Long Term Care Facilities
My family member lives at a facility where someone has tested positive. Why isn’t everyone (staff, residents) being tested?
Testing, testing supplies, and personal protective equipment (PPE) are very limited in Wisconsin and Dane County. According to the Wisconsin Department of Health Service (DHS), testing is reserved for those patients who are symptomatic. As of April 16, DHS health care providers are encouraged to obtain COVID-19 testing for all who are symptomatic, even patients with mild symptoms. Even though DHS has recommended healthcare providers to perform additional tests, there is still a shortage of PPE.
Per CDC guidelines, facilities should screen all staff at the beginning of their shift for fever and respiratory symptoms. Facilities should actively take staff’s temperature and document absence of shortness of breath, new or change in cough, and sore throat. If staff are ill, they should be sent home to self-isolate.
What are the requirements for long term care facility staff wearing personal protective equipment (PPE)?
When COVID-19 is reported in the community, implement universal face mask use by all healthcare personnel (source control) when they enter the facility. If face masks are in short supply, they should be prioritized for direct care personnel. All healthcare personnel should be reminded to practice social distancing when in break rooms or common areas.
If COVID-19 is identified in the facility, restrict all residents to their room and have healthcare personnel wear all recommended PPE for all resident care, regardless of the presence of symptoms. Refer to strategies for optimizing PPE when shortages exist.
This approach is recommended to account for residents who are infected but not manifesting symptoms. Recent experience suggests that a substantial proportion of long-term care residents with COVID-19 do not demonstrate symptoms.
When a case is identified, public health can help inform decisions about testing asymptomatic residents on the unit and in the facility.
Assess supply of personal protective equipment (PPE) and initiate measures to optimize current supply. For example, extended use of face masks and eye protection or prioritization of gowns for certain resident care activities.
Can long term care facilities accept residents who have been tested positive for COVID-19?
According to CDC and the Wisconsin Department of Health Services, a nursing home can accept a resident diagnosed with COVID-19 and still under Transmission-Based Precautions for COVID-19 as long as the facility can follow CDC guidance for Transmission-Based Precautions.
If a nursing home cannot, it must wait until these precautions are discontinued. CDC has released Interim Guidance for Discontinuing Transmission-Based Precautions or In-Home Isolation for Persons with Laboratory-confirmed COVID-19. Information on the duration of infectivity is limited, and the interim guidance has been developed with available information from similar coronaviruses. CDC states that decisions to discontinue Transmission-based Precautions in hospitals will be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. Discontinuation will be based on multiple factors (see current CDC guidance for further details).
Nursing homes should admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was/is present. Also, if possible, dedicate a unit/wing exclusively for any residents coming or returning from the hospital. This can serve as a step-down unit where they remain for 14 days with no symptoms (instead of integrating as usual on short-term rehab floor, or returning to long-stay original room).
Other considerations for facilities:
- Review CDC guidance for Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019.
- Increase the availability and accessibility of alcohol-based hand rubs (ABHRs), reinforce strong hand-hygiene practices, tissues, no touch receptacles for disposal, and facemasks at healthcare facility entrances, waiting rooms, resident check-ins, etc.
- Ensure ABHR is accessible in all resident-care areas including inside and outside resident rooms.
- Increase signage for vigilant infection prevention, such as hand hygiene and cough etiquette.
- Properly clean, disinfect and limit sharing of medical equipment between residents and areas of the facility.
- Provide additional work supplies to avoid sharing (e.g., pens, pads) and disinfect workplace areas (nurse’s stations, phones, internal radios, etc.).
Why aren’t you releasing the names of long term care facilities where there have been people who have tested positive for COVID-19?
We do not release the names of facilities with clusters, but you can learn more about facilities on the Wisconsin Department of Health Services' website.
We are in contact with facilities to make sure they are aware of the guidance from both the CDC and to Wisconsin Department of Health Services to prevent the spread of COVID-19, and we of course follow-up with long term care facilities if a case has been identified. The facilities we have worked with that have people with a positive test have been responsive and fast-acting in order to ensure the safety of staff and residents.
When a confirmed COVID-19 case is identified within a long term care facility, we identify a point person for that facility. That person is available to answer questions from the facility and remains the point person until the facility has gone two weeks without a newly diagnosed confirmed or probable case. They advise on things like isolation practices, cleaning procedures, and other ways to prevent the spread of the disease that are site specific. As with all confirmed cases, public health nurses are also assigned to each individual for individual case specific follow-up.
Are long term care facility staff allowed to treat residents that are healthy, as well as those who are COVID-19 positive and/or showing symptoms at the same time?
Long-term care facilities are regulated by the State and have their own protocols for staff interaction with residents. We recommend long-term care facilities follow State and CDC guidance to prevent the spread of COVID-19.