The current approach to infection control management is too manual, too compartmentalized, too narrow in scope, and too slow. Strengthen your COVID-19 response and prepare for future pandemics by using CARES Act funds to digitize your entire infection control program.
- CARES Act funding for senior care
- Quick demo the CareSafely infection control platform
Click to read the full audio transcription
CARES Act and CareSafely
Raj Shah: Welcome everybody. We’re going to go ahead and get started. My name is Raj Shah and our topic today is the CARES Act and CareSafely, improving COVID response and preventing the next one. I’m joined by my colleague Kate Wallace. Kate, if you can unmute yourself, that would be great. Oh, that’s good. Kate is my colleague. She’s our Director of Infection Control and Safety here at CareSafely. She’s got over a decade of experience in clinical, she’s an LPN clinical nursing experience in long-term care and also has a master’s in Health Leadership. So, she’s the perfect person to talk to us about the CARES Act itself.
Raj Shah: Some quick housekeeping notes. We have a lot to cover in 30 minutes. We’re going to talk about the CARES Act itself, Kate is going to give a pretty detailed overview of the Act and what it means for you. We will very briefly talk about the CareSafely solution itself and how it could be used as part of your prevention program and some of the additional resources we have provided for you. And we will of course have some Q&A. If you don’t mind, just make sure that on your button on your Zoom system, at the bottom there’s a Q&A section. So, as we go through the materials, you know, if you have any questions, just pop them in there and we will try to get them to all of them at the end of the 30-minute session. Also, if you can’t see the screen here that says housekeeping in full mode, you may need to adjust your Zoom settings on full view and then you’ll be able to see everything, as well. And we will definitely leave some time in the end for Q&A.
With that, let me just set some little bit of a context for the conversation we’re about to have right now. If you step back and just think about the COVID crisis, the American taxpayer, which means all of us combined have been incredibly generous, right? We’ve put, between the CARES’s Act and the supplemental bills over three trillion dollars has been allocated by the US government and therefore all of us, towards the care relief efforts, necessary important relief efforts across the board, right? Everything from businesses to individuals, to all kinds of, including obviously nursing homes and healthcare, etc. And Kate is going to cover all those details but it’s an incredibly large and generous response from the American taxpayers to help with the COVID response. Now, thankfully with the COVID vaccine rollout that’s happening right now over the next few months, hopefully, we’ll get at least caught up if you will from the response point of view. And so then the important question that comes around is “Well, the COVID response funds were not just for the response but also to prevent future crises from happening, right?” And so we need to start thinking also about not just responding but how do we make sure we prevent the next one from happening?
As you all know, sadly over 130,000 seniors have died in nursing homes in the last year and over a million have been infected with COVID. And in fact, in many cases, I just read in the New York Times today that the Attorney General of New York is opening an investigation because what was reported to the Attorney General’s Office is 50% higher than what’s been reported to Public Departments of Public Health in New York itself. So there’s a lot of, in addition to patients and their families, being impacted by this, now the state and local and federal governments are also having a much tougher stance and scrutiny about the response and making sure this doesn’t happen again in future. So that’s sort of the overall context of the CARES Act. I’m going to now pass it on to my colleague Kate and she’s going to walk us through some of the specifics of the CARES Act itself.
CARES Act Overview
Kate Wallace: Raj, thanks so much for setting the scene. As many of you already know that the bill was passed into law at the end of March in 2020, really at the height of the pandemic. It really sought to safeguard the public health and economic interests of Americans during the height of the COVID-19 crisis. It stands for the Coronavirus, Aid, Relief, and Economic Security Act. And under this general generous act passed by Congress was 185 billion dollars for healthcare providers.
Intent of CARES Act “Provider Relief Fund” (PRF)
Kate Wallace: So, under that 185 billion dollars, the Provider Relief Fund was set up and the Department of Health and Human Services are known as HHS and CMS were tasked with distributing these funds to healthcare providers. The intent is to prevent, prepare, and respond to coronavirus. It was distributed anywhere from hospitals to skilled nursing facilities, nursing homes, providers, drug makers, CDC, and CMS, anywhere from ophthalmologists received these funds, dentists, pharmacies, vaccine makers, and any kind of healthcare provider could be able to get some of these resources. These monies were not intended to be repaid to the US government. They were set up more as grants.
PRF – General and Targeted Disbursements for Healthcare
Kate Wallace: So, under the Provider Relief Fund were two different types of disbursements – general and targeted for these monies. General disbursements total 92.5 billion dollars and have gone out in three different phases – Phase 1 went out in April for 50 billion dollars, Phase 2 went out in June for 18 billion, and Phase 3 just went out in December 2020 for 24.5 billion dollars. The last two phases were application-based, you had to apply for them. Targeted disbursements have been in a total of 9.4 billion dollars and they have gone to specific areas. They went out in May and in August 2020. The first one in May went out to about 13,000 skilled nursing facilities and the second one went out to about 15,000 nursing facilities, nursing homes, and SNFs.
General Distribution Allocations
Kate Wallace: Phase 1 was really distributed based on sort of fee for service, general revenues under Medicare. Phase 2 for general disbursements was basically the folks that were missed for Medicare disbursement, receiving facilities under Phase 1, and then more of the Medicaid facilities. Phase 3, that’s still, sort of in the process of receiving these funds from general disbursements for 24.5 billion dollars to about 70,000 providers is currently in progress. Nursing homes out of this have received 1.1 billion dollars for a total under the Provider Relief Fund the large umbrella 16.1 billion dollars and it just goes to show how vastly hit this industry has been and specifically nursing homes, how much Congress has paid attention to allocating these monies.
Targeted Distributions for Certified SNFs with 6 or More Beds
Kate Wallace: Under targeted disbursements, especially for skilled nursing facilities with six or more beds, in May 4.9 billion was distributed to over 13,000 SNFs. And then in August 2.5 billion to over 15,000 SNFs, as a one-time payment for both of these disbursements and then a per bed amount. So, the first one was a fixed amount of $50,000, the second disbursement was a fixed amount of $10,000, and then an amount depending on your bed size.
Additional Fund: Nursing Home Incentive Payment Plans
Kate Wallace: An additional fund also allocated by HHS from the total funds under the Provider Relief Fund was a two billion dollar performance-based incentive plan, which was set up in September. In order to be eligible for these monies, you had to meet two different criteria, both of the criteria. One being your COVID infection rate had to be below the rate in the county in which you were located and the COVID death rate below a nationally established performance threshold. So, out of this incentive pool, from the September and October performance periods that went out in October and December, the first one was 333 million dollars to 10,000 nursing homes and 523 million to 9,000 nursing homes. So, now the next phases will go out at the, you know, sort of the first half of this year, in 2021.
One of the most important things that I found that HHS has done with the Provider Relief Fund and giving out these monies is transparency. And they’ve done their best to show the attestation of nursing homes receiving these funds under this new website. So, the link is at the top here and you can go and look there and you can see the name of the nursing home or whoever has received the monies, the provider, the state they’re located in, the town they’re located in, and how much they’ve received. So, I think it really helps us as taxpayers see where these monies are going to obviously a very important area that’s been so badly hit under the pandemic.
Raj Shah: I forgot to mention something. Folks, we’re going to send all these slides and the recording on Monday. So, don’t worry about having to type it or write up the hash stuff at the top, the URL. So, we’ll send everything to you later on Monday. Sorry about that. Go ahead.
Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act of 2021
Kate Wallace: So, the latest bill that was passed was in December, on December 21st under the Trump Administration, the Coronavirus Response and Relief Supplemental Appropriations Act of 2021. This allocates an extra three billion dollars to the Healthcare Provider Relief Fund and is an added money to help pay for expenses and lost revenues. There’s also a change in the lost revenue calculation, which definitely will help facilities, a change in how parent organizations can reallocate their target distribution monies within the company. It was a little bit trickier before under the law. Now, they have greater autonomy to disperse the funds within their broader organization without the red tape. 68 billion for testing tracing vaccine development and vaccine distribution, which obviously we’re dealing with right now and looks like potentially even more money coming under the Biden Administration and if the American Rescue Plan gets passed. And then under what was passed in December, there was also about roughly 3 million in funding for healthcare pilot programs run by CDC for social determinants of health programs, which doesn’t seem like a large amount but you know, it’s interesting because a lot of the CARES Act monies largely have been dispersed to really underserved areas and underserved facilities, which is really a wonderful thing. And unfortunately, they were the ones so badly hit and now these programs will help us better understand and hopefully improve programs going forward for these areas. Just want to quickly touch upon what President Biden is hoping to pass under the American Rescue Plan. It’s a 1.9 trillion dollar plan. It’s the latest coronavirus relief monies, hopefully going to be passed and allocated to the country. One major area in which it will help providers and nursing homes is to send out strike teams, more strike teams via the states. So, an example of this was basically when nursing homes had these outbreaks, the states were able to send in outside infection control specialists and consultants and teams of folks to better help the facility when staffing was low and you know, it was a huge problem to manage the outbreak. So, under this, potentially these new monies under President Biden, there will be more of that available and obviously some more scaling up of the vaccine program which we’ve heard a lot about in the news lately.
So, under the Provider Relief Fund which we just talked about, I want to highlight some of the areas in which these monies have specifically gone to. One area has been PPE, staffing, additional resources, equipment, and supplies, and lastly, technology. And these monies from the CARES Act have gone to these various areas and more to really help manage the coronavirus outbreak now, the pandemic now, but also really to prepare us for the future. Because we know sadly, that endemics and pandemics are likely to happen in the future and we need to be better prepared than we were this time to manage that in the future. So, I’m gonna kick it back to Raj and he’s going to talk a little bit about that technology piece.
Infection Control/COVID Response Platform
Raj Shah: Thanks. That was a lot to cover in 15 minutes. So, thank you for working through that. And folks, if you have any questions about the specifics, feel free to ask us through the Q&A button. I’m going to shift a little bit then and talk a little bit about the technology part, right? So, all of you have been just working incredibly, heroically working on the front lines of responding to COVID over the last, gosh, it seems like forever, but my last 12 months or so. And I think that that’ll continue going on for another six to nine months, just giving vaccines plus all the variants and other things that are still happening. So, we’re not out of the woods yet, for sure. But hopefully, with the vaccines, we’re starting to look at the next phase of it. And the next phase has to be about not just how we respond. And as the generals used to say “We can’t just prepare for the last war. We got to prepare for the next one.” Right? So, how do we ensure that our infection control programs, our safety programs have all the tools necessary to make sure that we can see the high-risk areas of the facility, of the staff members, even of the patients and residents? And that’s one of the things that a technology platform can do really well. If you think about it, most of you will have some sort of an EHR system for your health records. Most of you will have some sort of a building and financial system to manage your accounting and invoicing. But if you step back and think about it, how are you currently doing your infection control program management, how are you currently doing your safety management, both your employees and staff, employees and your residents, and it’s typically paper-based checklist and audits, spreadsheets, emails asking people to take care of certain action items or mitigation of risks, occasionally Power Points. All this is very sort of backward-looking and sort of stuck in the 70s type of thing.
CareSafely Platform for Safety, Quality, Compliance
Raj Shah: So, one of the things we’ve done is CareSafely, a built platform, a software platform just like your HR systems or your accounting systems, specifically for managing your safety, quality, and compliance programs. It was specifically designed for the senior care industry sector. Things like this have existed in other sectors for decades, actually to be honest, but this industry just hasn’t had the kinds of technology and the tools that are necessary to take safety and compliance and quality at the level that it needs to and I think the COVID pandemic has sort of opened up our eyes to the need for this. So, at a high level what the CareSafely platform does is that it enables you to assess all of your risks, not just those related to your residents or your patients, but all risks across the entire facility and track all those risks over time and across your departments and facilities. Also, it enables you to manage your COVID response in terms of symptoms checks for your staff and your residents, as well as visitors, and manage your PPE inventory levels. And one of the most important parts that we’ve seen is managing staff competencies, things like PPEs, donning and doffing PPE and hygiene, all those different competencies that you need to make sure your team has, our system enables you to manage that. Because the entire system is digital, paperless, our finding is that at least 40 to 50 percent reduction time spent, administrative time spent managing and chasing all the different issues related to safety and compliance and infection control management. Because the data is digitized immediately in a current way most of y’all are probably doing it on paper or spreadsheet, 90% of data is not analyzed or it doesn’t turn into digital data that can be analyzed. With our system, because it’s all digital from day one, you can very quickly, immediately, real-time see who your high-risk staff members are, high-risk departments and functions are, early on, so you can do something about it and prevent an incident from happening, rather than react to an incident, right? And that’s the ultimate goal here. It is to get ahead of the curve, not try to constantly try to catch up.
As we’ve seen when we did a webinar on this a few months ago, there’s going to be a lot of regulatory compliance and legal liability risk coming out of this. In the webinar we did back in November, I believe, 55 lawsuits have already been filed, some are criminal lawsuits against individuals who would go to jail and others are mostly civil lawsuits against the actual organization. So, the ability to limit your regulatory and legal liabilities with a platform is a really important part of what we are providing. The other important part of all of this is you know, the whole COVID crisis has really shaken the trust that seniors and their families have on safety overall in a senior care environment. The last study I saw shows 49 percent of seniors do not trust safety in nursing homes. 49%. So, to get their trust back, both their families’ and as well as the patients’, the ability to amplify that safety commitment through programs, like what we’re offering is an important part of that. So, that’s about a high level, you know, what our solution can do in terms of helping you get ahead of the curb and manage the overall response. Let me very quickly then just give you a quick glimpse as to how the solution would work.
Hopefully, you can see the screen here. This is literally our platform. We’ve designed this platform literally, in early, in the mid-part of 2019, using the latest technologies, but also to make it incredibly easy to implement and use. Think of it more like an Apple-type interface rather than a Microsoft interface. And four key components of the solution are obviously the ability to assess everything, act on anything that’s an issue of risk area that needs to be mitigated, the ability to audit everything, and the ability to real-time analyze. Sort of like mission control for NASA, for your safety and compliance programs. The assessments are very straightforward, depending on your facility, we’ve already pre-built assessments whether you are assisted living, by the way, I mentioned the assessments are not just for COVID but also for C.diff, for employee safety, MRSA, patient safety, etc. So, we’ve already pre-built a variety of different assessments. I’ll pick this one as an example. So, our COVID-19 assessment for skilled nursing has 79 different risk areas. I often ask folks when we’re talking about this “How many risks are you managing in your skilled nursing facility?” And about half the time their answer will be “I don’t know.” or “Maybe 20 to 30.” And it turns out if you talk with the CDC, CMS, and the Public Health Departments, what we’ve done is aggregated the best thinking and the best guidance and brought it all together. In fact, my colleague Kate is the one who’s done the bulk of that work with our content team and then we’ve also vetted that with our Advisory Group to make sure we’ve got it all actionable and real-time and workable, right? It’s not just something coming from the Government that is actually doable. So, this is an example of one of our assessments for, in this case, skilled nursing COVID, you can see there are different sections that are much more than just managing resident care. So, this assessment looks at things like program management, staffing management, PPEs, resident care, dining facilities, communications with all of your different stakeholders, visitor management, and screening and testing. And so, as a management team, whether it be infection control lead, director of nursing, or executive director, your team would go through these assessments typically once a month or once a quarter right now, given it’s the COVID crisis, and then hopefully over time maybe once every three to six months. And keep in mind we keep updating these as the guidance changes. So, with the CMS, for example, I’m just randomly answering some of these questions, so you can get a feel for the types of detail that we put into our assessments. As a CMS or others change the guidance as the science improves, we go back and update these, as well. So, about three months ago, CMS changed the guidelines on visitation rights and, within a week, we updated our assessments. So, you get the idea in terms of what the assessments look like.
Just to show you one. Let me just go down to the skilled nursing one. There’s a lot to do obviously, a lot to see, but if you had an assessment completed this is what it would look like. The cool thing about all of this is because it is now digitized, you can immediately analyze assessment and see where your issues are. So, for example, if this were a home hospice COVID assessment, we have about 30% of the issues that are in yellow that need to be fixed. So, it’s a very quick way to assess where things are going and the most important part of all of this is the ability to build action plans, which is what this does. And what an action plan is, is the ability to find an issue, if there is an open issue, to create an action plan to work on it. You can create one from the actual assessment itself or create one from scratch. And what an action plan is really simple and it’s very similar to the QAPI quality assurance kind of programs. It’s basically what the action plan for, what’s the root cause we’re solving for, what are the steps you take. But instead of doing all this on paper, you now have the ability to actually assign people to that action plan and provide deadlines, you create accountability, you create a timeline, you create budgets, etc. So, it’s much more actionable and nothing gets lost in the email or the conversation. It’s all tracked and managed. I’m jumping through very quickly, all of this. If you all are interested, would be more than happy to set up a much more detailed demonstration and talk you through some of the challenges you might be having and how we might be able to help. We have assessments, of course, for COVID checks for residents, visitors, and employees themselves, including the ability to email your employees ahead of their shift, so that they can get it on their smartphone and do their self-check before they come to the facility. We find it strange that they show up at the facility if they have the symptoms. That’s the last thing you want to do is walk into your facility and then find out they have the symptoms and then be heading back. This way, you have a heads up and they don’t show up in your facility with symptoms.
We also have audits related to staff observations. Here you can see some of those audits that we have. This is to make sure that your staff is actually following through on all the challenges, on the different competencies they may have. I’ll just quickly click one. Let’s say, it’s Medpass and so let’s say Peppa joined a month or two ago. You want to make sure she’s falling all over competencies. We find that a lot of the nursing homes are doing this work all on paper and maybe once a year more for compliance’s sake, but really if you think about it, this is more important to do on a much more regular basis. The research we’ve done shows that if you just hired somebody and just put them on the floor and say “Okay, follow somebody else and do on-the-job training.” you get about 68 percent compliance to your safety standards. If you provide really good training and then put them on the floor, you get 82 percent compliance. If you do three of these observations in the first two months you get 94 percent compliance to a safety standard. So, it’s a huge delta between just hiring somebody and putting them on the floor and actively coaching and managing them. So, this is a great example of how you can fundamentally get ahead of the curve rather than behind the curve. Then finally the ability to analyze everything, think of this sort of is the mission control. So, let’s say we want to check to make sure all of our staff have, you know, hand hygiene at all of our facilities in the last month. You can actually quickly see who’s got, who has done, this is all dummy data, but you can see, for example, Ariel had a zero score and Andy had a better score. So you can manage their entire program and make sure that all of the folks that are doing well, great, congratulate them, but the folks that are not, you can spend a lot more time with them. And similarly with other things like COVID audits and assessments. So, a really comprehensive program to make sure you can see everything, track everything, digitize everything, and be ready and get ahead of the curve rather than be behind. So, that’s a very quick, very quick high-level view of it. Obviously, there’s a lot more detail we can go through, and would be happy to do that with y’all later.
Raj Shah: So, with that, I want to get to some of the questions you all have where we’ve got only a few more minutes, and let’s see what the questions are around. The first question, I think Kate, this one might be good for you. “Are senior living facilities eligible for any of the dollars, meaning non-skill like independent living memory care assisted livings?”
Kate Wallace: Yes. Absolutely. Absolutely, under the Provider Relief Fund. So, definitely, something to look into, because they are absolutely eligible.
Raj Shah: The second question is, oh, I’ll answer that. “Do we have any integrations with LTC EHRs?” We do not, but our platform because it’s using the latest technologies, we can any APIs to any of them if the LTC HR is an open system, we can definitely do it. We are working with the client right now which we’re doing integration. It’s a large assisted living facility, for example. So, yes, we can do it.
Next question “You mentioned infection tracking. How about antibiotics and resistant bacteria?” Kate, you want to answer the question on C.diff, MRSA, and things like that.
Kate Wallace: Yeah, so we absolutely have content on our platform to manage with the best practices to manage MRSA and to really get ahead of it, so you make sure that your facility is at least risk for having MRSA outbreak, also C.diff. So, that’s definitely something that’s also integrated. Yeah, Raj is just showing right now on our platform. Prior to the pandemic, obviously, those were the main things on the forefront of facilities’ issues with infections. So, not something to forget about certainly and certainly is an issue.
Raj Shah: Next question is “Can you elaborate briefly on cost structure?” I assume you mean pricing. We totally recognize how difficult the budgets have been, so our solution’s incredibly affordable. Basically, it’s very simple, 190 dollars per month per facility, plus three dollars per user per month, basically the price of a cup of coffee per employee. So, a typical mid-size SNF would let’s say, 30 to 50 employees, about $800 a month or so. So, it’s incredibly reasonably priced in terms of what the value is.
The next question is “Can this be used on an iPad?” Yes, absolutely. Great question. The whole solution is mobile-based. In fact, you can notice up here. It says “demo” so we started the demo, but it’s basically you need, either an iPad, a tablet, or a laptop. You can also use a smartphone itself and just use that as long as you have Wi-Fi access. That’s all you really need is access to get to our system. Our entire system is all cloud-based, using Amazon web services, etc. It is secure and all that. But it allows us to then constantly be adding new features and functionalities. So, every two weeks we have additional new content like these assessments I am showing you and other things as well.
All right. I think we are running out of time, we are about one minute ahead. But there are no other questions. Again, we want to thank you all for joining us for this session today. Also just that deep heartfelt thank you from all of our entire team in terms of all of the incredibly hard work you’re doing.
Kate Wallace: Thank you so much. It’s a tough environment out there right now.
Raj Shah: Yes, absolutely. So, thank you again. Kate, any last words from you?
Kate Wallace: Everyone, stay safe. Vaccines are right around the corner. Things will get better. Stay safe and thanks for your hard work.
Raj Shah: Take care guys. Bye.