A notice was released today by both the Pennsylvania Department of Health (DOH) and the Department of Human Services (DHS) regarding the continued ongoing support for long-term care (LTC) facilities and outbreaks associated with COVID-19. The ongoing support will be provided by utilizing Regional Congregate Care Assistance Teams (RCAT), staffing, testing, and more. Prior support (from July 2020 through December 2020) was provided through the Regional Response Health Collaborative (RRHC) program. This program was funded by the federal CARES Act and created by the General Assembly. That program began with select health systems providing support to long-term care facilities across the state under the direction of Pennsylvania’s Long-Term Care Task Force (LTCTF). With federal dollars ending on December 30, 2020 and a constrained state budget, the Wolf Administration prioritized the allocation of limited funds to continue providing facilities with support during COVID-19 outbreaks.
This state-funded effort will leverage the expertise of ten health systems through the RCATs and continued direction of the LTCTF. Starting on December 31, 2020 and lasting through February 28, 2021, RCATs will provide COVID-19 outbreak support to long-term care facilities that were eligible for the RRHC program. The primary focus of the RCATs will be to respond to COVID-19 outbreaks at long-term care facilities. Additional assistance provided to facilities experiencing an outbreak includes call centers for infection control assistance, personal protective equipment (PPE) distribution, staffing assistance, and testing for staff and residents through a variety of resources.
Long-Term Care Response Resources
Most of the health system partnerships established for the RRHC program will also be leveraged for the RCAT to cover six regions. The participating health systems are Thomas Jefferson University in partnership with Main Line Health and the University of Pennsylvania in partnership with Temple University Hospital, Inc. serving Southeast Pennsylvania; Geisinger Clinic and UPMC Susquehanna serving Northeast Pennsylvania; Pennsylvania State University serving Southcentral Pennsylvania; Geisinger Clinic serving Northcentral Pennsylvania; UPMC Community Provider Services in partnership with Allegheny Health Network serving Southwest Pennsylvania; and LECOM Health and UPMC Community Provider Services in partnership with Allegheny Health Network serving Northwest Pennsylvania. The Department of Health is providing staffing and testing support to congregate care facilities using contracted partners.
Curative Labs, Inc. (Curative) has been contracted to provide an end-to-end testing solution for COVID-19. The simple-to-use oral fluid or shallow nasal test is self-administered under the supervision of facility staff. Facilities will be brought on in a phased approach, and each facility will receive two to four weeks’ worth of testing kits that include (at a minimum) a specimen tube, bio-hazard bag, oral or nasal canular swab, vial with label, absorbent pad, and shelf stable medium. Facilities will also receive pre-paid shipping labels and packaging (including laboratory grade boxes) to send specimens to the lab using next-day shipping.
Two staffing agencies, Maxim and General Healthcare Resources (GHR), have been contracted to provide crisis staffing to congregate care facilities within established mission critical deadlines. The size and duration of the crisis staffing deployment is based on a review and subsequent approval by the LTCTF. That review includes an overall assessment of the facility’s COVID-19 mitigation needs, including testing, staffing, and PPE. Maxim will serve specific counties, mostly in the western part of the state. Health systems can also provide staffing assistance if they have the resources available. The Pennsylvania National Guard will also provide limited clinical support and primarily general-purpose support as determined by the LTCTF.
Prevention
In response to COVID-19 outbreaks in long-term care facilities, infection prevention practices and continuity of care and other services that mitigate the risk of spread of COVID-19 to staff and residents will be reviewed. The RCATs are available to work directly with facilities to implement current state and federal COVID-19 clinical guidance and instruct staff on ways to provide daily care in a way that minimizes the risk of COVID-19 spread. The Department of Health’s Infection Control and Outbreak Response (ICOR) team and Emergency Care Research Institute (ECRI) provide remote infection prevention consultation to facilities experiencing an outbreak as well as follow-up consultation to improve baseline practices after the outbreak is over.
Response
When long-term care facilities’ resources engage with a facility or are called in to help with a concern identified by collaboration between DHS, DOH, and the Pennsylvania Emergency Management Agency (PEMA) daily calls, these are classified as missions. A mission could be anything from assistance with testing, staffing support, and rapid response deployment to facilities and other questions or concerns requiring consultation. The RCATs also offer 24/7 call centers that are available to provide direct support and assistance as issues arise. If a facility is at risk of an outbreak or experiencing an outbreak, RCAT rapid response teams can be deployed to help facilities manage difficult situations. Rapid response teams are comprised of registered nurses, clinicians, epidemiologists, and infection control experts who assist with cohorting of residents, transferring residents if needed, and providing other support necessary to stabilize the outbreak and prevent further spread.
Education
The Jewish Healthcare Network operates a statewide learning and peer support network that is available to all long-term care facilities. This network is available for ad-hoc webinars on topics related to responding to and mitigating the spread of COVID-19. In addition, regional Health Care Coalitions host bi-weekly calls for facilities in which ICOR presents to provide clinical guidance and updates.
Expectations
The RCATs will leverage the knowledge and experience the health systems, LTCTF, and PA National Guard obtained through their engagement in the RRHCP to respond to COVID-19 across our long-term care system. While the RCAT funds are limited, the teams involved are committed to collectively working together and sharing the knowledge and resources needed to support long-term care facilities who are experiencing an outbreak. While we are in unprecedented times, there is assurance that commonwealth agencies, contracted testing and staffing partners, contracted health systems, and educational resources have resolved to provide continued support for the residents, staff, caregivers and communities of congregate care facilities in the commonwealth.