The Department of Labor reported that 6,648,000 Americans filed for unemployment insurance benefits in the week ending March 28, 2020 as the COVID-19 pandemic continues to shut down many businesses and much of the economy.  This was an increase of 3,341,000 from the previous week’s upwardly revised level of 3,307,000.  While last week’s report shattered records, this week’s report was even more shocking due to the magnitude of the increase.  The speed and scale of the job losses is unprecedented.  In the past two weeks, 6.5% of employed people or nearly 10 million people have filed claims according to Bloomberg analysis.  It was the highest level of initial claims in the history of the series.  At its worse during the Great Recession, there were 665,000 first-time claims filed in the week ended March 28, 2009.  That was second only to the week ended October 2, 1982, when 695,000 first-time claims were filed. 

Continuing claims for regular benefits, which are reported with an extra week’s lag, rose 1,245,000 to 3,029,000. 

The largest increases in initial claims for the week ending March 21 were in Pennsylvania, Ohio, Massachusetts, Texas and California. Many states reported increased layoffs in service-related industries broadly and in the accommodation and food services industries specifically, as well as in health care and social assistance, and the travel and transportation industries.

The increase in unemployment claims is a preview of the March unemployment rate to be announced by the BLS tomorrow, on April 3^rd.  Most analysts expect it to rise from its February 2020 50-year low of 3.5%, but the larger impact will likely show up in the figures in the April employment situation report due to the timing of the surveys. The majority of the reported layoffs occurred after the Labor Department’s reference week in the March report.   In response to the expected sharp slowdown in the economy, the President signed into law a $2 trillion economic stimulus rescue package that broadly expands unemployment benefits. 

The Centers for Medicare and Medicaid Services (CMS) have taken numerous actions in response to the coronavirus pandemic. Importantly, some are actions to assist with continued access to care and many to ensure the safety of residents and staff. Initial responses included restricting visitors to skilled nursing facilities and changing the rules for covered facility stays. Patients who remain in the hospital fewer than three days may now receive Medicare-reimbursed skilled nursing care. The following are the summaries and links to CMS for further details. 

CMS Approves 12 Additional State Medicaid Waivers to Give States Flexibility to Address the Coronavirus Disease 2019 (COVID-19)

CMS approved an additional 10 state Medicaid waiver requests, bringing the total number of approved waivers for states to 23. The waivers offer states new flexibilities to focus their resources on combatting the outbreak and providing the best possible care to Medicaid beneficiaries in their states.

In addition, CMS also approved one additional Appendix K Amendments request to existing Home and Community Based Services (HCBS) Waivers under Section 1915 (c) of the Social Security Act (Act), bringing the total to 3 approved waivers to date. Appendix K is a tool states may use to temporarily modify approved HCBS Waivers during emergency situations.

https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/index.html  

https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/hcbs/appendix-k/index.html

New Guidance Regarding Enhanced Medicaid Funding for States – Federal Medical Assistance Percentage (FMAP)

CMS has released new guidance under the Families First Coronavirus Response Act that provides states with more federal Medicaid funding during the COVID-19 pandemic. This includes a 6.2 percentage point FMAP increase which all states are eligible for provided they meet certain requirements. This is effective beginning January 1, 2020 and extending through the last day of the quarter in which the public health emergency declared by the Secretary of Health and Human Services for COVID-19 ends.

https://www.medicaid.gov/state-resource-center/downloads/covid-19-section-6008-faqs.pdf

CMS is Prioritizing and Suspending Certain Surveys

CMS is prioritizing surveys by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and generally exercising enforcement discretion for three weeks. During the three week time period, only the following surveys will be prioritized and conducted:

1. Complaint/facility-reported incident survey
2. Targeted Infection Control Survey
3. Self-assessments

https://www.cms.gov/files/document/qso-20-20-allpdf.pdf

CMS is Expanding Telehealth Benefits

CMS is expanding Medicare’s telehealth benefits under the Coronavirus Preparedness and Response Supplemental Appropriations Act. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes. Considering the safety of residents and the need to continue physician care within nursing homes, telehealth will enable care to still take place in addition to mitigating COVID-19 infection.

https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak

Coronavirus Stimulus Bill Includes $200M for Nursing Home Infection-Control Efforts

Given the fact that CMS has made infection control a priority for nursing and current surveys of nursing homes, this bill will put additional support behind the current efforts of CMS to help ensure the safety of nursing home residents and staff. In addition, this is targeted to help the states’ efforts to prevent the spread of the virus.

https://www.appropriations.senate.gov/imo/media/doc/Coronavirus%20Supplemental%20Appropriations%20Summary_FINAL.pdf

The Department of Labor reported that 3,283,000 Americans filed for unemployment insurance benefits in the week ending March 21, 2020 as the COVID-19 pandemic shut down much of the economy.  The weekly report is among the first economic indicators to show the effects of the virus on the economy.   This was an increase of 3,001,000 from the previous week’s level of 282,000.  This shattered records and was the highest level of initial claims in the history of the series.  At its worse during the Great Recession, there were 665,000 first-time claims filed in the week ended March 28, 2009.  That was second only to the week ended October 2, 1982, when 695,000 first-time claims were filed.  This report compares poorly with the average 225,000 claims filed by people during each week during the past six months. 

The total number of people claiming benefits in all programs for the week ending March 7 was 2,006,363, a slight decrease from the previous week. There were 2,039,322 persons claiming benefits in all programs in the comparable week in 2019. 

The largest increases in initial claims for the week ending March 14 were in California, Washington, Nevada, Pennsylvania and Massachusetts.

The sharp increase in claims is attributable to impacts form the COVID-19 virus.  Many states reported increased layoffs in service-related industries broadly and in the accommodation and food services industries specifically, as well as in health care and social assistance, and the travel and transportation industries. States that depend heavily on tourism, were especially hard hit.

The increase in unemployment claims is a preview of the March unemployment rate to be announced by the BLS on April 3^rd.  Most analysts expect it to rise sharply from its February 2020 50-year low of 3.5%.  In response to the expected sharp slowdown in the economy, the Senate approved a $2 trillion economic stimulus rescue package that broadly expands unemployment benefits.  The deal will go to the House for a vote on Friday, March 27th.

Residents and Their Families Are Not Abandoning These Communities

Contrary to speculation that families are removing their elderly loved ones from senior housing and care properties, a new survey reports that 79 percent of operators saw no significant changes in move-outs last week and no significant changes in occupancy. Activated Insights, the senior care group of Great Place to Work, conducted this survey of private pay senior housing operators representing 1,078 buildings and 100,899 units.

Several U.S. operators noted that sales and marketing activities including all move-ins have been halted completely in this COVID-19 pandemic. Other operators continued to allow pre-scheduled move-ins to occur, though with extra steps and screening. 

Moreover, 21 percent of operators reported increased occupancy. Some operators attributed this increase to how families often realize they are not in a position to take care of an elderly or disabled loved one at home. Moreover, as one CEO commented, “they are much safer with us since we are cleaning and screening like mad.” Many of these move-ins are from pre-scheduled moves or families who have toured and were in sales consideration. Nearly all are heavily screened.

“The data reflect how quickly senior housing operators have adapted lessons learned in Washington state to protect our nation’s vulnerable elders and frontline staff by upholding the highest standards of care,” said Robert Kramer, Founder and Strategic Advisor at the National Investment Center for Seniors Housing and Care. “The results from this survey are especially timely since the investment community has been starved for data in this time of uncertainty.” 

The methodology for this study was based on phone surveys conducted on Wednesday, March 18 and Thursday, March 19 by Activated Insights. The 100,899 units represent close to 8 percent of the overall senior housing and care inventory. Moreover, the majority of the 19 operators are companies that have applied for Great Place to Work certification, an indication that they strive to be leaders in their field. Wharton and London Business Schools have published longitudinal, peer-reviewed studies concluding that Great Place to Work companies across a variety of industries perform better on key business indicators.

When asked why this survey was undertaken, Dr. Jacquelyn Kung, CEO of Activated Insights replied, “We were seeing new reports of families and their elderly loved ones fleeing senior housing and care properties but had not heard the same – so we thought it was strange. We conducted this survey to check the facts of what is actually occurring.”

While the COVID-19 pandemic is developing quickly and occupancy could change, this survey of senior housing operators by Activated Insights indicates that senior housing continues to serve an essential role in meeting the housing and care needs of frail older adults who are most at-risk in this pandemic.

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Medicare just announced that it will − temporarily − reimburse for telehealth-provided services, opening an opportunity for seniors housing providers to provide residents with access to vital health services without exposing them to pathogens circulating at hospitals and clinics as a result of the coronavirus outbreak.

A very timely panel discussion at the NIC Spring Conference on “Telehealth: Boon or Threat to Senior Care?” offered an overview of telehealth options, as well as concrete suggestions for seniors housing companies wanting to get started.

Panel moderator Kelsey Mellard, CEO of Sitka, laid the groundwork by clarifying that the general concept of “Telehealth” includes very different services.  Many people assume that telehealth describes remote monitoring of patient vitals, with smart devices transmitting health data to providers automatically and securely for analysis. The NIC panel, however, focused on another service category getting a lot of attention recently: virtual consultations by medical professionals, whether RNs, primary care doctors, or specialists; via phone, secure messaging, and/or video conferencing. Sitka and Doctor On Demand, whose president and chief commercial officer Robin Glass was also represented on the panel, both fall into this category.

Panelist Michael Kurliand, director of telehealth and process improvement at West Health, a non-profit focused on lowering health care costs for seniors, pointed out that telehealth is not new – it has been around since the 1960s – and that peer-reviewed and anecdotal evidence show up to a 40% reduction in hospital admissions with the deployment of telehealth practices in post-acute care settings.

Glass described the services of Doctor On Demand, where people consult via video and online chat with their care team. They can develop a relationship with a specific doctor, scheduling appointments in advance with him or her, or get help at any time from any doctor available. Doctor On Demand also supports multi-party calls so family members can join the conversation.

Sitka facilitates secure consultations with specialists, if the primary care physician needs a second opinion from an expert, and creates video messages from the specialist with specific instructions for patients, said Mellard.

Seniors housing staff members can assist residents with appointment scheduling online, or with using conference calling or messaging technology, keeping frail seniors from being exposed to dangerous viruses in doctors’ waiting rooms. Plus, as Kurliand points out, virtual visits can reduce the chance of a staff member getting infected.

During the question period, several operators asked about using telehealth for remote patient monitoring. Kurliand said this can be problematic because as soon as you get involved, you incur responsibility and liability.

For seniors housing operators wanting to explore telehealth, Kurliand said his team at West Health offers a free guide to getting started, available on the West Health website. Kurliand also suggests engaging with your regional Telehealth Resource Center. These government-funded centers offer connections and state-specific advice to organizations wanting to explore telehealth. You can find your local center at telehealthresourcecenter.org.

While the current CMS ruling applies only until the end of the healthcare emergency that the U.S. Department of Health declared on January 31, legislation pending in Congress could extend some or all of the provisions of the bill into the future. For more information, see the Medicare Telemedicine Health Care Provider Fact Sheet available on CMS.gov.

“There are a lot of good things in this ruling, and I commend Seema Verma and her team. It will give people a running start in implementing telehealth services, but it doesn’t really go far enough and will probably get revised,” Kurliand commented after the CMS ruling was announced.