We know that many long term care facilities around the country are struggling with staffing shortages due to the rapid spread of the Omicron variant. The Centers for Disease Prevention and Control (CDC) provides contingency and crisis capacity standards to help mitigate staffing shortages created by staff testing positive or PPE shortages. These standards were also outlined in a recent blog post.
There is no standard template or established process to move between these standards. Rather, CDC has left it up to each health care organization who knows its situation and needs the best to determine based on patient acuity, staffing needs, staffing levels, unique staffing positions, backup staffing availability, patient volume, patient needs, equipment and resource availability, etc. However, the lack of specific guidance leaves many providers uncertain on how to utilize these standards. Transitioning to different standards does not need to be facility wide. Rather, it may be necessary for certain units in the facility. Also, the duration of the transition can be short until the situation leading to the transition is resolved. Regardless, we recommend clearly documenting the reasons for the transition.
As you determine whether you need to activate these standards, we recommend that when you transition from conventional standards to contingency or crises:
- Contact your local or State Department of Health (DOH) and the State Survey Agency (SSA) to let them know why you are taking these actions, your staffing issues, and all the actions you have and will be taking to find staff and meet residents’ needs.
- Document why, when, how, and where it is making these transitions to contingency or crises standards, as well as what aspects of the CDC standards it will be adopting.
- Document all outreach/efforts to find staff and communication with the local or State DOH and SSA.
- Notify staff that you have made a transition and what it means to them.
Note that as you are considering whether to deploy these contingency and crisis standards of care, you may also need to consider pausing admissions and/or closing units/wings/floors to reallocate resources or, if all else fails, transferring residents to surrounding facilities or hospitals. If transferring residents is considered, you should contact the state DOH, the hospital(s), and ombudsman. The approaches used should also be consistent with the emergency preparedness plan. Some steps to help identify additional staff include:
- Put in a request to the local governor’s office for national guard support.
- Call your Ombudsman to ask for help in securing staffing help from the state.
- Reach out to your local health care coalition.
- Reach out to temporary staffing agencies.
- Reach out to other health care providers (e.g., hospitals and LTC providers).
We recognize that many of you are facing very real challenges and have deployed all these strategies and more with no or little results, which will cause a transition to contingency or crisis standards to meet the needs of residents. Documenting when and why you make these transitions and notifying others, including local authorities, is an important step helping your staff navigate through the crisis and may identify additional resources.