Do you really understand, comply with all the PINs?

The apparent first U.S. death related to COVID-19 (C-19) occurred on January 20, 2020 (according to USA Today) in Snohomish County in Washington State. California governor Gavin Newsom declared a state of emergency on March 4 related to the spread of C-19, and DSS released its first provider information notice (PIN) on February 28. Each DSS-issued PIN was an attempt to keep facility operators and administrators informed about the pandemic and prevent its spread into the states’ assisted living facilities.

Health and Safety Code 1569.1 describes RCFEs as “not primarily medically oriented” and a “homelike environment.” The agency tasked with enforcing the laws of California is, according to Health and Safety Code, “the State Department of Social Services.” It is not a medical agency, and Title 22 and Health and Safety Code state DSS is “not responsible for the evaluation of medical services provided to the resident….”

DSS has presented several zoom webinars to non-medical, facility operators using health care “consultants” to explain issues, precautions, and management of the virus. Since facilities are not medical, why the medical consultants? Health and Safety Code also states RCFEs under six-beds—the majority of elder care homes in California—are considered a “residential use of property,” the “residents and operators of the facility shall be considered a family,” and facilities are no different “in any other way from a family dwelling.” Was it appropriate for the hundreds of non-medical facilities to be told what to do by non-DSS staff, medical consultants Questions arose when these consultants were telling facilities to discuss C-19 with dementia clients.

Since March 6, 2020, DSS has released over 50 PINs to inform licensees how to manage the pandemic. Here is how the industry has responded to these PINs: there are too many and no time to read them all; too expensive to do everything the PINs require; each one seems to cancel a previously issued PIN; the language is confusing; having to look up too many external references for information; which agency am I supposed to obey; and analysts want immediate compliance or want what is not in the PIN.

I believe it is the intent of DSS to assist facilities to prevent the spread of C-19, but the PINs are overwhelming the industry with confusing, lengthy, hard to comprehend information, then using “consultants” without hands-on, facility-operating experience telling operators what to do.

Should the PINs stop? No, but should be in “lay terms,” not redirect licensees to “authorities” that conflict other “authorities,” then tell licensees to pick the stricter provisions without expressly telling facilities which are the strictest provisions. In other words, keep it simple so compliance is easier.