Forum Posts

Mary Nichols
Jun 17, 2022
In Advocacy
Y'all, I don't know why it took so long for HHSC to put its foot down about SB25 and SB572 since these bills have been in effect since Sept 1, 2021. Actually, my pants are on fire. I do know the reason. HHSC has been waiting on the new permanent rules to go into the Texas Administrative Code that function under those laws. I understand but I am very disappointed with how little has been mentioned in the long-term care environment regarding the essential caregiver statute AND constitutional amendment when discussions take place about resident rights. I still feel now and then like I'm shouting into a void. Nevertheless, HHSC did just issue PL 2022-13, an official provider ANNOUNCEMENT letter to long-term care facilities, with information on new permanent rules implementing Senate Bill (S.B.) 25 and Senate Bill (S.B.) 572, 87th Legislature, Regular Session, 2021 as new Chapter 570. Read PL 2022-13 here.
HHSC Issues Provider Letter 2022-13 Regarding Implementation of SB25 and SB572 content media
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Mary Nichols
Jun 17, 2022
In Webinars
A recording of the June 15 Assisted Living Facility Provider COVID-19 Webinar with Long-term Care Regulation is now available. Listen to the webinar recording. Read the webinar slide presentation (PDF). Email LTCR Policy for the transcript.
June 15 Recording of ALF Provider COVID-19 Webinar with LTCR Available content media
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Mary Nichols
Jun 17, 2022
In Intermediate Care Facilities
Emergency rules for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions that contain the COVID-19 requirements for visitation expired June 16. What does this mean? It means they must follow COVID mitigation rules but there are no emergency visitation rules in effect. If visitation is ever stopped again, they must follow Chapter 570 of the Texas Admnistrative Code. The following rules expired June 16: 26 TAC §551.47 - ICF COVID-19 Response - Expansion of Reopening Visitation. ICF providers are still expected to comply with §551.46, ICF/IID Provider Response to COVID-19 - Mitigation emergency rules. Visitation requirements for essential caregivers and clergy in a disaster can be found in Texas Administrative Code Chapter 570. I know you have questions. I have them too. Let's ask them here in this thread or email Email questions to LTCR Policy.
HHSC ICF COVID-19 Expansion of Reopening Visitation Rules Expired June 16 content media
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Mary Nichols
Jun 16, 2022
In Assisted Living Facilities
Emergency rules for Assisted Living Facilities COVID-19 Response —Expansion of Reopening of Visitation in 26 TAC, Chapter 553.2003 expire on June 16 and will not be renewed. Effective June 17, providers will no longer need to follow these emergency rules. Here's where this gets confusing: ALF's must still follow 26 TAC, Chapter 553.2001, ALF COVID-19 Response emergency rules. That's rules about infection control, COVID response and mitigation, etc. Essential Caregiver rules are STATUTORY now so IF - that's IF - general visitation is ever stopped in an assisted living facility, PERMANENT ESSENTIAL CAREGIVER RULES are in place. Not temporary rules. Not emergency rules. These are permanent rules that you and I helped put in place under SB25 to make sure that residents would never wholly and completely be isolated ever again. Visitation requirements for essential caregivers and clergy in a disaster can be found here: https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC... If you are still confused, you can email questions to LTCR Policy
ALF COVID-19 Visitation Emergency Rules Expiring June 16 - NOT BEING RENEWED content media
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Mary Nichols
Jun 14, 2022
In Assisted Living Facilities
Assisted Living Facility providers, advocates, families, and ombudsma are invited to attend this and all Long-term Care Regulation ALF COVID-19 webinars. Provider attendance is critical to staying current with COVID-19 requirements and guidance. ALF Provider Webinar June 15, 2022 11 a.m. – 12:30 p.m. Register for the COVID-19 webinar
COVID-19 Webinar with LTCR on June 15 for ALF Providers content media
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Mary Nichols
Jun 05, 2022
In Advocacy
Y'all, we have an opportunity to make known our thoughts to the Senate Committee on Health and Human Services regarding COVID-19 policies that affected the patient-doctor relationship. I invite each of you to attend this hearing or attempt to submit written testimony. Three issues immediately come to mind that tie directly to how pandemic policies affect long-term care facilities. I'm sure I'll think of more. Since we only have TWO MINUTES to speak, the bulk of my remarks will be in writing. If there are policies you would like to see addressed by the committee but cannot testify, feel free to mention them here. REMINDER: we are not here to fault facilities. This post is about pandemic policies that hospitals and long-term care facilities were required to follow AND how those policies affected our loved ones living in long-term care. Facility bashing will be deleted and you may be also. MY RECOMMENDATIONS: Recommendation #1 Prevent waivers to a resident's right to in-person doctor visits and hospice visits in long-term care facilities. CMS waived the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allowed visits to be conducted via telehealth options which were inappropriate and wholly ineffective for many/most dementia patients, residents with intellectual and developmental disabilities, and veterans with traumatic brain injuries. This waiver is only JUST NOW being lifted as of June 6, 2022. We also know that telehealth visits do not work for cardiovascular and neurological issues in general. It's ludicrous that residents with intellectual disorders and disabilities were forced to participate in telehealth visits and their in-person doctor visits were denied. Recommendation #2 Make sure long-term care residents are never again prevented at a facility's discretion from leaving the facility for medical reasons like dental appointments, colonoscopies, mammograms, oncology appointments, and other visits that were deemed "routine" and "non-essential" during the pandemic and delayed to the detriment of a resident's health. I don't know how it was legal or under what waivers but residents were prevented from leaving facilities and consequently suffered from undetected and escalating conditions and diseases directly related to lack of preventive care outside the facility due to pandemic protocols. Recommendation #3 In-person hospital visitation must be addressed much the way long-term care visitation was addressed in SB25. Visitation is regulated by hospital policy and varies across the state. Incapacitated people went into ER's with no voice and no advocacy while many family members watched from the parking lot as a loved one was unloaded from an ambulance. Long-term care residents made ER visits with nobody to make medical decisions, push call buttons, speak for them, alert hospital staff to reactions, or keep up with treatments and medications. The resulting anaphylactic shock, sepsis, UTIs, escalation of disease, undetected cancers, etc. were wholly unnecessary and contributed to the lives of long-term care residents lost during pandemic protocols. We are Texas Caregivers for Compromise and we are #notgoingaway
ADVOCACY OPPORTUNITY - Public Hearing Before the Senate Committee on Health and Human Services content media
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Mary Nichols
Jun 05, 2022
In Advocacy
Hi folks, this is very long. If you don't wanna read it all, here's the crux. Please contact your U.S. House Rep and tell them HR3733 needs their support as a co-sponsor. You don't need to meet with them or write long letters (unless you want to). Just leave a voice mail or fill out the email form on their website. Find your U.S. rep here: https://www.house.gov/representa.../find-your-representative HR3733 posts are always long because of our history in Texas with essential caregivers. So hang in there. OR only read the parts that interest you. But, I want to update you on our group’s efforts re: HR3733, the FEDERAL essential caregivers act, and ask for your support. I know the writing is tiny on the graphic. Click on it to enlarge it or you can find the text of the full bill here: https://www.congress.gov/.../117t.../house-bill/3733/text... This is NOT our state law. It’s a federal one. To be clear - especially for any new group members - THIS IS NOT related to our HHSC guidelines, state law, or our constitutional amendment. This is not a Texas bill and does not take away any resident rights in place in Texas today. Our Texas essential caregiver rights stand regardless of this bill. This is a national bill that applies to all 50 states and will specifically help those states who have not put essential caregivers in place, default wholly to CMS guidance, or put bills in place that are not person-centered (translation: they are lip service). Background - For long-time group members and founding group members, you’ll remember that advocacy groups across the country came together last year and published a national version of the Texas “Saving Them to Death” book called “Protecting Them to Death”. We have used that book to promote the need for HR3733. We have also participated in a Washington D.C. round table discussion regarding the bill and we’ve shared our advocacy experiences with states throughout the U.S. via media and conferences: our traveling signs, letter campaigns, proposals, legislative efforts, relationships with our elected officials, successes/failures, and our recognition as family stakeholders in Texas with our Health and Human Services Commission which allows us to participate in work groups and task forces with HHSC and provider groups like the re-organization of the Texas Administrative Code as it applies to assisted living facilities, an Infection Prevention and Control Building Design Task Force, and the review of HHSC emergency visitation rules and guidelines for nursing facilities and assisted living facilities. BOTTOM LINE - We want other states to have what we have. We want Texas to be an example of how family advocacy can work well for long-term care residents. We want legislators to see how health authorities and provider groups can reach safe and reasonable solutions that take into consideration input from long-term care residents and their families. Why does Texas need HR3733? We don’t. Lemme just throw that out there right now. Texas does not need it. We are the only state that can say that. Residents in long-term care in Texas have a solid statute, HHSC is committed to guidelines that protect resident rights, and Texas has a constitutional amendment that guarantees every resident the right to an essential caregiver with whom in-person visitation cannot be denied. We're golden. So, why should Texas care about this bill? Because only long-term care residents in the great state of Texas have an essential caregiver right that cannot be paused or waived. And Texas is the only state that has had COMPREHENSIVE essential caregiver guidelines in place since September 2020 and we can PROVE that essential caregivers help prevent the life threatening despondency, extreme weight loss, and cognitive decline from isolation protocols. We are also proof that the threat of families bringing disease into facilities is very minimal, and because no resident should be forced to live in isolation. Texas is proof essential caregivers are a good thing. IF ANY STATE CAN PROVE THAT ESSENTIAL CAREGIVERS ARE A SAFE AND REASONABLE ALTERNATIVE TO ISOLATION PROTOCOLS, IT’S TEXAS. Will HR3733 fix everything for the other states? NOPE. It only applies to Medicaid/Medicare funded facilities but it is our hope that if the bill is adopted, states will put equal legislation in place for their assisted living facilities. We gotta start somewhere, though. Haven’t other states adopted essential caregiver bills? Some have and a couple of them are even decent bills. But most either still give full discretionary authority to facilities in contradiction to federal law OR they only copy language from CMS’s end of life requirements and make that applicable to all health care facilities.. How is Texas Caregivers for Compromise working to promote HR3733? We have consistently met with and spoken to U.S. House reps over the past year and asked them to co-sponsor and/or support HR3733 and have asked our U.S. Senators for their support with a Senate Companion bill. Just in the past two weeks, I’ve had nine meetings with U.S. House rep offices including five of the seven Texans in the two committees of jurisdiction, House Ways and Means and House Energy and Commerce. Why are Texans not co-signing? Because we don’t need it and our legislators know that. We need to make sure our U.S. House reps understand that Texas is the testing ground for essential caregiver guidelines that proves it can work at the federal level for all states. Texas is the groundbreaker, the flagship, the trailblazer. But our essential caregiver guideline development process has not been flawless in Texas. Of course not. But we’re the state that has learned through 21 months of trial and error what works and what doesn’t. And we are the state where the health authority, provider groups, ombudsman office and family stakeholders (Texas Caregivers for Compromise) HAVE ALL WORKED TOGETHER. How can you help? There are 38 U.S. House districts in Texas. This is NOT THE SAME as the 150 Texas House Representatives. Contacting a state rep does no good. None. Zero. They passed SB25 and SJR19 (Prop6) and we are grateful. Your U.S. HOUSE REPs are the elected officials to tell that HR3733 needs their support. There are over 7,000 bills in the U.S. House right now. They need to know this one matters. Use this link to find your US Representative. As a constituent, your voice carries much weight. Just leave a voice mail or drop an email and say that we need HR3733 in this country so Texas is not the only state where long-term care residents are protected from isolation protocols. https://www.house.gov/representa.../find-your-representative We are Texas Caregivers for Compromise. We are not Texas Caregivers for Perfect Justice. And we are #notgoingaway
ADVOCACY OPPORTUNITY - Contact your U.S. House Representative content media
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Mary Nichols
May 22, 2022
In Webinars
A recording of the May 18 Assisted Living Facility Provider COVID-19 Webinar with Long-term Care Regulation is now available. Listen to the webinar recording. Read the webinar slide presentation (PDF). Email LTCR Policy for the transcript.
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Mary Nichols
May 22, 2022
In Webinars
A recording of the May 11, 2022, NF COVID-19 webinar with the CDC, LTCR and DSHS is now available. Listen to the webinar recording here. Read the webinar slide presentation (PDF). Email LTCR Policy for a transcript.
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Mary Nichols
May 22, 2022
In Nursing Facilities
A recording of the May 11, 2022, NF COVID-19 webinar with the CDC, LTCR and DSHS is now available. Listen to the webinar recording here. Read the webinar slide presentation (PDF). Email LTCR Policy for a transcript.
May 11 Recording of NF COVID-19 Webinar with LTCR Available content media
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Mary Nichols
May 22, 2022
In Intermediate Care Facilities
HHSC Long-term Care Regulation updated the COVID-19 FAQ document for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions program (ICF/IID). The update removes instructions on how to request emergency staffing from HHSC. Read the updated Frequently Asked Questions for ICF/IIDs about COVID-19 (PDF).
HHSC Updates the ICF/IID COVID-19 FAQ Document – May 10 content media
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Mary Nichols
May 22, 2022
In Assisted Living Facilities
A recording of the May 18 Assisted Living Facility Provider COVID-19 Webinar with Long-term Care Regulation is now available. Listen to the webinar recording. Read the webinar slide presentation (PDF). Email LTCR Policy for the transcript.
May 18 Recording of ALF Provider COVID-19 Webinar with LTCR Available content media
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Mary Nichols
May 14, 2022
In Advocacy
Scroll down on this link to the 35th amendment to the Texas Bill of Rights. Notice, this doesn't happen "all the time". ONLY FIVE SINCE 1876! This was historic. HISTORIC! You did this! You did it with your Texas tenacity! Go have a big ol' glass of sweet tea (of COURSE you can use Splenda or Stevia, I don't care) and pat yerselves on the back! YEE HAW! Also, be sure to thank Rep James Frank and Senator Lois Kolkhorst, if you haven't already. #notgoingaway https://statutes.capitol.texas.gov/Docs/CN/htm/CN.1.htm
The Capitol records are now updated! ONLY FIVE OTHER AMENDMENTS TO THE TEXAS BILL OF RIGHTS SINCE 1876! content media
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Mary Nichols
May 14, 2022
In Assisted Living Facilities
Assisted Living Facility providers are urged by HHSC to attend this and all Long-term Care Regulation ALF COVID-19 webinars. Advocates are also invited to attend. Provider attendance is critical to staying current with COVID-19 requirements and guidance. ALF Provider Webinar May 18 11 a.m.–12:30 p.m. Register for the COVID-19 webinar.
Register for May 18 LTCR COVID-19 Webinar for ALF Providers content media
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Mary Nichols
Apr 25, 2022
In Long-Term Care Resources
NURSING FACILITIES (NF) ​ ASSISTED LIVING FACILITIES (ALF) ​ STATE SUPPORTED LIVING FACILITIES (ICF/IID)
Texas HHSC Information Portals by Facility Type content media
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Mary Nichols
Apr 25, 2022
In Intermediate Care Facilities
Intermediate Care Facility Visitation Guidelines & Resources ICF/IID Emergency Rules (texas.gov) FAQs for ICF Providers April 18, 2022 Updated ICF COVID-19 Response Plan - April 18, 2022 Provider Letter 2021-21 (replaces 2021-10)
Intermediate Care Facility Resources content media
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Mary Nichols
Apr 25, 2022
In Assisted Living Facilities
Assisted Living Facility Visitation Guidelines & Resources ALF Emergency Rules (texas.gov) Updated ALF COVID-19 Response Plan - April 18, 2022 FAQ's for ALF Providers April 19, 2021
Assisted Living Facility Resources content media
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Mary Nichols
Apr 25, 2022
In Nursing Facilities
Nursing Facility Visitation Guidelines & Resources NF Emergency Rules (texas.gov) CMS Nursing Home Visitation FAQ's - March 10, 2022 UPDATED CMS Guidance for Visitation in Nursing Homes
Nursing Facility Resources content media
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Mary Nichols
Apr 25, 2022
In Webinars
Nursing facility providers should attend this and all COVID-19 webinars with HHSC Long-term Care Regulation and the Texas Department of State Health Services. LTCR and DSHS will provide the latest information on the COVID-19 pandemic and take live questions from participants. Staff from the Centers for Disease Control and Prevention will be joining the webinar as special guests to discuss nursing facility guidance related to COVID-19 infection control and contingency and crisis staffing. CDC staff will take live questions from nursing facility providers. Internet Explorer users may have difficulties registering for the webinar. Try another browser such as Google Chrome or Microsoft Edge. NF Provider Webinar May 11, 2022 2:30 – 4:00 p.m. Register for the COVID-19 webinar.
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Mary Nichols
Apr 21, 2022
In Webinars
The April 11 recording of the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Q&A with HHSC Long-term Care Regulation and DSHS is available. The PowerPoint is updated with information given in the DSHS webinar. Read the COVID-19 Q&A (PDF). Listen to the webinar recording here. Email LTCR Policy for the transcript.
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Mary Nichols

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