January 6, 2021

Agenda

2021 Scheduling

Advocacy Update

Member Experience - Vaccinations

Michigan Situation Update

Vaccination Update

Monoclonal Antibodies

Other Resources and Guidance

Advocacy

Safe and Calm Webinar Schedule January 2021

Starting the first week in January, the Safe and Calm Webinar will be held once weekly on Wednesdays at 10:00 a.m.

The Safe and Calm email address (safeandcalm@LeadingAgeMI.org) can be used for any additional issues or questions.

We will continue to disseminate information via the appropriate listserv (SNF, Assisted Living, and/or Housing) between webinars and when appropriate. And we will continue to use COVID Member Updates for other messages

mailto:safeandcalm@LeadingAgeMI.org

Advocacy

Michigan does not currently have a legislature until next week.

The new legislature begin next week - The first legislative session will be on January 13th

The Governor’s office has been working on reviewing bills from the last legislative session

All bills that are not signed will need to go through the process again

Currently there is no legislature to adjust the legislation

Governor Whitmer has been vetoing and pocket vetoing a lot of bills

Currently in Lansing….

Advocacy

On December 30th, the Governor signed the new budget

While there was a number of line item vetoes, the

healthcare dollars remained largely untouched.

$103.85 million for vaccination, testing and COVID-19

response efforts

$100.0 million to extend the $2.00 per hour direct care

worker wage increase for an additional 2 months.

$2.0 million to extend the $200 per day enhanced payment

for CRCs for an additional 2 months

Plante & Moran will be doing a review of the state and National budgets and their impact on long term care during tomorrow’s Finance and Strategy Series session.

Supplemental Budget

Senate Bill 1185– Health Care Facility Legal immunity

This bill would have extended the period of legal immunity for healthcare facilities for their response to the COVID-19 pandemic and added CRCs to the definition of a health care facility

Passed along party lines

Trial Attorney Groups have fought very hard to get this legislation vetoed

House Bill 4910/4911 – Misrepresentation of Emotional Support Animals Act

Creates more flexibilities for housing providers who are seeking more information regarding a support animal

Passed with bipartisan support

Advocacy

Directly Vetoed

Bills

http://www.legislature.mi.gov/documents/2019-2020/billenrolled/House/pdf/2019-HNB-4910.pdf

Senate Bill 77 - Electronic Monitoring in SNFs

Passed with bipartisan support

Trial attorney groups are very close with the Governor and some of the legal immunity clauses in this bill are likely the reason this bill was pocket vetoed

House Bill 4098 – Allows for the use of Medication Aides in SNFs

Passed along party lines

This bill has been in the works for years and has struggled to get across the finish line

Traditionally labor groups have opposed the bill

House Bill 4042 – Would add Michigan to the national nurse licensure compact

Passed with bipartisan support

Traditionally labor groups have opposed the bill Advocacy

Pocket Vetoes

http://www.legislature.mi.gov/documents/2019-2020/billanalysis/House/pdf/2019-HLA-4098-43BE623C.pdfhttp://www.legislature.mi.gov/documents/2019-2020/billanalysis/House/pdf/2019-HLA-4042-8E7577C8.pdf

Senate Bill 1021 - Creates license reciprocity for

individuals educated in Canadian

Passed by the full chamber

House Bill 4491 – Would change the licensure

requirements relating too “good moral character”

Only felonies can be reviewed upon licensure application

with some expectations

Passed with bipartisan support

Advocacy

Signed Bills

http://www.legislature.mi.gov/documents/2019-2020/billenrolled/House/pdf/2019-HNB-4491.pdf

1/31/2020Estimated end date for the distribution of the 3rd round of PRF funds

2/1/2021Deadline for SNFs to submit expenditure documentation of the Nursing Facility Infection Prevention grant funds to MDHHS

2/28/20End of the third reimbursement period for Direct Care Worker Wage Pass-through payments

2/28/2020 End of the $200 Enhanced CRC payments

Advocacy Questions?

Advocacy

Member Experiences

Vaccines

Libby DelaneyBellbrook

Barb GilesJewish Senior Life

Paul BarberHeritage Community

Kristen Packard Grand Traverse Pavilions

Michigan

Situation

Update

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Michigan 7-Day Rolling Average of Daily New Cases – 1/5/2021

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Michigan 7-Day Rolling Average of New Daily Deaths – 1/5/2021

CMS Positivity

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12/30/2020

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CMS County Positivity Rates, week ending….

Red Yellow Green

All but 7 Michigan Counties

continue to be Risk Level E 1/4

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11/2/2020 11/9/2020 11/16/2020 11/23/2020 12/1/2020 12/8/2020 12/14/2020 12/22/2020 12/28/2020 1/4/2021

Series 1 322 532 719 792 1126 1150 1091 753 514 415

Michigan SNF Weekly Case Reporting 11/2/2020-1/4/2021

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Michigan HFA Weekly Case Reporting 11/2/2020-1/4/2021

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Series 1 0 13 87 64 122 190 174 182 141 146

Michigan AFC Weekly Case Reporting 11/2/2020-1/4/2021

1/4/2021 SNF HFA AFC Total Total LTCFCases

Total LTCFDeaths

New Resident Cases 415 157 146

New Resident Deaths 191 39 13 243

Cumulative Resident Cases

16499 2862 2047 21408

Cumulative Resident Deaths

3683 826 390 4650

Staff New Cases 455 171 109 735

Staff New Deaths 2 0 1 3

Cumulative Staff Cases 12702 2750 1754 17206

Cumulative Staff Deaths

34 4 26 64

38,614 4,711

Increased from last week

Resources and Guidance

Updated MDHHS Vaccination Strategy

Vaccinations-Includes priorities to categorize risk for essential workers

Coronavirus - COVID-19 Vaccine (michigan.gov)Critical Infrastructure Protection • Complex and will take time to determine • Essential workers not covered in earlier phases – Phase 1C• Goals: Decrease death and serious disease as much as

possible; preserve function of society; Reduce the extra burden on people already facing disparities

• Priorities• 1A Critical health care; Long term care staff and

residents; necessary healthcare• 1B Frontline essential workers who keep critical

infrastructure, persons over 75• 1C Persons at risk of serious illness, other essential

workers• 2 – all others 16 years and older

https://www.michigan.gov/coronavirus/0,9753,7-406-98178_103214---,00.html

Michigan Vaccine UpdateNew CDC vaccinations count at website from CDC that tracks COVID vaccinationsby state and county, as well as by selected populations such as long-term care residents.

Additional vaccines in testingEstimate that 100 million doses will be available by the end of February

Current bottlenecks seems to exist in distribution rather than manufacturing

April/May is the estimate start of healthy adult vaccinationsAnother 2-3 weeks will tell us about the holiday surgeWe will need 80-90% vaccination to achieve herd immunity

https://nam04.safelinks.protection.outlook.com/?url=https://covid.cdc.gov/covid-data-tracker/#vaccinations&data=04|01|Deanna@leadingagemi.org|b4f414e142a343cccdbc08d8b245be71|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637455359926641571|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=xjcyChgsDabbwumMgKgUIpfW3zhnpB5t0y3Z1qqBaRs%3D&reserved=0

CDC COCA (Clinician Outreach and Communication Activity)Webinar 12/30 on vaccineshttps://www.leadingagemi.org/resource/resmgr/covid-19/documents/dec-30-coca-call.pdf

CDC Recommendations for allergic reactionshttps://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html

MDHHS clinic date confirmations at https://info.omnicare.com/covid-19-clinic-confirmation.html

LeadingAge Vaccine FAQsFAQs and Resources on COVID-19 Vaccines - Dec 15.pdf (leadingage.org)

HUD Section 202 – Pharmacy Program Toolkit – LeadingAgeVaccine Toolkit Affordable Housing_0.pdf (leadingage.org)

CDC Updates on Vaccines• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-

BioNTech.html• https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

https://www.leadingagemi.org/resource/resmgr/covid-19/documents/dec-30-coca-call.pdfhttps://nam04.safelinks.protection.outlook.com/?url=https://info.omnicare.com/covid-19-clinic-confirmation.html&data=04|01|Deanna@leadingagemi.org|79eb69e99ec1484395b808d8b0d85af6|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637453790570519240|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=0MbfbdWl3TGgpy%2BCp3aFjF7VE7PbJSNcTYTdkG0RvyU%3D&reserved=0https://www.leadingage.org/sites/default/files/FAQs%20and%20Resources%20on%20COVID-19%20Vaccines%20-%20Dec%2015.pdf?_ga=2.116528134.1813536801.1609888835-1533915436.1525359211https://leadingage.org/sites/default/files/Vaccine%20Toolkit%20Affordable%20Housing_0.pdfhttps://nam04.safelinks.protection.outlook.com/?url=https://info.omnicare.com/covid-19-clinic-confirmation.html&data=04|01|Deanna@leadingagemi.org|79eb69e99ec1484395b808d8b0d85af6|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637453790570519240|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=0MbfbdWl3TGgpy%2BCp3aFjF7VE7PbJSNcTYTdkG0RvyU%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https://info.omnicare.com/covid-19-clinic-confirmation.html&data=04|01|Deanna@leadingagemi.org|79eb69e99ec1484395b808d8b0d85af6|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637453790570519240|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=0MbfbdWl3TGgpy%2BCp3aFjF7VE7PbJSNcTYTdkG0RvyU%3D&reserved=0https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

HUD Q&A Update - 1/4/2020

Addresses vaccines in housing, but questions still exist. Temporary use of common or vacant areas for testing or vaccinations is allowable – cannot affect operating costs beyond budgeted

Extended eviction moratorium to January

Management and Occupancy Reviews may continue to be conducted without entering resident units until May 31 …total suspension only where there are no local or state restrictions

Project Capital Needs Assessment delayed until May 31, 2021

https://www.leadingagemi.org/resource/resmgr/covid-19/documents/HUD_Multifamily_Corona_QA_FI.pdf

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Monoclonal Antibodies• FDA EUA for bamlanivimab for persons with mild to moderate

COVID at least 12 years of age• At high risk for progressing to severe COVID 19 and/or

hospitalization

Not authorized for those• Currently hospitalized for COVID• Who require oxygen therapy due to COVID or• Who require an increase in baseline oxygen flow rate due to

COVID for those on chronic oxygen therapy

• Benefits have not been observed in hospitalized patients, and maybe associated with worse outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation.

Monoclonal Antibodies• High Risk means having at least one of the following:

• Body mass index equal to or greater than 35• Chronic kidney disease• Diabetes• Immunosuppressive disease or currently receiving

immunosuppressive treatment• Over age 65• At least 55 with CVD, hypertension, or COPD/resp• Age 12-17 with

• BMI > 85th percentile for age/geneder• Sickle cell disease• Congenital or acquired heart disease• Neurodevelopmental disorders such as cerebral palsy• Medically related technological dependence such as

gastrostomy, tracheostomy• Asthma or other chronic airway disease requiring daily

medication• Provided by IV infusion

FDA Fact Sheet for Healthcare Providershttps://www.fda.gov/media/143603/download

https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fmedia%2F143603%2Fdownload&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937141960%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=CbBIxGagU0nFInAc1Jr42Zc0OFyqdFlxEeGnwoSuN6o%3D&reserved=0

Monoclonal Antibodies – Other Resources

FDA Fact Sheet for Patients / Caregivershttps://www.fda.gov/media/143604/download

FDA Fact Sheet for Healthcare Providershttps://www.fda.gov/media/143603/download

NEJM Article on Bamlanivimabhttps://www.nejm.org/doi/full/10.1056/NEJMoa2029849

Info from CMS on Reimbursement for Infusionshttps://www.cms.gov/medicare/covid-19/monoclonal-antibody-covid-19-infusion

Patient Profile Form - To be completed for each patient receiving mAb therapy (also attached printable form that can be used to collect the data to be entered later into the form.https://forms.office.com/Pages/ResponsePage.aspx?id=sgF4Zzdipk67RItjfx6ergRINfmr3E1Njq-ZF3K4vsBUMjRaVE43VjM1MFJRTllCVzBMMk9HWVVBTiQlQCN0PWcu

Patient Follow-up Form - To be completed when patients within 14 days of administration of mAbare hospitalized or die. Also attached is a printable version.https://forms.office.com/Pages/ResponsePage.aspx?id=sgF4Zzdipk67RItjfx6eroELYMLt2W5FvlKQ7QFuQSZUN1lGRzRXWUFTNEsyUUhXS1dCSU5DQThTNi4u

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Michigan Project Speed

Medication provided at no cost; distributed through hospitals in MIRapid response – less than 24 hours to SNFs with large outbreaksMDHHS responsible for allocating Resources – MDHHS Mobile Crisis Teams and local paramedicsRequest state support through local public health or regional health care coalitionsMDHHS can provide technical support

SNF mAB Presentation: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/SNF_mAb_Presentation.pdf

Bamlanivimab Order Form: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/Bamlanivimab_Order_Form.V2.1.pdf

mAB Therapy Patient Follow-Up: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/mAb_Therapy_Patient_Follow-u.pdf

mAB Therapy Patient Profile: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/mAb_Therapy_Patient_Profile_.pdf

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Questions?

PPP Second Draw

Second draw loans are available to most organizations that received an initial PPP loan and can demonstrate a reduction in gross receipts of at least 25%.

https://www.leadingagemi.org/resource/resmgr/covid-19/documents/PPP_second_draw.pdf

FMLAMandatory paid sick leave and FMLA leave ended December 31, 2020. However the Consolidated Appropriations Act (HR 133) that the President signed on Dec. 27 does allow employers to provide paid leave voluntarily for COVID-related reasons set out in FFCRA (and be reimbursed through payroll tax reductions). Here are updated FAQs. https://leadingage.org/legislation/paid-sick-leave-and-fmla-leave-no-longer-mandatory

https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FPPP_second_draw.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7C36834d47416a4f3e3b6308d8b0c00e34%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453686198034232%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=prsfjgBkj9pNWvlbzAGOfVqcs7sW98VhIgf%2FYV5Iy%2BM%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fleadingage.org%2Flegislation%2Fpaid-sick-leave-and-fmla-leave-no-longer-mandatory&data=04%7C01%7CDeanna%40leadingagemi.org%7Cb480217cf09a491a0c2508d8b19b0a65%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637454626734796088%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=eJbMWe6av8dSIS87NPEILMEM%2F1r%2Bab75uZL7YETudPc%3D&reserved=0

Updated Provider Relief Q&A from HHSProvider Relief is the Payer of Last Resort.Here’s a PRF Q and A on this topic that was added this week; some states have advised providers to apply for and use PRF before Medicaid reimbursement including Medicaid COVID 19 Supplemental Payments to cover healthcare related expenses or lost revenues – added 12/28/2020CARES Act Provider Relief Fund Frequently Asked Questions (hhs.gov)

This is not permissible…

As it relates to expenses, providers identify their health care-related expenses, and then apply any amounts received through other sources (e.g., direct patient billing, commercial insurance, Medicare/Medicaid/CHIP, reimbursement from the Provider Relief Fund COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured, or funds received from FEMA or SBA/Department of Treasury’s Paycheck Protection Program) that offset the health care-related expenses. Provider Relief Fund payments may be applied to the remaining expenses or cost, after netting the other funds received or obligated to be received which offset those expenses.

https://www.leadingagemi.org/resource/resmgr/covid-19/documents/HUD_Multifamily_Corona_QA_FI.pdf

https://www.hhs.gov/sites/default/files/provider-relief-fund-general-distribution-faqs.pdfhttps://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FHUD_Multifamily_Corona_QA_FI.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7C276dce7557c8478ae2ae08d8b10b8b12%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637454010428840902%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=%2B5UMkahOMgY%2B%2BY0838WSsGB5rkDksE2N1XTwX3vgFLM%3D&reserved=0

CDC

Updates

Considerations for Retirement Communities and Independent Living Facilities – 12/29/2020

o Defines the type of facilities covered under the guidance

o Defines facility behaviors that drive COVID risk for the community

o Summarizes essential elements and resources for the development of an emergency response plan

o Identifies key facility behaviors to mitigate risk

https://www.cdc.gov/coronavirus/2019-ncov/community/retirement/considerations.html

CDC Updates

Summary for Healthcare Facilities – Optimizing N95s---12/29/2020Engineering Controls: place patients with suspected or confirmed SARS infection in an airborne infection isolating room for AGP when possible.Use physical barriers at reception areas and between patientsProperly maintain ventilation systems to provide air movement from clean to contaminated areasAdministrative controls: Use telemedicine where possibleLimit personnel not directly involved in resident careLimit face to face patient encountersLimit visitors to those essential to comfort and well beingImplement source control for everyoneCohort infected personsCohort personnelTrain staff or proper use, fit, donning and doffing of N95sImplement just in time fitting. Plan for larger scale evaluation, training and fit testing when necessaryLimit respirators during training – allow limited re-use of respirators by one individual for training and then fit testingImplement qualitative fit testing to minimize destruction and allow for re-use

https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html

CDC Updates

Summary for Healthcare Facilities – Optimizing N95s/12/29/2020PPE: Respiratory Protection• Use surgical N95s only for persons who need protection from both

airborne and fluid hazards – if unavailable, use faceshield over standard N95

• Use alternatives to N95s when feasible • NIOSH approved particulate filtering facepieces• https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/d

efault.html• Elastomeric respirators with filters or cartridges• https://www.youtube.com/watch?v=8wd5Bx2fVDI• Powered air purifying respirators• https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-

strategy/powered-air-purifying-respirators-strategy.html• Contingency strategies during expected shortages

• Temporarily suspend annual fit testing per OSHA guidance

https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.htmlhttps://www.youtube.com/watch?v=8wd5Bx2fVDIhttps://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/powered-air-purifying-respirators-strategy.html

CDC Updates

Summary for Healthcare Facilities – Optimizing N95s/12/29/2020PPE: Respiratory ProtectionCrisis Strategies• Use respirators beyond the manufacturer shelf life that have been

identified by the CDC as performing adequately• Use respirators approved under standards used in other countries that

are similar to NIOSH approved respirators• Implement limit re-use of N95 to nor more than five donnings per

device by the same individual. • Use additional respirators beyond shelf life that ARE NOT identified by

the CDC as performing adequately for healthcare delivery• Prioritize the use of N95 respirators and masks by activity type,

distance from patient, and use of source control by patient

When there are NO N95s availableConsider excluding staff who are at high risk for illness Use a ventilated headboard to decrease risk of staff exposure to patient generated aerosol

https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html

Discussions with MIOSHA

N95s required for AGP for those who are COVID positive or have been exposed

N95s required for COVID related care

KN95 can be used if persons are not COVID positive nor have been exposed or if not carrying out AGP. Other COVID protections must be in place.

When N95s are used, fit testing is required but a test check rather than a fit test can be used if kits are not available and documented. The use of a fit check video or other fit check training of staff is required. (https://www.youtube.com/watch?v=CoSb-HJJ5tk .

MIOSHA and

N95s

This is what we

are hearing….it

is not clearly

written in any

guidance.. We

are tracking

this

https://www.youtube.com/watch?v=CoSb-HJJ5tk

COVID Relief FacilitiesMSA 20-76 – exempts CRFs who will be admitting new COVID positive residents from the 85% occupancy limitation ONLY for the designated space for COVID positive residents.

All admissions-approved CRFs will be required to use the Bed Capacity Change form to apply for any increase or decrease in bed capacity and MDHHS will provide a formal determination in response.

Infection Control Survey Triggers -Released 1/4/2020

• 3 or more cases new in a week or 1 new case in a previously COVID free facility along with at least one of the following

• Multiple weeks of new cases

• Low staffing

• Selection as a special focus facility

• Concerns related to conducting outbreak testing

• Allegations or complaints related to abuse or quality of care triaged at level of harm or immediate jeopardy

• Within 3-5 days of identification unless surveyed in past 3 wks

• Enhanced enforcements still in place but not updated

• New FAQs

CMSQSO 20-31-ALL

Surveys will continue during an outbreakCOVID positive residents will be interviewedCMS will not be mandating surveyor testingRelationship to 1135 Blanket Waivers

Final Questions

Thank You MembersFor all that you do…

For all that you give…

For your dedication and patience….

Safeandcalm@LeadingAgeMI.orgDeanna@LeadingAgeMI.orgDalton@LeadingAgeMI.org

mailto:Safeandcalm@leadingagemi.orgmailto:Deanna@LeadingAgeMI.orgmailto:Dalton@LeadingAgeMI.org