Vice Admiral Bono Responds to LTC Priority Requests 

Vice Admiral Bono Responds to LTC Priority Requests 

The associations had a follow-up call with Vice Admiral Bono after she assumed lead role on the COVID-19 response for Long Term Care.

The general tone of the call was consensus that long term care has seen the worst of this outbreak, yet we are still lacking the necessary resources to more effectively fight it. Last week VADM Bono did accept our recommendations for two LTC representatives, Laura Hofmann and Elena Madrid, to work with her and her response team directly. Some of the primary areas of focus will be working on discharge guidelines, the possibility of COVID + units, and central data collection. Here are some of the other highlights from the conversation.

PPE and Testing 

VADM Bono has requested all long term care be made a priority in Tier 1 to increase access to both PPE and testing. This heightened prioritization is regardless of whether there is a COVID+ case. Until there is widespread testing, allocating PPE to positive only buildings is not helping to slow the spread of the virus. Once testing in LTC expands, guidance is then needed on what to do with asymptomatic staff who will likely test positive as well as guidance as to where (separate unit, floor or distinct facility) positive residents will be placed.

HHS staff 

VADM Bono requested the additional staff that was sent to Washington from HHS be reassigned to help support the needs of LTC as this staff is no longer needed to address hospital surge in Yakima. The additional Public Health staff will be visiting communities where there are COVID outbreaks to offer training and education. The will also help administer testing to staff and residents. Initially, the Public Health staff was going to operate under the direction of DSHS. LeadingAge Washington was alarmed when we received notice from DSHS that they would be helping identify regulatory concerns as well as support.  The federal staff has now been moved under to local public health authorities to ensure these are assist and not compliance visits.

Agency Responses 

We expressed concerns about DSHS’s role and response to this outbreak. Ultimately the agency, both state and federal, needs to remove the punitive survey process so that the more pressing needs of saving lives takes precedence.  If compliance surveys continue, surveyors need to have very limited  scope of review and only in the event of knowing failure to act or act in disregard for resident well-being, should citations be issued.  Certainly facilities should not be held accountable for actions over which they could not foresee or areas over which they have no control such as PPE, testing or the nature of the virus itself.  Citations must also take into consideration the need to staff to implement breaking guidelines.  

We expressed the continuing concern over multiple reporting requirements. We are hearing from many providers that it’s time-consuming and hard to submit all of these reports. There is also an undercurrent of fear that DSHS RCS reports will trigger survey and then citations.  Reporting should be consolidated and include positive and suspected cases, staff needs, bed capacity, PPE and testing needs to one single entity. 

The call wrapped up talking about next steps for the future given the predicted resurgence of COVID in the fall along with Type A influenza.  We firmly articulated the need for one single agency to take the lead during a pandemic response.  “Home rule” of county public health agencies works well when the response required is geographically contained but, in an infectious disease-based pandemic, we need a more cohesive and coordinated response. DSHS is not knowledgeable or trained in infectious disease and public health matters and we suggested that the lead agency should be Department of Health.  More conversations will be needed to resolve this as we strive to avoid these inter-agency conflicts in the near future.




Alyssa Odegaard- Vice President, Public Policy 

c: 206.948.2279