Home Care Matters Home Care and Assisted Living

Home Care Matters Home Care and Assisted Living Program November 28, 2018

Agenda Time Topic 10: 00 -10: 15 Welcome and Updates – Cindy Vargas, Lari Anne Mazzitello 10: 15 -10: 30 License Renewal Tips – Neng Vang 10: 30 -10: 45 Survey Information – Jonathan Hill 10: 45 -11: 00 Multi-drug Resistant Organisms – Sean O’Malley, CHAIN 11: 00 -11: 25 Caller Questions – HCALP and CHAIN Team 11: 25 -11: 30 Closing 2

Home Care and Assisted Living Program (HCALP) Staff • • Jonathan Hill, Survey Supervisor Lari Anne Mazzitello, Operations Coordinator Neng Vang, Licensing Specialist Cindy Vargas, Organizational Coordinator Collaborative Healthcare Association Infection Network (CHAIN) • Sean O’Malley, Epidemiologist Healthcare-Associated Infections and Antimicrobial Resistance Unit Welcome

Housekeeping Lari Anne Mazzitello

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General Updates Cindy Vargas

Communication When Contacting Us 1) Emailing scanned documents is better than faxing 2) When leaving voicemail messages, speak slowly and include your 1) HFID 2) Name 3) Agency name 4) Telephone number 9

Reminder for Temporary Licensees Home care law requires that temporary licensees • Notify the Department of Health when you get your first client • Within five days of starting services By notifying MDH • You are complying with the law • We can put you on the survey schedule • We can determine if we can grant you a license 10

License Renewal Fees • License fees increased by 10% in July 2018. • Use the Revenue Worksheet to calculate revenue from licensed home care services. 11

Fines for uncorrected orders • Invoices for fines are now issued by Financial Management at MDH. • Send your payments of fines to the address on the invoice. • Interest charges will accrue if not paid in 30 days. • Past due fines are sent to the Minnesota Department of Revenue for collection. 12

New Survey Forms Coming Soon! • New forms are being piloted by HCALP surveyors now. • Forms were designed to help • Surveyors be more efficient • Providers conduct self-audits • Watch for them in early January 2019! • We will notify providers via Home Care Updates. 13

Licensing Neng Vang

License Renewal Reminders: Time Submit early • At least 60 days before expiration of license 15

License Renewal Reminders: Revenue • Do not use decimals • Round to nearest dollar • Do not use commas $289592 Include revenue from licensed home care services • Home Care Revenue Worksheet 16

License Renewal Reminders: Payment Pay by e-check • • Convenient No fee Faster to process More secure If you send a check include • Copy of confirmation page • HFID # on check 17

License Renewal Reminders: Application To ensure your license renewal is not delayed • Complete all required fields • Be accurate and thorough You only need to return the confirmation page if • Paying by check • Mailing your certificate of insurance • Your agency is Medicare certified (HHA) 18

License Renewal Responsibilities Licensees • Renew at least 30 days before current license expires • It is illegal to operate without a license MDH will • Notify licensee if application appears complete OR • Inform licensee if items are missing • Process renewal applications within 60 days of receiving complete application 19

Survey Jonathan Hill

Correction Orders • Top 5 Correction Orders • Common Home Care Correction Orders (http: //www. health. state. mn. us/divs/fpc/homecare/providers/commonviolations. html) • Comprehensive • Basic • Quality Management • Minn Stat 144 A. 479 Subd. 3 21

Home Care Matters Statewide Call November 28, 2018 Sean O’Malley, Epidemiologist Healthcare-Associated Infections & Antimicrobial Resistance Unit sean. omalley@state. mn. us

Objectives • Overview of multidrug-resistant organisms (MDROs) • Overview of carbapenem-resistant Enterobacteriaceae (CRE) • What is CRE? What is carbapenemase-producing CRE (CP-CRE)? • What can we do to prevent spread of MDROs, specifically CRE? • Risk factors for colonization and infection • Prevention efforts • Coordinated approach • Resources 23

Overview of Multidrug-Resistant Organisms

How do bacteria develop resistance? 25

CDC Hazard Levels 26

Overview of Carbapenem-Resistant Enterobacteriaceae

The Enterobacteriaceae • Family of over 70 species of bacteria • Most common: Klebsiella spp. , Escherichia coli, Enterobacter spp. • Enteric organisms • Common cause of healthcare-associated infections • • Urinary tract infections Bacteremia Pneumonia Wound infections • Carbapenem antibiotics (e. g. , meropenem) 28

Carbapenem-Resistant Enterobacteriaceae (CRE) • Difficult to treat • Pan-resistant strains • New antibiotic development is slow • Infections associated with high mortality rates • Prolonged colonization • Resistance can spread 29

Carbapenemase-Producing CRE (CP-CRE) • Carbapenemase: enzyme that breaks down carbapenems and other antibiotics • CP-CRE: CRE that carry genes for carbapenemase production • Can spread the genes to other bacteria, making them resistant • Can cause major outbreaks in health care facilities Susceptible Bacteria KPC Containing Bacteria XX XX Resistance Gene Transfer XX New KPC Containing Bacteria 30

CP-CRE Cases by Patient Location, 2013 -2017 Long-term Acute Care Hospital 7% Outpatient 29% Long-term Care Facility 6% Hospital Inpatient 58% 31

MDRO CRE CP-CRE 32

What can we do to prevent spread of MDROs, specifically CRE?

Understand Risk Factors • Indwelling devices • E. g. ventilator, urinary catheter, central venous catheter, gastronomy tube • Immunocompromised status • Surgical procedures • Wound management • Prolonged antibiotic exposure 34

Practice Prevention • Perform evidence-based infection control practices • Wash hands frequently especially before/after handling indwelling devices, after contact with wounds, and after exposure to blood and bodily fluids • Communicate with healthcare facilities about transfer of patients with MDROs, particularly CRE • When possible, dedicate specific equipment to patients colonized or infected with MDROs • Ask questions! • Sean O’Malley: sean. omalley@state. mn. us • Infectious Disease Epidemiology, Prevention and Control Main Line: (651) 201 -5414 35

Implement Coordinated Approach 36

Resources MDH Resources: Antimicrobial Resistance and Stewardship (http: //www. health. state. mn. us/divs/idepc/dtopics/antibioticresistance/index. html) Infection Prevention and Control Resources (http: //www. health. state. mn. us/divs/idepc/dtopics/icar/res/icf. html) CDC Resources: Antibiotic/Antimicrobial Resistance (https: //www. cdc. gov/drugresistance) Carbapenem-resistant Enterobacteriaceae in Healthcare Settings (https: //www. cdc. gov/HAI/organisms/cre/index. html) Multidrug-resistant organisms (MDRO) Management (https: //www. cdc. gov/infectioncontrol/guidelines/mdro/index. html) CRE Toolkit: Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (https: //www. cdc. gov/hai/organisms/cretoolkit/index. html) 37

Thank you! Questions? Sean O’Malley sean. omalley@state. mn. us 651 -201 -5414 (Main Line) 38

Q & A Time Home Care and Assisted Living Team

Mark Your Calendars Next Home Care Matters Call Wednesday, February 20, 2019 10: 00 – 11: 30 am 40

Thank you for participating in Home Care Matters! 41