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Long-Term Care (LTC) Facilities

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Long-term care facilities serve vulnerable populations that are at higher risk of contracting COVID-19. Residents’ age and health status put them at greater risk for severe COVID-19 complications and potential death.

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Long-Term Care COVID-19 Response

Long-Term Care (LTC) Facilities 

Long-term care facilities serve vulnerable populations that are at higher risk of contracting COVID-19. Residents’ age and health status put them at greater risk for severe COVID-19 complications and death. COVID-19 can quickly spread in congregate care settings.

Benton-Franklin Health District has been working with these facilities throughout Benton and Franklin Counties to ensure strong infection control guidance, availability of testing, and other measures to identify cases and minimize the spread of disease and protect these vulnerable populations.

4.3.2023

COVID-19 Mask Guidance (wa.gov)

Masking in Health Care Settings

All health care settings can access personal protective equipment and source control guidance in COVID-19 Infection Prevention in Healthcare Settings (https://doh.wa.gov/emergencies/covid-19/healthcare-providers/infection-prevention). Licensed health care facilities are required to have infection prevention policies and systems in place. Any health care facility may choose to require workers and visitors to wear masks.

SARS-CoV-2 Infection Prevention and Control in Healthcare Settings Toolkit (wa.gov)

  • Because of the potential for asymptomatic and pre-symptomatic transmission, source control measures are encouraged for everyone in a healthcare facility, even if they do not have symptoms of COVID-19.
  • Healthcare facilities should follow the CDC’s Interim Infection Prevention and Control Recommendations for HCP During the COVID-19 Pandemic, in addition to Washington DOH masking guidance and requirements.

Most current updates:

Interim Recommendations for SARS-CoV-2 Infection Prevention and Control in Health care Settings

Skilled Nursing Facilities (SNF's)

Skilled Nursing Facilities

Wa DOH

 

SARS-CoV-2 Infection Prevention and Control in Healthcare Settings Toolkit (wa.gov)

·         Signage

·         Establish a process for everyone entering the facility.

·         Hand Hygiene – Hand Hygiene Guidance | Hand Hygiene | CDC

·         Cleaning and disinfecting

·         PPE use for specific scenarios – page 10 & 420-380 Donning and Doffing PPE_2.27.23 (wa.gov)

·         Know the difference between source control vs PPE

·         Testing during an outbreak

o   Day 1

o   Day 3

o   Day 5

o   If positive is identified, repeat testing every 3-7 days until no new cases are identified for 14 days. If antigen testing is used, more frequent testing (every 3 days), should be considered.

·         Quarantine

o   10 days or 7 days with a negative test

·         Isolation

o   10 days

·         Mitigation for HCW’s

o   Contingency staffing capacity

§  Return to work after 5 full days of isolation

o   Crisis staffing capacity

§  Contact RCS and/or DSHS prior to implementing

CDC

 

Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC

·         Post signage

·         Establish a process for everyone entering the facility

·         When community transmission = high

o   source control is recommended for everyone in a healthcare setting where they encounter patients

o   HCP can choose to not wear source control in areas restricted from patient access.

OR

o   N95 + eye protection for patient encounters

·         When transmission = low, moderate

o   source control in not required

·         Testing during an outbreak

o   Day 1

o   Day 3

o   Day 5

o   If positive is identified, repeat testing every 3-7 days until no new cases are identified for 14 days. If antigen testing is used, more frequent testing (every 3 days), should be considered.

·         Isolation

o   10 days

  • A single new case of SARS-CoV-2 infection in any HCP or resident should be evaluated to determine if others in the facility could have been exposed.
  • When performing an outbreak response to a known case, facilities should always defer to the recommendations of the jurisdiction’s public health authority.
  • The approach to an outbreak investigation could involve either contact tracing or a broad-based approach; however, a broad-based (e.g., unit, floor, or other specific area(s) of the facility) approach is preferred if all potential contacts cannot be identified or managed with contact tracing or if contact tracing fails to halt transmission.
  • Testing is recommended upon resident admission when community levels are HIGH
    • If negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test.
    • They should also be advised to wear source control for the 10 days following their admission. Residents who leave the facility for 24 hours or longer should generally be managed as an admission.
  • Testing upon resident admission when Community Transmission is low, medium
    • At the discretion of the facility.

Adult Family Homes (AFH)/Assisted Living (AL)

Adult Family Homes/Assisted Living

DOH

 

SARS-CoV-2 Infection Prevention and Control in Healthcare Settings Toolkit (wa.gov)

NOTE: Healthcare services delivered in these settings should be informed by CDC’s Infection Prevention and Control recommendations.

 

Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC

CDC

 

Additional Information for Community Congregate Living Settings (e.g., Group Homes, Assisted Living) | CDC

 

How to Protect Yourself and Others | CDC

 

What to Do If You Were Exposed to COVID-19 | CDC

·         At all community levels

o   Stay up to date on vaccination, including recommended booster doses

o   Maintain ventilation improvements

o   Avoid contact with people who have suspected or confirmed COVID-19

o   Follow recommendations for isolation if you have suspected or confirmed COVID-19

o   Follow recommendations for what to do if you are exposed to someone with COVID-19

o   If you are at high risk of getting very sick, talk with a healthcare provider about additional prevention actions.

·         When community transmission is medium or high

o   If you are at high risk of getting very sick, wear a mask or respirator when indoors in public

o   If you have household or social contact with someone at high risk for getting very sick, consider self-testing to detect infection before contact, and consider wearing a mask when indoors with them

·         When community transmission is high

o   Wear a mask or respirator

o   If you are at high risk of getting very sick, consider avoiding non-essential activities in public where you could be exposed

·         Visiting or shared healthcare personnel who enter the setting to provide healthcare to one or more residents (e.g., physical therapy, wound care, intravenous injections, or catheter care provided by home health agency nurses) should follow the healthcare IPC recommendations. Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC

·         If staff in a residential care setting are providing in-person services for a resident with SARS-CoV-2 infection, they should be familiar with recommended IPC practices to protect themselves and others from potential exposures including the hand hygiene, personal protective equipment and cleaning and disinfection practices. Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC

·         Exposure to COVID-19

o   Wear a mask when indoors around others for 10 days and test on day 5

o   Monitor symptoms

·         Positive with COVID-19

o   Isolate for 5 days

o   After isolation, mask for 5 days to complete the 10 day period

Infection Control based on Community Transmission guidance

When SARS-CoV-2 Community Transmission levels are high, source control is recommended for everyone in a healthcare setting when they are in areas of the healthcare facility where they could encounter patients.

  • HCP could choose not to wear source control when they are in well-defined areas that are restricted from patient access (e.g., staff meeting rooms) if they do not otherwise meet the criteria described below and Community Levels are not also high. When Community Levels are high, source control is recommended for everyone.

When SARS-CoV-2 Community Transmission levels are not high, healthcare facilities could choose not to require universal source control.  However, even if source control is not universally required, it remains recommended for individuals in healthcare settings who:

  • Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
  • Had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure; or
  • Reside or work on a unit or area of the facility experiencing a SARS-CoV-2 outbreak; universal use of source control could be discontinued as a mitigation measure once no new cases have been identified for 14 days; or
  • Have otherwise had source control recommended by public health authorities.

Individuals might also choose to continue using source control based on personal preference, informed by their perceived level of risk for infection based on their recent activities (e.g., attending crowded indoor gatherings with poor ventilation) and their potential for developing severe disease.  For example, if an individual or someone in their household is at increased risk for severe disease, they should consider wearing masks or respirators that provide more protection because of better filtration and fit to reduce exposure and infection risk, even if source control is not otherwise required by the facility.  HCP and healthcare facilities might also consider using or recommending source control when caring for patients who are moderately to severely immunocompromised.

Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC

 

Required COVID-19 Reporting for Facilities

Required COVID-19 Reporting

Washington Administrative Code WAC 246-101 requires laboratories to report all COVID-19 results to DOH and their Local Health Jurisdiction within 24 hours (including positive, negative (DOH only), inconclusive; and other results based on State Health Officer Letters). This reporting requirement applies to all facilities using POC or rapid screening tests for COVID-19. This includes clinics that are not traditionally a lab, such as long-term care facilities, schools, and correctional facilities.

Step 1 – Required reporting to DOH:

Option 1: Submit online to DOH via SimpleReports.  You can enroll in this process here SimpleReport

Options 2: Submit a Report Form (PDF) via fax to DOH at (206) 512-2126.  If you need to submit a line list, please contact BFHD for an approved template.

Step 2 – Required reporting to BFHD-LHJ:

Option 1: Report each case individually OR attach a BFHD approved template via  BFHD COVID-19 LTC Reporting Form (iths.org)

Option 2: Call BFHD to report cases

Skilled Nursing Facilities continue to report to NHSN / CDC

Testing

  • Community levels definition – positive tests divided by total number of tests performed within a 7-day period.
  • Community transmission definition – positive tests divided by total number of tests performed within a 7-day period x 100%.

Point of Care Testing

Request test supplies: https://app.smartsheet.com/b/form/a026d012a1ec47b78ff15a2f495de863

CLIA waiver information: https://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/LaboratoryQualityAssurance/Licensing/Applications

Reporting POC tests:

Washington Administrative Code WAC 246-101 requires laboratories to report all COVID-19 results to DOH and their Local Health Jurisdiction within 24 hours (including positive, negative (DOH only), inconclusive; and other results based on State Health Officer Letters). This reporting requirement applies to all facilities using POC or rapid screening tests for COVID-19. This includes clinics that are not traditionally a lab, such as long-term care facilities, schools, and correctional facilities

Mitigating Healthcare Worker Staffing Shortage

Considerations for Healthcare Personnel

Mitigating Healthcare Worker Staffing Shortage

Maintaining appropriate staffing in healthcare facilities is essential to providing a safe work environment for HCP and safe patient care. In times of COVID-19 surge, healthcare facilities may experience HCP shortages due to employee illness, exclusion from work due to higher-risk exposure, the need to care for ill family members, fear of illness, and burnout.

 This guidance is for COVID-19 contingency capacity staffing and crisis capacity staffing strategies. *, which are defined as:

 Contingency Capacity Staffing: Healthcare facilities and employers should work with human resources and occupational health services to carry out contingency capacity strategies that plan and prepare for staffing shortages.

 Crisis Capacity Staffing: When staffing shortages occur, healthcare facilities and employers should work with human resources and occupational health services to carry out crisis capacity staffing strategies that ensure safe patient care.

*Note: These strategies are independent of “contingency standards of care” and “crisis standards of care” based on the framework the National Academies of Medicine developed. Unlike implementation of crisis standards of care, which in Washington requires a formal statewide declaration, healthcare facilities and employers may choose to implement contingency capacity staffing and crisis capacity staffing independently.

 The following are considerations for managing healthcare personnel in your facility with infection or exposure to SARS-CoV-2:

 Staffing shortages

CDC’s Strategies to Mitigate HCP Staffing Shortages offers a continuum of options for addressing staffing shortages. Contingency and then crisis capacity staffing strategies supplement conventional strategies. Contingency strategies should be used before crisis strategies. Facilities experiencing staffing shortages should reach out to their local health jurisdiction, local emergency management and regional health care coalition.

https://doh.wa.gov/about-us/programs-and-services/emergency-preparedness-and-response/emergency-preparedness-regions/regional-healthcare-coalition-leads

 

LTC Visitation

A facility’s process to educate visitors and prospective visitors on core infection prevention practices should include:

  • Recommended actions to prevent transmission if they have:
    • a positive viral test for SARS-CoV-2
    • symptoms of COVID-19, or
    • close contact with someone with SARS-CoV-2 infection (for patients and visitors) or a higher-risk exposure (for healthcare personnel (HCP).
  • Performing hand hygiene before and after their visit.
  • Wearing source control (for example, facemask) always while in the facility.
  • Not being present in the patient room during aerosol generating procedures and other procedures.
  • If visiting a patient when PPE is indicated, how to properly wear PPE.
  • The risks associated with visitation should be explained to patients and their visitors so they can make an informed decision about participation.
  • Nonadherence to any of the infection principles outlined in the facility’s policy will result in denial of visitation.

COVID-19 Vaccines

LTC FAQ

What precautions are in place to prevent outsiders from introducing infection?
Please contact Facility

Do residents that leave facilities for medical and non-medical appointments need to be quarantined or isolated?

  • If they are residing at a Skilled Nursing Facility (SNF) and community transmission levels are high, residents are tested upon admission. If they test positive, they are isolated. 
  • If the resident of the SNF leaves the SNF for greater than 24 hours when community transmission levels are high they are tested upon return.If they test positive, they are isolated. 
  • If the resident has had an identified exposure and meets the quarantine guidelines below, they will enter quarantine. 
    • Patient is unable to be tested or wear source control as recommended for the 10 days following their exposure
    • Patient is moderately to severely immunocompromised
    • Patient is residing on a unit with others who are moderately to severely immunocompromised
    • Patient is residing on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions

Are LTC facilities required to notify residents and families if a positive COVID-19 case is identified in the facility?
Yes, DSHS requires facilities to notify all staff, residents, and families when a positive COVID-19 case is identified in the facility.

If I am concerned that a facility or agency policy is unsafe, what can I do?
If you have any concerns, please contact the LTC surveillance team at BFHD. You can contact us by email at eoc.operations.ltc@bfhd.wa.gov or call us at 509-460-4200.

If you feel that a LTC facility is in violation of state law, please file a complaint with Residential Care Services. Complaints to the Residential Care Services (RCS) Complaint Resolution Unit (CRU) will inform DSHS of potential violations of Safe Start for Long Term Care criteria. CRU staff will investigate complaints. 

The RCS Complaint Resolution Unit may be reached at 1-800-562-6078, or a complaint may be lodged online. 

Other Resources

Additional Guidance:

Isolation and Quarantine Summary for Residents

Patients that are asymptomatic with an exposure to COVID-19 generally do not require quarantine. Exposed patients should wear source control for 10 days post-exposure. If Patient has not recovered from COVID-19 in the last 30 days, they should be tested immediately on post exposure day 1 (but not before 24 hours from exposure) day 3 and day 5.

Patients with an exposure to COVID-19 need to be placed in quarantine if they meet one of the following criteria:

  • Patient is unable to be tested or wear source control as recommended for the 10 days following their exposure
  • Patient is moderately to severely immunocompromised
  • Patient is residing on a unit with others who are moderately to severely immunocompromised
  • Patient is residing on a unit experiencing ongoing COVID-19 transmission that is not controlled with initial interventions
Table 4: Summary of COVID-19 Isolation and Quarantine
Quarantine Isolation
Days

For patient that meets criteria for quarantine, quarantine ends when:

10 Day Quarantine or 7-day Quarantine with negative tests on day 1, 3 and 5.:

Isolation ends for patients who are not severely immunocompromised when:

·      At least 10 days have passed since symptoms first appeared

AND

·      At least 24 hours have passed since last fever without the use of fever reducing medications

AND

·      Symptoms (for example cough, shortness of breath) have improved
Reason for TBP

The incubation period for COVID-19 is thought to extend to 14 days, with a median of 4-5 days from exposure to symptom onset. Most people with COVID- 19 who have symptoms will do so within about 11 days of infection.

If exposed to COVID-19, perform post-exposure testing.

 It takes about 10 days for someone to stop being infectious after they become ill with COVID-19, which is why it is recommended that someone who tests positive for COVID-19 isolates for 10 days.

Are you experiencing elevated stress due to COVID-19?

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