Friday, May 29, 2020

Washtenaw County Democratic Party Special Education Summit, 6/18 @ 6-8 pm

from the Washtenaw County Democratic Party:

Special Education Summit, K-12
June 18 @ 6:00 pm - 8:00 pm


The Washtenaw County Democratic Party is working hard to tighten our connection to the community and serve as a bridge between politics and people. Since parents have started crisis schooling, many of the gaps in our education system have been exposed. What does the “sense of urgency” in our response say about our commitment to educational equity? The WCDP’s Dems Care has organized the Special Education Summit to address this question. This event will include a number of speakers as well as several breakout panels with experts in the field. These panels include:

  • The Tea Room: Open discussion for parents
  • How Stuff Works: IEPs during COVID-19, summer resources and services
  • Advocacy is Self-Care: Special education advocacy
  • Big Changes: Social-emotional support, advice for families with students who were in self-contained classrooms
  • Ally/Working with Families and Intersections: How to support non-parent allies including teachers, social workers, and service providers
More information is forthcoming including a link to the Zoom meeting.

Wednesday, May 27, 2020

Parenting a child with severe autism during a pandemic

This is an NPR interview with Feda Almaliti, the mother of a 15-year-old son with severe autism. Feda is also the Vice President of the National Council on Severe Autism and has written articles for the NCSA Blog and the Autism Society San Francisco Bay :

'He's Incredibly Confused': Parenting A Child With Autism During The Pandemic  


May 22, 2020
Heard on All Things Considered 
by Courtney Dorning and Mary Louise Kelly 

Here are some excerpts from the interview: 

"'Muhammed is an energetic, loving boy who doesn't understand what's going on right now. He doesn't understand why he can't go to school. And school is one of his favorite places to go. He doesn't understand why he can't go take a walk in the mall when that was one his favorite things to do. He doesn't know why he can't go to the park, why he can't go down to the grocery store,' Almaliti says. 'So he's incredibly confused, in this time when we're all confused, but he really doesn't understand it.'"
 

..."It's the unknowing. ... We don't know when it's going to end. We don't know what's going on, and to deal with autism at home makes it even harder. The only support that I get to get through it is through fellow autism parents. We have Zoom calls, and we try to find humor in this thing. ... We're just trying to lean on each other to get through. Because I can't do it alone. Nobody can."...

"...I almost feel like nobody hears us. Because my son doesn't really talk. He doesn't talk. And I'm supposed to be his voice. And no one's listening to what's going on for our families. You know, no one gets that we are just as vulnerable as coronavirus people. The coronavirus is going to come and go. Autism is here to stay." ...

..."We desperately need extra help to get through this. And I firmly believe that autism support workers, aides, their teachers and caregivers are as essential as nurses and doctors and should be given the same accommodations. People don't understand that for our families, caregivers are our first responders. Special needs schools are our hospitals. Our teachers are our ventilators. And we can't do this without them."

More articles by Feda Almaliti:


Three Strikes... and He's Out?
May 23, 2020 [Reprinted from
a 2018 blogpost at Autism Society San Francisco Bay Area]

What happens when the regular world has had enough of my son's autism 
..."Inclusion is a hot topic in disability circles, but when our kids can’t play by society’s rules, inclusion can truly suck. Instead of some fantasy of joyful acceptance, we get black-listed. Over and over and over. How I dream of places, spaces and programs fully accepting of our special children. Autism-friendly rules, not 'If you act autistic you’re out' rules."

"...At Autism Society San Francisco Bay Area’s Summer Pool Parties we make sure an autistic kid can be him or herself. Where they can chew on pool noodles, bellow and flop around, and no one judges them. So here we are, me in the burkini and Mu in his element. A place, however small, where everyone with autism belongs... on the VIP List. If only the rest of the world were so accommodating."

Inclusion Sucks. Or, Why My Son with Severe Autism Has Nowhere to Swim this Summer 

May 22, 2020

"An autism mom stuck at home with her son on a hot summer day meditates on the smallness of his world when inclusion is the only option. ...Of course my pool predicament is a microcosm of a bigger problem: disability-friendly day programs, jobs, housing, and therapeutic care—vital lifelines for parts of our population—are at risk given the direction of federal policy. The trendy mantra is 'community integration' while options for the severely disabled slowly disappear into the black hole of red tape and de-funding."...

..."They say, 'Why maintain an autism day program when Joe could just go to the local Y?' or 'Why have sheltered workshops when Sam can get a competitive job at Safeway?' Please tell me, what are these people smoking and in which smoking lounge can I find them? Have they ever tried caregiving for someone like my son?

"So let's make a deal. Let's ensure inclusion and integration for all those who want it. And let's support acceptance of all, including acceptance of alternative options for the Muhammeds of our world. Don't let narrow ideology throw our babies out with the bath, or, er, pool water. It's just common sense. In the meantime if you'll invite us over for a swim, we'd appreciate it."

Monday, May 25, 2020

Michigan voter information - the Secretary of State's Website is the most reliable source

Last week, Michigan was the subject of a tweet storm between President Trump and Jocelyn Benson, the Michigan Secretary of State. As the dust settled, it turned out the President’s assertions were without merit and the original tweet was deleted, but the odor lingered of a grossly misleading accusation - that the Michigan Secretary of State was implicated in voter fraud. 

I looked to Factcheck.org for an accurate account of what happened. Factcheck.org is a “nonpartisan, nonprofit 'consumer advocate' for voters that aims to reduce the level of deception and confusion in U.S. politics.” It is a project of the Annenberg Public Policy Center of the University of Pennsylvania. 


According to this article at Factcheck.org, “Trump’s False Tweet About Michigan Absentee Ballot Applications” by D’Angelo Gore, 5/20/20:
 

“President Donald Trump erroneously tweeted that Michigan’s Democratic secretary of state was 'illegally' sending 'absentee ballots to 7.7 million people' for this year’s primary and general elections.

“The state said it will send absentee ballot applications — not actual ballots — to all registered voters, who may want to vote by mail.”


The article confirms that Benson’s Republican colleagues in Iowa, Georgia, Nebraska, and West Virginia have also mailed absentee ballot applications to voters and there is nothing illegal about it.


“The National Conference of State Legislatures says that all U.S. states allow qualified voters to vote by absentee ballot, and five states (Utah, Colorado, Hawaii, Washington and Oregon) currently conduct all their elections primarily by mail. Michigan is one of 34 states that do not require an excuse from those who want to vote by absentee ballot, according to the NCSL." [emphasis added]

 
The President deleted his original tweet and replaced it with one that claimed incorrectly that sending out ballot applications is illegal. He also threatened to withhold unspecified federal funds from Nevada and Michigan for sending out “illegal” ballot applications.


Furthermore, “Election experts previously told us that fraud via mail-in ballots is more common than in-person voting fraud, but still rare. Plus, a recent study by Stanford University’s Democracy & Polarization Lab found that neither the Democratic or Republican parties would benefit from an entirely vote-by-mail system.”
 

Putting all this aside, the Michigan Secretary of State Website has tons of information on voting. Here are some excerpts that tell you who can vote, where to vote, and how to vote;

How does one register to vote and who is eligible to vote?

 

You can register to vote through Election Day.
 

You must be:
  • A Michigan resident (at the time you register) and a resident of your city or township for at least 30 days (when you vote)
  • A United States citizen
  • At least 18 years of age (when you vote)
  • Not currently serving a sentence in jail or prison

[Note that a person under guardianship as determined by a Probate Court is not disqualified from voting. My husband and I are plenary co-guardians for our two sons who have profound developmental and Intellectual disabilities. If we thought they had opinions on who they would like to vote for, we would be happy to facilitate that. But they are unable to communicate or give any indication that they understand the concept of voting, so we will not do that. If we did, I think one could easily question whether we were having them express their own thoughts and opinions, or just giving ourselves two extra votes based on our own opinions.]

Check to see if you are registered to vote
 

[Michigan does not register voters by political party. If you vote in a primary election to choose a candidate for a political party, you must pick which party primary you want to vote in. You may not split your vote between parties.]

Frequently asked questions about voting

 

Excerpts:

Do I need to show identification in order to vote?


Michigan does have a voter identification requirement at the polls. Voters are asked to present an acceptable photo ID such as a Michigan driver's license or identification card. Please note that voters who do not have an acceptable form of ID or failed to bring it with them to the polls still can vote. They simply sign a brief affidavit stating that they're not in possession of a photo ID. Their ballots are included with all others and counted on Election Day….


Can Michigan residents in jail or prison still vote?


Michigan residents confined in jail or prison who are awaiting arraignment or trial are eligible to vote. However, residents who are serving a sentence in jail or prison after conviction cannot vote during the period of confinement. When residents are released from jail or prison after serving a sentence, they are free to participate in elections without restriction.


Can voters be challenged based on home foreclosures?
 

The compilation of home foreclosure information alone does not provide sufficient reason to challenge a person's voting status. In fact, the Michigan Republican and Democratic parties are in agreement that so-called foreclosure lists do not provide a reasonable basis to challenge voters.

How does the voter ID requirement affect me if I vote with an absent voter ballot?
 

If obtaining your absent voter ballot in person, you will be requested to show photo ID. If you are not in possession of photo ID, you can simply sign an affidavit stating you are not in possession of photo ID. This requirement does not apply if requesting your ballot via mail. 

Does Michigan allow early voting?


Michigan Voters can cast absentee ballots beginning 45 days prior to Election Day. These ballots are tabulated on Election Day.


For more information and answers to questions, see Michigan Election and Voter Information

Future Scheduled elections: 


Primary elections: August 4, 2020
General election: November 3, 2020

Saturday, May 23, 2020

Covid-19 Transmission: the risks and how to avoid them

When it comes to Covid-19 and the global pandemic, we are constantly advised to “follow the science” without considering what that means exactly. There are many variations of the definition of science. Here are parts of a definition from dictionary.com  that go a long way to describe what I refer to as “science”:

“...systematic knowledge of the physical or material world gained through observation and experimentation”…”knowledge, as of facts or principles; knowledge gained by systematic study”

Add to that this excerpt from Miriam-Webster.com : “..the state of knowing : knowledge as distinguished from ignorance or misunderstanding”. This covers the territory for me.

“Science” is not static. A body of knowledge about a new human virus changes with time as we get to know more and more about it. What we do about it is sometimes based on misleading and incomplete information. Combined with wacky conspiracy theories and unproven assertions of fact, the public response to the presence of the virus can veer into irrationality.

Early on in the pandemic, medical authorities recommended that masks should be worn by front-line medical workers, but were not necessary for average citizens without symptoms to contain the spread of the disease. This was based partly on a shortage of masks for medical workers who were most at risk of coming into contact with people who were contagious and falling ill because of it. As the shortage of masks eased and more studies came out about the value of masks in controlling previous epidemics, the recommendation changed to encourage the use of masks by everyone who was in a situation where strict social distancing could not be observed, and, finally, everyone out in public should wear a mask because many people can be contagious with the virus before they experience symptoms. Many others transmit the virus without ever knowing they have it.

For some, this seemed like a betrayal. People we are supposed to trust told us one thing and then recommended the exact opposite a few weeks later. “Science” does not offer certainty or necessarily comfort for people who are confused and fearful. But scientific knowledge, even as it changes, usually gives us the best chance to protect ourselves and our fellow citizens - in other words, to do the right thing.

***************************

“News” about Covid-19 that is more than two weeks old may be out of date. But this article, "The Risks - Know Them - Avoid Them", 5/6/2020, that appeared as a blog post by Erin Bromage, an Associate Professor of Biology at the University of Massachusetts, Dartmouth, functions as a little instruction manual for understanding the virus that causes Covid-19 and what we can do to avoid infection and prevent its spread. This is especially relevant as states remove restrictions on activities that have helped to contain the virus.

Here at two things from Bromage’s blog post to keep in mind when you read the article:

“As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I've said before, if you don't solve the biology, the economy won't recover. “ [emphasis added]
 

and
 

“Remember the formula: Successful Infection = Exposure to Virus x Time”

Highlights from “The Risks - Know Them - Avoid Them”
 

Based on infection dose of other Corona viruses, “Infection could occur, through 1000 infectious viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.”

Sources of Infection


"A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite [objects or materials that are likely to carry infection] transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk...."

A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds."


"A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room)."


"A breath: A single breath releases 50 - 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled."
 

"Speaking increases the release of respiratory droplets about 10 fold; ~200 virus particles per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose.
 

Who is contagious?

“Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections--and the majority of community-acquired transmissions--occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.”

“The amount of virus released from an infected person changes over the course of infection and it is also different from person-to-person. Viral load generally builds up to the point where the person becomes symptomatic. So just prior to symptoms showing, you are releasing the most virus into the environment. Interestingly, the data shows that just 20% of infected people are responsible for 99% of viral load that could potentially be released into the environment.”


Where are you most likely to contract the virus?

 
“We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection."...

“But where are people contracting the infection in the community? I regularly hear people worrying about grocery stores, bike rides, inconsiderate runners who are not wearing masks.... are these places of concern? Well, not really. Let me explain….”


Bromage gives excellent explanations with references to relevant studies of outbreaks that show where an invidual is most at risk to contract the virus. 


“The reason to highlight these different outbreaks is to show you the commonality of outbreaks of COVID-19. All these infection events were indoors, with people closely-spaced, with lots of talking, singing, or yelling. The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections.”


…”Basically, as the work closures are loosened, and we start to venture out more, possibly even resuming in-office activities, you need to look at your environment and make judgments. How many people are here, how much airflow is there around me, and how long will I be in this environment. If you are in an open floorplan office, you really need to critically assess the risk (volume, people, and airflow). If you are in a job that requires face-to-face talking or even worse, yelling, you need to assess the risk. “


Most importantly, “… if you don't solve the biology, the economy won't recover. “


************************
Read “The Risks - Know Them - Avoid Them” by Erin Bromage to see all the graphics accompanying the article, references to studies, and information about the author.

Friday, May 1, 2020

Michigan: more information on pay increases for Direct Care Workers

This is a letter from the Michigan Department of Health and Human Services, Behavioral Health and Developmental Disabilities Administration, to PIHPs (regional administrative agencies that pass on Medicaid funding to local Community Mental Health agencies).

It deals with proposed Medicaid funding changes that have not been approved yet by CMS (the Federal Centers for Medicare and Medicaid Services) and are subject to change.
 

"...The purpose for sharing this information is to let you know what we are working on and to keep you as informed as we can as we all work to manage this crisis...."
 

*************************** 
April 30, 2020

TO: Executive Directors of Prepaid Inpatient Health Plans (PIHPs) and Community Mental Health Services Programs (CMHSPs)
 

FROM: Jeffery L. Wieferich, M.A., LLP, Director JW
Bureau of Community Based Services
Behavioral Health and Developmental Disabilities Administration

SUBJECT: Funding Information
 

[See the full letter here. It is missing its original formatting, but is the best I can do for now.]
 

Excerpt on pay increase:

Direct Care Wage Increase
The Direct Care Wage increase is intended to be effective from April 1, 2020 to June 30, 2020. [emphasis added] The increase does have limited funding and a limited scope of which workers are included. The behavioral health direct care workers impacted by this increase include those providing:

• Community Living Supports
• Overnight Health and Safety Supports
• Personal Care
• Prevocational Services
• Respite
• Skill Building.

There will be a Medicaid L-letter coming out shortly with this information.

The wage increase will be pushed out through the PIHPs in the same manner as the last two wage increases and funding will support the $2 an hour increase along with an additional 12% employer cost.

Please let us know if you have any questions.


cc: Allen Jansen

Thursday, April 30, 2020

Michigan Covid-19 Update for 4/30/2020

Although the number of deaths and hospitalizations are slowing in Michigan, there is ample evidence that we are still facing an uphill battle in controlling the spread of the virus.

The recommendations for people especially vulnerable to the worst effects of the disease, including death, still apply. That includes people who are aging or have underlying disabilities or conditions that make the virus life-threatening (including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy). 


The solution for this population is to self-isolate and avoid contact with others who could be spreading the virus. My sons, who live in a group home with four other residents who are medically fragile, have not left their home for about 6 weeks. There is no end in sight until there is adequate testing that makes it possible to assess who they can safely associate with. We can learn, however, how to deal with this in innovative ways, but the risk is too great at the moment to let the virus rampage through the general population, increasing everyone’s probability of contracting the virus.

Here is a timeline of events from the Detroit Free Press, to remind us of how quickly the virus spread:


Governor Whitmer declared a state of emergency on March 10, 2020, after confirming the state’s first two cases of Covid-19. As of April 29, 2020, we have had 40,399 confirmed cases in Michigan. 3,670 corona virus-related deaths have been reported since March 18, 2020.

As reported in the Detroit Free Press on 4/30/20, the state had 103 more corona virus deaths and 1,137 more confirmed cases statewide over one day, according to the Michigan Department of Health and Human Services data.

[For more information, see the state’s Covid-19 Website that includes reports from long-term care facilities (so far I have not seen any data for group homes), testing results, and a breakdown of data by county.  See also the Michigan Medicine Website from the University of Michigan.]

Michigan’s State of Emergency
 

The Michigan legislature has challenged Governor Whitmer’s use of emergency powers, first to declare an emergency and then to extend stay-at-home orders without the express approval of state legislators. A Detroit Free Press article, “Michigan's governor and emergency powers: What you need to know” by Paul Egan, 4/30/20, explains the issues involved:
 

“Whitmer, who holds most of the power in a state emergency, wants to extend it by at least 28 days, and said last week that it should remain in effect even beyond that.
 

“The state of emergency should not be confused with the stay-at-home order, which currently runs through May 15 and could be further relaxed by then.
 

“States of emergency are not uncommon in Michigan. Stay-at-home orders are extremely rare.”

What is the dispute about? For the state of emergency to continue, doesn't the Legislature have to vote to extend it?

“Michigan has two different emergency laws that say two different things about the role of the Legislature.
 

“The Emergency Powers of Governor Act of 1945 gives the governor additional emergency powers, sets no time limit on how long an emergency declared by the governor can last, and sets out no role for the Legislature in approving or extending a state of emergency.
 

“The Emergency Management Act of 1976 provides the governor with even broader emergency powers. But it says for a state of emergency to continue beyond 28 days, approval of the Legislature is required.”

Why doesn’t the more recent 1976 Act apply?

“…the Emergency Management Act, says, in part: 'This act shall not be construed to ... limit, modify or abridge the authority of the governor to proclaim a state of emergency  under the 1945 law, The Emergency Powers of Governor Act.'"
 

Whitmer is seeking to work in unison with the legislature. One reason is that the Emergency Management Act has more detail than the Emergency Powers of Governor Act,
 

“…one detail Whitmer says she wants to keep.
 

“It sets out immunity from civil liability for first responders and medical professionals for actions they take in response to the emergency.”
 

The issue of the Governor’s powers could end up in court.

In the meantime, hunker down and isolate as necessary.

Don't drink the Lysol and don't drink the Kool-Aid!

Saturday, April 25, 2020

Michigan Updates for Direct Care Providers and Long-Term Care Facilities during Covid-19 Pandemic, 4/25/20

On April 22, 2020, according to Click-On Detroit, Michigan Governor Whitmer announced a temporary pay raise of $2/hour for direct care workers providing Medicaid-funded in-home behavior health and long-term care services during the Covid-19 pandemic:

“'It has never been more important to care for our most vulnerable residents, and these direct care health workers are risking their lives every day to make sure we continue to flatten the curve,' Whitmer said. 'It is our duty as Michiganders to ensure these front-line heroes have the financial support they need to continue doing their critical work while caring for themselves and their families.'"


The program will apply to services provided between April and June.

“'Every day, caregivers are going into the homes of disabled and elderly residents to help them live with dignity,' said State Sen. Jeff Irwin (D-Ann Arbor). 'These heroes work long hours for low pay and little recognition for the critical care they provide. Thank you, Governor Whitmer, for looking out for these caregivers who are risking themselves to look out for our neighbors in need.'"

**************************
On April 15, 2020, Michigan Governor Whitmer issued Executive Order 2020-50, “Enhanced protections for residents and staff of long-term care facilities” .

A “long-term care facility” means a nursing home, home for the aged, adult foster care facility, or assisted living facility. Licensed group homes for people with developmental disabilities (DD) are adult foster care (AFC) facilities.

Protesters against the governor’s executive orders, including stay home orders, have complained that the governor is acting illegally. They have revived the “Lock Her Up” chant, heard mostly in opposition to female politicians they disagree with.

Executive orders include the legal basis for their use - the Emergency Management Act and the Emergency Powers of the Governor Act of 1945:

“The Emergency Management Act vests the governor with broad powers and duties to ‘cop[e] with dangers to this state or the people of this state presented by a disaster or emergency,’ which the governor may implement through ‘executive orders, proclamations, and directives having the force and effect of law.’ ...Similarly, the Emergency Powers of the Governor Act of 1945 provides that, after declaring a state of emergency, ‘the governor may promulgate reasonable orders, rules, and regulations as he or she considers necessary to protect life and property or to bring the emergency situation within the affected area under control.’ ....”

Excerpts from EO 2020-50


I. Protections for residents of long-term care facilities


1. Notwithstanding any statute, rule, regulation, or policy to the contrary, a long-term care facility must not effectuate an eviction or involuntary discharge against a resident for nonpayment, nor deny a resident access to the facility, except as otherwise provided in this order.


2. A long-term care facility must not prohibit admission or readmission of a resident based on COVID-19 testing requirements or results in a manner that is inconsistent with relevant guidance issued by the Department of Health and Human Services (“DHHS”).

3. The following apply to a resident that obtained housing outside of a long-term care facility, including but not limited to living with a family member, during the declared states of emergency and disaster:

(a) The resident does not forfeit any right to return that would have been provided to the resident under state or federal law had they been hospitalized or placed on therapeutic leave.
(b) The long-term care facility of origin must accept the return of the resident, provided it can meet the medical needs of the resident and there are no statutory grounds to refuse the return, as soon as capacity allows.
(c) Prior to accepting the return of such a resident, the long-term care facility must undertake screening precautions that are consistent with relevant DHHS guidance when receiving the returning resident.

4. Nothing in this order abrogates the obligation to pay or right to receive payment due under an admission contract between a resident and a long-term care facility.

5. All long-term care facilities must use best efforts to facilitate the use of telemedicine in the care provided to their residents, including, but not limited to, for regular doctors’ visits, telepsychology, counseling, social work and other behavioral health visits, and physical and occupational therapy.

II. Protections for employees and residents of long-term care facilities


1. It is the public policy of this state that employees of long-term care facilities or regional hubs who test positive for COVID-19 or who display one or more of the principal symptoms of COVID-19 should remain in their homes or places of residence, as provided in section 2 of Executive Order 2020-36 or any order that may follow from it, and that their employers shall not discharge, discipline, or otherwise retaliate against them for doing so, as provided in section 1 of Executive Order 2020-36 or any order that may follow from it.


2. Long-term care facilities must:

(a) Cancel all communal dining and all internal and external group activities throughout the duration of the declared states of emergency and disaster;
(b) Take all necessary precautions to ensure the adequate disinfecting and cleaning of facilities, in accordance with relevant guidance from the Centers for Disease Control and Prevention (“CDC”);
(c) Use best efforts to provide appropriate personal protective equipment (“appropriate PPE”) and hand sanitizer to all employees that interact with residents;
(d) As soon as reasonably possible, but no later than 12 hours after identification, inform employees of the presence of a COVID-19-affected resident;
(e) Notify employees of any changes in CDC recommendations related to COVID-19;
(f) Keep accurate and current data regarding the quantity of each type of appropriate PPE available onsite, and report such data to EMResource upon DHHS’s request or in a manner consistent with DHHS guidance; and
(g) Report to DHHS all presumed positive COVID-19 cases in the facility together with any additional data required under DHHS guidance.

III. Procedures related to transfers and discharges of COVID-19-affected

residents

1. A long-term care facility must report the presence of a COVID-19-affected resident to their local health department within 24 hours of identification.


2. A long-term care facility must transfer a COVID-19-affected resident who is medically unstable to a hospital for evaluation.

3. A nursing home with a census below 80% must create a unit dedicated to the care of COVID-19-affected residents (“dedicated unit”) and must provide appropriate PPE, as available, to direct-care employees who staff the dedicated unit. A nursing home provider that operates multiple facilities may create a dedicated unit by dedicating a facility for such a purpose.

4. A long-term care facility must adhere to the following protocol with respect to a COVID-19-affected resident who is medically stable:

(a) If the long-term care facility has a dedicated unit and provides appropriate PPE to the direct-care employees who staff the dedicated unit, the facility must transfer the COVID 19-affected resident to its dedicated unit.
(b) If the long-term care facility does not have a dedicated unit or does not provide appropriate PPE to the direct-care employees who staff the dedicated unit, it must transfer the COVID-19-affected resident to a regional hub, if one is available to accept the resident. If no regional hub is available to accept the transfer of the COVID-19-affected resident, the long-term care facility must attempt to send the resident to a hospital within the state that has available bed capacity. If no hospital will admit the COVID-19-affected resident, the long-term care facility must transfer the resident to an alternate care facility.

5. Once a long-term care facility resident who has been hospitalized due to onset of one or more of the principal symptoms of COVID-19 becomes medically stable and eligible for discharge in the judgment of the resident’s medical providers, a hospital must discharge the resident in accordance with the following protocol:

(a) If the long-term care facility where the resident resided prior to the onset of one or more of the principal symptoms of COVID-19 (“facility of residence”) has a dedicated unit and provides appropriate PPE to the direct-care employees who staff the dedicated unit, the hospital must discharge the resident to their facility of residence for placement in the dedicated unit, provided there is available bed capacity.
(b) If a discharge in accordance with section 5(a) of this part is not available, the hospital must discharge the resident to a regional hub, provided there is available bed capacity.
(c) If a discharge in accordance with section 5(a) or 5(b) of this part is not available, the hospital must transfer the resident to any alternate care facility with available bed capacity in accordance with the following protocol:

(1) Any alternate care facility within the state that has available bed capacity to receive the resident must accept a transfer authorized by this order.

(2) An alternate care facility must discharge a long-term care facility resident to the facility of residence as soon as capacity allows. If the facility of residence lacks available capacity, the alternate care facility must transfer the resident to a regional hub. If a regional hub receives a resident under this part, it must transfer the resident to the facility of residence as soon as capacity allows.


6. For any transfer or discharge of a resident, the transferring or discharging entity must ensure that the resident’s advance directive accompanies the resident and must disclose the existence of any advance directive to medical control at the time medical control assistance is requested.

7. Any long-term care facility that has a dedicated unit and provides appropriate PPE to the direct-care employees who staff the dedicated unit must admit anyone that it would normally admit as a resident, regardless of whether the individual has recently been discharged from a hospital treating COVID-19 patients.

8. A long-term care facility that transfers or discharges a resident in accordance with this order must notify the resident and the resident’s representative of the transfer or discharge as soon as practicable.

9. A transfer or discharge of a long-term care facility resident that is made in accordance with this order constitutes a transfer or discharge mandated by the physical safety of other facility residents and employees as documented in the clinical record,…and constitutes a transfer or discharge that is necessary to prevent the health and safety of individuals in the facility from being endangered…

10. To the extent necessary to effectuate this terms of this order, strict compliance with any statute, rule, regulation, or policy pertaining to bed hold requirements or procedures, or to pre-transfer or pre-discharge requirements or procedures, is temporarily suspended. …

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See the executive order for references to Michigan law and regulations