AZ TB FAQs
Arizona has recently changed its regulations regarding screening for tuberculosis (“TB”) in the assisted living home setting, as well as other healthcare institutions that are regulated by the AZ Department of Health (“DHS”). The changes have brought about a lot of questions from assisted living facility owners. DHS has published an informational sheet that is intended to assist providers in understanding when they do and do not have to perform a Mantoux skin test or other TB screening tests.
A link to the guidance is here: Regulation Summary and flow chart
What is TB?
According to the CDC: “TB is a disease caused by germs that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment. The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood.” CDC Basic Facts of TB
Danger of TB in Assisted Living
With the advent of Covid-19, TB has taken somewhat of a back seat in terms of attention. However, there are up to 13 million people estimated to be living in the US with a latent TB infection. TB germs become airborne when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. Breathing those germs in can cause a latent TB infection. The TB bacterium can also attack part of the body other than the lungs, such as the kidneys, spine, or brain. Because many residents in the assisted living setting have compromised immune systems, this makes them more susceptible to an outbreak of TB, with serious health consequences.
Arizona Approach
In the past, every staff member and resident had to be tested for TB prior to admission or hire, and annually thereafter. Many caregivers who were not immunized in the US would have “false positive” test results from the commonly-given Mantoux skin test. Other times, residents would arrive to assisted living following chest x-rays that showed “no evidence of active TB,” however, DHS had taken the position that the x-rays were not sufficient to comply with the rule. And there have been occasions when the serum contained in the Mantoux skin test was in short supply and not generally available to assisted living homes. Thus, the new “emergency regulations” were passed in an attempt to clarify the old rule and prevent unnecessary skin tests.
We recommend that licensed owners and operators familiarize themselves with the Regulation Summary and the hyperlinked resources contained within it. There will likely need to be revisions made to that section of facilities’ Policies and Procedures to come into compliance with DHS’ new expectations regarding TB screening, testing, and “Annual training and education related to recognizing the signs and symptoms of TB to individuals employed by or providing volunteer services for the HCI.” Thus, caregiver training requirements are creeping further into the assisted living setting – first with mandatory fall prevention training and now with A.C.C. R9-10-113(A)(2)(c). TB screening training even extends to persons providing volunteer services.
The information herein is intended to be educational and an introduction to the subject matter presented. It is NOT specific legal advice to be relied upon for specific individual circumstances. Contact your own legal professional or reach out to our firm if you would like specific advice on this topic. Look for more weekly blog posts on topics of interest to Arizona Assisted Living and Behavioral Health operators. We welcome topic suggestions! Write to info@pinkowskilaw.com to recommend a particular subject for us to explore.