FOR IMMEDIATE RELEASE: Oct. 28, 2020

CONTACT: Lynn Sutfin, 517-241-2112

LANSING, Mich. – Today the Michigan Department of Health and Human Services (MDHHS) issued an epidemic order adding requirements for COVID-19 diagnostic testing in homes for the aged (HFAs) and larger adult foster care facilities, and modifying requirements for skilled nursing facilities (SNFs).

The state has already provided direct support that has resulted in nearly 70,000 samples that have been tested from patients and staff in nursing homes and other long-term care settings, and given the significant risk of outbreaks in long-term care facilities and the higher likelihood of severe health outcomes from COVID-19 among the elderly, it is imperative that routine testing be provided to identify infections quickly and contain spread. As of this week, more than 100 new or ongoing outbreaks were reported in long-term care facilities.

Today’s order makes modest updates to testing requirements that have been in place for skilled nursing facilities since June 15, with new requirements that homes for the aged and large adult foster care facilities conduct the same testing. Testing is part of a comprehensive prevention and infection control plan for congregate care settings. MDHHS has provided financial support to facilities for PPE, provided technical assistance and support on infection prevention measures, and put in place preventative measures like safety protocols for visitation to prevent COVID-19 spread in long-term care facilities.

“COVID targets individuals who live in group care, and it’s our job as Michiganders to protect them,” said MDHHS Director Robert Gordon. “Less COVID in the community means less COVID in group homes, so each of us helps when we wear masks, watch our distance, and wash hands. But these homes also need a second line of defense, and that defense is regular testing for residents, staff, and visitors.”

The testing order requires that all SNFs, all HFAs, and AFCs licensed to serve 13 or more individuals provide for the following:

Initial testing of all residents and staff;

• Testing any resident or staff member with symptoms of COVID-19 or suspected exposure;
• Weekly testing of all residents and staff in facilities with any positive cases among residents or staff, until 14 days after the last new positive;
• Weekly testing of all staff in counties of risk levels A through E on the MI Safe Start Map;
• Testing of all new or returning residents during intake unless tested in the 72 hours prior to intake;
• Testing of all newly hired staff on their start date or in the 72 hours prior to start date.

MDHHS’s Oct. 21 Epidemic Order “Requirements in residential care facilities” also requires testing of visitors to residential care facilities that have an MDHHS-required resident and staff testing regimen. This will include HFAs and AFCs serving 13 or more individuals, as well as SNFs, after today’s testing order takes effect.

To help implement these testing requirements, the state will provide antigen testing supplies for all facilities affected by this order, and MDHHS has established a system for refilling antigen supplies provided directly by the federal government. Facilities may alternatively develop their own testing program and seek reimbursement; MDHHS will reimburse testing expenses not covered by insurance.

Hospice facilities licensed by the state as a nursing home must test all staff at the same intervals of nursing home staff, and may test a hospice patient with consent of the individual or other person legally authorized to make medical care decisions for the individual.

Nursing homes have been testing under a prior order and must continue it under the new order. HFAs must begin as soon as practicable and not later than Nov. 18.

AFCs serving 13 individuals or more must begin testing as soon as practicable and no later than Nov. 24 for testing individuals with symptoms or exposure, weekly testing in facilities with positives, and testing of new residents or staff. AFCs must begin initial testing of all residents and staff, as well as weekly staff testing, by December 2. However, AFCs must test any resident leaving the facility to spend the Thanksgiving holiday in a residential home or for an overnight stay in the community prior to that resident’s departure and upon return to the facility.

Consistent with MCL 333.2261, violation of this order is punishable by a civil fine of up to $1,000, and may also be treated as a misdemeanor punishable by imprisonment for not more than six months, or a fine of not more than $200, or both.

This order is effective immediately and remains in effect until rescinded. Persons with suggestions and concerns are invited to submit their comments via email to [email protected]. An infographic that explains visitation requirements in long-term care facilities can be found on the MDHHS website.

Information around the COVID-19 outbreak is changing rapidly. The latest information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.

FOR IMMEDIATE RELEASE
October 21, 2020
Contact: Lynn Sutfin, 517-241-2112

LANSING, MICH. Michigan Department of Health and Human Services (MDHHS) Director Robert Gordon today issued an Emergency Order under MCL 333.2253 that updates and further expands requirements for residential care facilities, while also permitting indoor visitation in residential care facilities in certain circumstances. Throughout the pandemic, MDHHS has used a range of public health tools and guidance to contain the spread of COVID-19 and protect the public health, including emergency orders.

“As we grapple with both colder weather and rising cases, our task is to increase access to visitation in ways that do not increase the spread of the virus,” Gordon said. “Visitation is a substantial source of risk.  This order provides a plan for visitation that mitigates risk and continues necessary protections in facilities across the state.”

The residential care order continues to limit communal dining and internal and external group activities consistent with Center for Medicare and Medicaid Services guidance and it requires quick notification in the event an employee or resident is confirmed as positive for COVID-19.

Under the order, visitation rules are linked to the risk level of the county. A list of county risk levels is available on the MI Safe Start Map.

Indoor visitation is now allowed in areas where the current risk level is A, B, C, or D, so long as the facilities have had no new cases, including those involving residents or staff, originating within the prior 14 days. Indoor visitation is not allowed when the county is at risk level E, which means there is an elevated incidence growth rate with average daily cases/million greater than 150 or a positivity rate greater than 20%. It is also not allowed if the local health department has made a determination that it would be unsafe. Outdoor visitation is allowed throughout the state so long as the facility assures that the outdoor visitation area allows for at least six feet between all persons and adequate protection from weather elements is provided.

Based on county risk levels and the type of visit, some visitors will be required to receive COVID testing prior to entry. Most nursing homes now are able to conduct point-of-care testing with a rapid turnaround.

Visitors will be required to wear facemasks (or other PPE when required by the facility) at all times. In general, visitors will need to maintain six feet from residents. However, visitors who are providing support for Activities of Daily Living (ADLs), medical services or non-medical services requiring physical contact are not expected to abide by social distance requirements between the visitor and the resident while providing services. Visitors participating in visits at the end of life may have physical contact with a resident if that resident is not COVID-19 positive, the visitors are wearing appropriate PPE and the time spent within six feet of the resident is no longer than 15 minutes.

“This is a delicate balance of trying to prevent the further spread of the virus while still allowing for family members and friends to visit their loved ones in residential care facilities,” said Dr. Joneigh Khaldun, chief medical executive and chief deputy for health at MDHHS. “I remain concerned about the increase in case levels across the state, so it will be vitally important that the order be followed closely in order to keep the facilities safe and prevent the spread of the virus.”

Visits will be allowed by appointment only and facilities may impose reasonable time limits on visits, with requirements that visitors log arrival and departure times, provide their contact information and attest, in writing, that they will notify the facility if they develop symptoms consistent with COVID-19 within 14 days after visiting. The number of visitors per scheduled visit will be limited to two persons or fewer and will exclude visitors who are unwilling or unable to wear a face covering. A health evaluation of all visitors will be required to enter the facility, including tests for fever, and facilities must restrict anyone with fever, symptoms or known exposure from entering the facility.

Consistent with MCL 333.2261, violation of this order is punishable by a civil fine of up to $1,000, and may also be treated as a misdemeanor punishable by imprisonment for not more than six months, or a fine of not more than $200, or both. This order is effective Oct. 26, 2020 and remains in effect until lifted. Persons with suggestions and concerns are invited to submit their comments via email to [email protected].

Information around this outbreak is changing rapidly. The latest information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.