Jacqueline Vance, RNC, CDONA/LTC

Keeping up with the constantly changing guidance between the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention regulations would make even a rocket scientist’s head spin. 

It’s especially mind-boggling if you have nursing facilities in multiple states.

Take, for example, the supplement to the QSO-22-07-All (what the heck does QSO mean anyway?) memorandum: Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination, which came out mid-January. 

First, it stated that the regulations and guidance described in this attachment do not apply to the following states at this time: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia and Wyoming. 

At first, you might want to say, wouldn’t it have been easier to just say which ones it does apply to? But then it makes sense because they have to be specific about who was part of what legal action. But just saying …  

OK, so starting Jan. 27, in whatever states that are not mentioned above we have to make sure we have our 30-day vaccination mandates in place and a plan for the 60- and 90-day rollout. Be ready to tell how you will get all staff, volunteers, physicians, NPs, etc., fully vaccinated. (Basically, anyone who walks in your door but visitors … oh, and CMS surveyors). Got it.

Wait, what? With visitors, they don’t have to be vaccinated and we can’t ask them to show us if they are because we can’t violate their privacy? We can’t ask them not to bring COVID in the building after we’re doing all this?

And CMS is working on its rules for surveyors getting vaccinated, exempted and if not vaccinated, what masks they should wear? And before they work that out, surveyors can still come in unvaccinated, without the same strict KN95 or N95 mask rule we have and that’s OK for now? Uh, right. Got it. 

But wait. Then there was QSO-22-09-ALL that came out at the end of January. It said the regulations and guidance described in this attachment specifically applies to the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming. 

Oh, OK. Well at least in this one we list the states it applies to. So, these states started their 30-day compliance rule on Feb. 14. Got it. I think. Fun rollout, gang!

But then there’s the CDC guidance on a return to work if exposed or had COVID? Really clear, right? Five to seven days if not symptomatic and you can test or not test? Maybe 10 days if you had symptoms, not super clear on if you test, but if in crisis mode maybe test and come back earlier? Wait, what? 

Oh, it depends on if you are vaccinated, vaccinated and boosted, not vaccinated but exempt? Maybe depends if contingency or crisis staffing? So maybe five to seven days or 10 days, test or not test and then depends on the type of patients you care for. OK. Got it! But wait, then there may be state-specific requirements that make all this null and void. Got it, clear as mud. (Praise the Lord, we have super smart people that figure this out for us!)

Oh, and now with the massive exodus of front-line care workers who have not been replaced (425,000, according to the American Health Care Association), and no regulations on the price-gouging premiums charged by agencies, CMS feels now is just a super great time to publicly report the percent of nursing staff and number of administrators who stopped working at a nursing home over a 12-month period?

And — more fun — this information started being added to the Care Compare website and will be used in your Five Star Quality Rating System in July 2022. (Of course, it will. Let the beatings continue until the morale improves …)

Why? Because, as the Director of the Division of Nursing Homes explained at both NADONA and AHCA meetings, CMS feels the need to be transparent to consumers. Except there is no explanation to consumers about why there has been this mass exodus from our workforce. The agency actually wrote in QSO-22-08-NH, and I quote, “We believe making this information available to consumers will help them understand more about each facility’s staffing environment.” Wait, what? 

The environment sucks and we’re doing the best we can. You want to do this now? Fabulous.

Oh, I actually got a text from an agency for travel nurses for long-term care last week. It said that since I have a compact license, I could work in almost any state at $200 an hour. I texted back, “Sounds cool. Let me ask my parole officer if I can travel out of state.” Almost surprisingly, I did not hear back.

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities, LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real-life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.