The toll that Covid-19 has taken on long-term care(LTC) residents is staggering, from increased likelihood of elder abuse to being targets for scams related to COVID-19. The risks that COVID-19 placed on the health of older adults and the ways it swept through long-term care homes caused residents to lose many of their rights. As the vaccine became more widely available, risks decreased and some of these restrictions were rolled back. Things have been slowly returning to normal. 

Unfortunately, despite the availability of the vaccine, the vaccination rate of Missouri’s long-term care staff is the lowest in the country. With the new Centers for Medicare and Medicaid (CMS) regulation that states all healthcare workers must be vaccinated by January 4, 2022, concerns over how this will affect residents have arisen. VOYCE released a statement on this regulation, noting that, among other things, this mandate will ensure residents can be safe in their own homes. While we recognize that this mandate will ultimately be in the best interest of residents, there is a concern about how it will affect staffing, which is already low.

One concern is that staffing will be so low in some LTC homes that they will be unable to stay operational. The Department of Health and Senior Services (DHSS) released an emergency amendment to their licensure to address this concern that staffing shortages might cause LTC homes to shut down. This statement, which becomes effective November 29, 2021, provides LTC homes with a procedure to temporarily close without surrendering their license. 

What Does the Amendment Say?

Prior to this emergency amendment, a licensed LTC home that was not in operation was required to notify DHSS and surrender their license within thirty days of closure, or the license was considered void. In order to regain that license, they would need to submit a complete application. This new amendment allows for an eligible LTC home to temporarily close without having to surrender its license. 

If staffing shortages due to the COVID-19 vaccine mandate result in an LTC home closing for two years or fewer, that LTC home is eligible to temporarily close and would need to submit a closure plan to DHSS. The department will approve or disapprove this closure plan. If the plan is approved, the LTC home must provide residents with a discharge notice. This notice must follow all federal and state laws. The LTC home then consents to a probationary license, which states that all residents will be discharged by the effective date of the temporary closure and that they will not admit any new residents.

Within two years, the LTC home must be reopened by the same operator. The department will need to approve the reopening of any LTC home that is temporarily closed. They will conduct a full inspection. The LTC home will need to submit a plan of corrections, applications, and licensure fees. Any LTC home that is not approved for temporary closure or is closed for more than two years will be considered fully closed and will be required to surrender its license and follow the standard steps for facility closure.

How This Affects Residents

Residents in homes that have to temporarily close due to staffing shortages will be discharged according to state and federal laws. These residents have the right to participate in the decision of where they go, so LTC homes will need to work with their residents to develop a safe discharge plan and placement.

Ultimately, by giving LTC homes a method to close and reopen without surrendering their license, DHSS has provided an incentive for these homes to take careful steps when closing due to staffing shortages. If the home wants to reopen without having to surrender their license and submit a complete application, they will need to follow the temporary closure procedure, including finding placement for residents. 

However, while this amendment provides specific steps that LTC homes must follow to be considered “temporarily closed,” we know that things don’t always work out exactly as planned, and we don’t know how these closures will look in practice. If you or your loved one are in an LTC home that is temporarily closing and you have concerns or questions about the procedure or if you feel that the LTC home is not following the appropriate discharge steps, contact your ombudsman.

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