprehensive, organized and funded response plans at national and state levels for additional waves of COVID-19 and future pandemics.

This workforce needs to be officially identified as essential workers in order to retain DSPs in their jobs. Some DSPs left work to care for children or other family members. Access to essential worker status and pay can help to offset added costs experienced by DSPs such as childcare. It can also provide financial support needed to remain in their job. Given their close proximity to people who receive supports and their loved ones, DSPs need to have access to PPE to protect everyone’s health and safety. A main way to support and recognize this workforce is to establish a standard occupational classification (SOC) code. Establishing a SOC code for direct support workers would make it much easier to identify this workforce as “essential workers.”

Wage increases for essential workers commensurate with the increased level of exposure.

Direct support depends largely on human interaction, placing workers at increased risk for contracting COVID-19. Only 24% of respondents indicated they were paid higher wages during the pandemic and many employees were working a high number of overtime hours. Recognizing their increased risk through increased wages allocated for other groups of workers is critically important.

Access to career pathways.

Nearly 74% of respondents indicated they were primary wage earners in their household, earning an average of $13.63 per hour. This workforce should have access to career pathways and credentialing programs that result in increased wages and access to benefits. Credentialing programs provide opportunities for DSPs to increase their skills, resulting in the provision of higher quality supports.

Increased training on health and safety.

Nearly 27% of new hires during the COVID-19 pandemic were reportedly not getting typical orientation and preservice training. Comprehensive safety training needs to be provided at the onset of a public health crisis. New hires need comprehensive orientation and onboarding to enter this line of work, in addition to knowledge about practices to manage health and safety related to the spread of COVID-19.

Access to childcare and support if schools or daycares close.

Ensuring essential worker status specific to this occupation would prioritize childcare availability for these families in most states. A large percentage of the workforce are mothers with children (PHI, 2019; Hewitt, Pettingell & Kramme, 2019). Access to childcare increases the likelihood that DSPs can continue coming to work.

Professional recognition of direct support.

Direct support workers have always provided critical, essential supports. The average wage of $13.63 per hour prior to the pandemic and the reality that the workforce was not identified as essential workers in most states is not reflective of the skilled nature of the work.

People with IDD need education and training on handwashing, hygiene, and social distancing.

While 60% of participants reported that people with IDD were good at following social distancing recommendations, the additional 40% were reportedly fair or poor on this. Some participants reported that people had difficulties understanding the changes to their lifestyle that had results from the COVID-19 pandemic. People with IDD need access to ongoing, effective education and training on health and safety practices.

Ensure access to technology for people with IDD that allows social interaction with others.

Invest in technologies that help people have greater control over their lives.

Develop evidence-based strategies for teaching people with IDD to use telehealth.

Work with the medical community to eliminate disparities and ensure people get the healthcare they need.

Review of policies to ensure person- and family-centered practices with informed decision-making regarding social contacts during a pandemic.

People with IDD and their families should be involved in decisions affecting them.
Click the ” Learn More” button below to view the full survey report. The webpage will feature both a printable (and accessible) pdf and the web version, featuring a “read it to me” function.

 

Learn More

 

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From our partners at ANCOR:

The White House and CDC announced this past Friday, the beginning steps towards vaccine distribution for LTC settings. The program is available to ICFs and group homes per their response to my inquiry: There is no size limit for facilities and groups homes for individuals with disabilities are included.”

Starting Monday, providers can sign up to enroll in the Pharmacy Partnership for Long-term Care Program. Through this program, the Centers for Disease Control and Prevention (CDC) has engaged CVS and Walgreens to secure the COVID-19 vaccine and provide on-site vaccination of residents in LTCF, at no cost to the facility.

Sign up should be done via the REDCap (redcap.link/LTCF) beginning on Monday, October 19. Nursing Homes will sign up via the NHSN portal.

Immunization with a safe and effective COVID-19 vaccine is a critical component of our Nation’s strategy to reduce COVID-19 related illness, hospitalizations, and deaths. Early in the COVID-19 vaccination program, there may be a limited supply of COVID-19 vaccine and vaccination efforts may focus on those critical to the response, providing direct care, and those at highest risk for developing severe illness from COVID-19. This includes long-term care facility (LTCF) residents (i.e., nursing home, assisted living facility, and independent living facility residents). When vaccine is available, it is important that LTCFs recognize that these vaccines will have requirements for storage, handling, administration, and reporting more stringent than seasonal influenza vaccine and other vaccines. 

 All LTCFs have an option to enroll in the Pharmacy Partnership for Long-term Care Program. Through this program, the Centers for Disease Control and Prevention (CDC) has engaged CVS and Walgreens to secure COVID-19 vaccine and provide on-site vaccination of residents in LTCF, at no cost to the facility. This program provides end-to-end management of the COVID-19 vaccination process, including cold chain management, on-site vaccinations, and fulfillment of reporting requirements, to facilitate safe and effective vaccination of this patient population, while reducing burden on facilities and jurisdictional health departments.

Starting October 19, 2020, LTCFs will be able to indicate how they would like to receive the COVID-19 vaccine and vaccination services.

When completing the form, facilities will need to indicate participation in the Pharmacy Partnership for Long-term Care Program and their preferred retail provider (CVS or Walgreens).  If opting to not participate in the program, facilities must indicate their alternate plan for securing vaccine supply and vaccinating residents. 

Sign Up will remain open for two weeks, this decision is not binding and can be changed during these two weeks. Once the forms close, a facility must coordinate directly with the selected pharmacy provider to change any requested vaccination supplies and services.  

For questions specific to the Pharmacy Partnership for Long-term Care Program, please contact [email protected].

  1. There is nothing indicating in this announcement that a vaccine is imminent (this is just signing up to be included in this vaccine distribution when one becomes available).
  2. This is a CDC program.
  3. Signing up is not binding and providers can opt out at any time should they choose.
  4. If providers don’t sign up for this program, it will be harder to ask for priority consideration with vaccine distribution for the folks we serve and their staff in the future.

From what I have read about the vaccines, they vary greatly in form and storage requirements, therefore, depending on which ones are approved and when, administration might not even be something we are able to handle in house.

Of note, when I signed up this morning, it did give an option for one to select their own pharmacy first and choose either CVS or Walgreens as a back-up.

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Catherine Thibedeau
Orono ME
207-866-3769 (103)
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The Statewide Provider Partnership meeting will be held on Thursday, October 22, 2020, from 1:00 pm to 4:00 pm. This meeting is open to all employment service providers in Pennsylvania. Please see the agenda and the “Meeting Question and Comment Form,” which is an important document for you to use before, during, and after the meeting. Please take the time to review it, as it includes the specific areas we hope to discuss during the meeting, and it will be critical to ensure that your feedback and questions are received if we run out of time during the meeting. Consider preparing answers to the questions beforehand, and adding to it if necessary, during the meeting. We want to make sure everyone has a chance to provide input, either during the meeting or after!

Please feel free to email if you have any questions or concerns. Register for the meeting here.