Mich Exec Order No 2020-191 rescinds and replaces Mich Exec Order No 2020-179, and establishes procedures in long-term care facilities to protect the health and safety of both employees and residents. There is no end date to the order. Changes made by this latest order require facilities to limit, not cancel communal dining and group activities. In addition, if there is a COVID-19 positive employee or staff member, all resident's guardians and health proxies must be informed within 24 hours.
Here are the highlights:
Protections for Employees of Long-Term Care Facilities
COVID-19 Affected Employees. Employees (of Care and Recovery Centers also) who test positive for or display symptoms of COVID-19 should remain home and cannot be discharged, disciplined, or retaliated against for doing so.
Protective Equipment. Appropriate personal protective equipment (PPE) and hand sanitizer will be provided to all employees who interact with residents.
Duty to Inform. Employees will be informed of
- a COVID-19 affected resident or employee as soon as possible and no later than 12 hours after identification, and
- any changes in CDC recommendations regarding COVID-19.
Protections for Residents in Long-Term Care Facilities
Eviction or Involuntary Discharge. No facility can evict or discharge a resident for nonpayment or deny a resident access to the facility except as otherwise stated in the executive order.
Admission or Readmission.
- A facility that has a dedicated unit and provides appropriate PPE to the direct-care employees who staff the dedicated unit must admit anyone that it would normally admit as a resident, regardless of whether the individual has recently been discharged from a hospital treating COVID-19 patients.
- A facility cannot prohibit a resident based on COVID-19 testing requirements or results unless consistent with guidelines issued by the DHHS.
- If a resident voluntarily obtained housing outside the facility (excluding hospitalization) during any state of emergency or state of disaster arising out of the COVID-19 pandemic, the resident still has the right to return, provided under state and federal law, as if they had been hospitalized or placed on therapeutic leave. The facility must accept their return if it can meet their medical needs and there are not statutory grounds to refuse (understanding the screening precautions per DHHS guidance). A facility must not accept the return of a COVID-19 positive resident if the facility does not have a dedicated unit or Care and Recovery Center. A Care and Recovery Center is a nursing home that temporarily and exclusively cares for COVID-19 affected residents.
Sanitary Precautions.
- Communal dining and group activities must be limited.
- Adequate disinfecting and cleaning of the facilities must occur per guidance from the CDC.
- Appropriate PPE and hand sanitizer will be provided to all.
Duty to Inform. As soon as reasonably possible and no later than 24 hours after identifying a confirmed COVID-19 positive employee or resident, legal guardians or health proxies for all residents must be informed. A notice must be posted near the main entrance indicating the presence of COVID-19 resident or employee and a protocol developed for informing prospective residents and staff of the confirmed positive cases.
Telemedicine. Facilities must use best efforts to provide telemedicine for regular doctors’ visits, telepsychology, counseling, social work, and physical and occupational therapy.
Transfers and Discharges of COVID-19 Affected Residents
Medically Stable COVID-19 Affected Resident. A facility must make all reasonable efforts to create a unit for the care and isolation of such residents and provide appropriate PPE to direct-care employees. This dedicated unit can be an entire facility. Medically stable COVID-19 residents must be transferred to this unit. A facility must not create or maintain a dedicated unit unless it can implement effective and reliable infection control procedures.
If there is no dedicated unit, the facility must attempt to transfer the COVID-19 affected resident to a Care and Recovery Center, an alternate care facility with physical and operational capacity, or an available swing bed at a hospital. An alternate care facility is a facility activated by the state to provide relief for hospitals that are at capacity. If these options are not available, the resident must be sent to an in-state hospital with an available bed.
Medically Unstable COVID-19 Affected Resident. A facility must transfer a resident who is medically unstable to a hospital for evaluation (unless otherwise provided in an advance directive).
Once the hospitalized resident becomes medically stable, the hospital must conduct testing before discharge. Discharge may be made to any of the following:
- a Care and Recovery Center
- the facility where the resident resided before hospitalization
- an alternate care facility with physical and operational capacity
- an available swing bed
Discharge destinations should be determined consistent with CDC and DHHS guidelines. Patient safety, the safety of residents at the destination facility, the wishes of the patient and the patient's family, and any guidance from the local health department should be considered. However, a resident may only be discharged to a facility which can safely isolate the resident. Until there is an acceptable discharge destination, the resident must stay in the hospital.
The resident’s advance directive must accompany the resident through any transfer or discharge.
A long-term care facility must notify the resident and the resident’s representative of a transfer or discharge within 24 hours.