Overview

Resources below aim to provide interim guidance for the prevention and control of COVID-19 in LTCFs.

Given the high risk of spread once COVID-19 enters a LTCF, facilities must act immediately to protect residents, families, and staff from serious illness, complications, and death.

Skilled nursing facilities can join the monthly CDPH SNF Team for the LTCF Roundtable webinars to learn about any updates related to COVID-19, click here to register.

Federal/State Guidance Documents

Skilled Nursing

Assisted Living/Supportive Living

COVID Data & Reporting

The table below shows COVID-19 reporting requirements for skilled nursing and assisted living facilities. There may be a need to report cases and/or outbreaks to multiple entities. Reporting to one does NOT satisfy the need to report to the others.
Reporting Requirements Skilled Nursing Assisted Living
CDPH Report all staff and resident COVID cases to the SNF Case Reporting Form Report all staff and resident COVID cases to the Communicable Disease Reporting Form
OHCR (facilities licensed by IDPH Report all staff and resident COVID cases to the Office of Healthcare Regulations (OHCR)
*same form is used to report any serious incident or accident and communicable disease
Report all staff and resident COVID cases to the Office of Healthcare Regulations (OHCR)
*same form is used to report any serious incident or accident and communicable disease
NHSN (CMS certified facilities) Report all staff and resident COVID cases AND vaccination using the SAMS portal N/A
Other Resources
  • I-CARE Enrollment
    • The I-CARE Registry is an immunization data registry operated by the Illinois Department of Public Health (IDPH), accessible only to enrolled users who have predefined roles. I-CARE is designed to help healthcare provider’s record, track, and report their patients’ immunizations. Click on the link to enroll.
  • NHSN COVID-19 LTCF Module 
    • Guidance for NHSN enrollment, training, and CMS requirements. Facilities eligible to report data to NHSN’s LTF COVID-19 Module include nursing home/skilled nursing, intermediate care facilities for individuals with Intellectual disability (ICF/ID), and assisted living facilities. 

Testing

Skilled Nursing Testing Guidance

Category Vaccination Status Testing Guidance
Residents (asymptomatic) Not up to date and up to date Not required
Residents (new/readmission) Not up to date and up to date At the discretion of the facility
Residents and Staff (close contact to confirmed case) Not up to date and up to date Day 1, day 3, and day 5 post-exposure
(Day 0 is day of exposure)
Resident and Staff (symptomatic) Not up to date and up to date Immediately

*Testing is not required if a resident or staff member has had COVID in the prior 30 days, unless newly symptomatic

 

Assisted Living/Supportive Living Testing Guidance

Category Vaccination Status Testing Guidance
Residents and Staff (asymptomatic) Not up to date and up to date Not Required
Residents and Non-Healthcare Staff (symptomatic) Not up to date and up to date Immediately
Residents and Non-Healthcare Staff (close contact to confirmed case) Not up to date and up to date Day 5 post-exposure
(Day 0 is day of exposure)
Healthcare Personnel (close contact to confirmed case) Not up to date and up to date Day 1, day 3, and day 5 post-exposure
(Day 0 is day of exposure)

*Testing is not required if a resident or staff member has had COVID in the prior 30 days, unless newly symptomatic

COVID-19 Outbreak Response

Skilled Nursing

  • Facilities must ensure a process is in place to inform HCP, residents, and visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts (e.g., signs, posters) at entrances and other strategic places. 
  • When COVID-19 Hospital Admission Levels are HIGH, or if the facility is in outbreak, all residents, including new admissions, should be evaluated at least daily for signs and symptoms of COVID-19.
  • When a new case is discovered, initiate outbreak testing immediately (but not earlier than 24 hours after exposure), test regardless of vaccination status.
    • Contact tracing approach: test all residents and HCP identified as close contacts or who had a high-risk exposure. Test on day 1, day 3, and day 5. If no additional cases are identified no further testing is required. If additional cases are identified, facilities should expand testing according to the distribution and number of cases (i.e. unit or facility wide testing).
    • Broad Based approach: requires testing of all residents and HCP when a single case of COVID-19 is identified, if unable to complete contact tracing. Test every 3-7 days until there are no more positives cases identified for 14 days.
  • HCP must wear a well-fitted mask while on the unit/floor experiencing an outbreak. Facilities should consider requiring an N95 respirator and eye protection during all resident care on the affected unit or floor.
  • Report all positive cases using the SNF COVID-19 Report Form

Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure
  • Work restrictions for HCP with SARS-CoV-2 infection and exposures
Strategies to Mitigate Healthcare Personnel Staffing Shortages

Communicating about COVID-19 in Congregate Settings (IDPH)
  • Notification procedures to residents and residents'’ next of kin, guardians, or emergency contact when that resident, another resident or a staff member is diagnosed with COVID-19
IDPH COVID-19 Signage
  • Example of signage that can be posted as a visual alert to prevent the transmission of COVID-19.

Assisted Living/Supportive Living

  • When a new case is discovered, identify exposures using person-based contact tracing or location-based contact tracing. 
  • Person-based contact tracing prioritizes identification of close contact who are more likely to get very sick from COVID-19.
  • Location-based contact tracing identifies exposures based on where a person spent time while infectious. (i.e., housing unit, transport bus, dining area). Conduct testing of those who were present based on exposure risk. See table 1.
  • Residents and non-healthcare staff who have had a moderate – or higher-risk exposure should test at least five full days after exposure (or sooner, if they develop symptoms) and should wear a well-fitted mask while indoors for 10 full days after exposure, regardless of vaccination status.
  • If any additional cases are identified, facilities should consider adding enhanced prevention strategies.
  • Isolate staff, volunteers, and residents who test positive for 10 days. If the individual has a negative viral test, isolation can be shortened to 7 days with symptoms improving and fever-free for 24 hours without the use of fever-reducing medications, the individual was not hospitalized, and the individual does not have a weakened immune system.
  • Healthcare personnel should follow nursing home guidance for work exclusion, testing requirements, and return to work criteria.
  • IDPH COVID-19 Signage
    • Signage can be posted as a visual alert to prevent the transmission of COVID-19.

Visitation & Resident Activities

  • Facilities must ensure a process is in place to inform residents and visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts (e.g., signs, posters) at entrances and other strategic places.
  • Facilities should provide instructions on hand hygiene, limiting surfaces touched, and use of PPE according to facility policy.
  • When COVID-19 Hospital Admissions Levels are HIGH, it is best practice for facilities to take extra precaution during communal dining and group activities. For instance, these measures include limiting the size of groups and staggering meals to reduce crowding in communal spaces.
CMS Memorandum QSO-20-39-NH on Nursing Home Visitation Revised 5/8/23

Personal Protective Equipment 

Skilled Nursing

  • Source control (e.g. masking) is recommended in the following circumstances:
    • For residents who have suspected or confirmed COVID when out of their rooms (COVID+ residents should only be out of room for medically necessary reasons)
    • For staff returning to work on day 8 with a negative rapid test (must wear for 10 days from positive test)
    • For individuals with respiratory infections (e.g. runny nose, cough, sneeze) until symptoms resolve
    • For individuals who had close contact or a higher-risk exposure to someone with COVID (for 10 days after last exposure)
    • For individuals who reside or work in a unit/area of the facility experiencing a COVID outbreak (for 14 days after the most recent case)
    • For individuals who have otherwise had source control recommended by public health authorities
  • When COVID-19 Hospital Admissions Levels are HIGH, source control is recommended for:
    • Staff and visitors in nursing homes and other long-term care facilities when they are in common areas of the facility where they could encounter residents.
    • Newly admitted residents for 10 days following their admission (day 0 is the date of admission)
  • Staff who enter the room of a patient with suspected or confirmed SARS-CoV-2 infection should adhere to transmission-based precautions and use a NIOSH-approved respirator with N95 filters or higher, gown, gloves, and eye protection.

Assisted Living/Supportive Living

  • Asymptomatic COVID negative residents or staff may choose to wear well-fitted masks or respirators, based on their personal preference.
  • Residents who have been exposed to someone with COVID, should wear a well-fitted mask for 10 days after their exposure, when around others.
  • Residents who have COVID or are suspected of having COVID, should wear a well-fitted mask or respirator for 10 days, when around others.
  • Staff who will have close contact with residents who are in isolation precautions, including during transport, should wear a NIOSH-approved respirator, eye protection, gown, and gloves.

Additional Links for Skilled Nursing and Assisted Living/Supportive Living


CDC PPE Sequence for donning and doffing
  • Printable PPE education, can be used to post in isolation/quarantine rooms.
Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and other Long-Term Care Facilities during the COVID-19 Pandemic (OSHA)
  • Guidance focusing on protecting workers from occupational exposure to SARS-CoV-2.
Respiratory Protection Program for Congregate Settings Template (OSHA)
  • Designed for use by personnel who have been suitably trained and charged with the responsibility of developing and implementing a respiratory protection plan (RPP) that addresses exposure to aerosol transmissible disease (ATD) pathogens and other respiratory hazards in congregate care facilities and environments.
Medical Evaluation Questionnaire (OHSA)
  • Before wearing a respirator, workers must first be medically evaluated using the medical questionnaire or an equivalent method.
Respiratory Protection Training Videos (OSHA)
  • Videos on fit testing, medical evaluations, respiratory protection for healthcare workers, the difference between respirators and surgical masks, donning & doffing, counterfeit respirators, maintenance and care, and the OSHA Respiratory Protection Standard.
Respirator Trusted-Source Information (NIOSH)
  • Information ranging from basic respirator facts to more complex subjects on respirator function and performance.
Job Hazard Assessment (OSHA)
  • Instructions on identifying work hazards and conducting hazard assessments.

COVID-19 Vaccination

  • Educate staff, residents, and family members about the benefits of receiving COVID-19 vaccinations
  • Work with your pharmacy partner to coordinate COVID-19 vaccine clinics for residents and staff
  • Allow staff who experience vaccine-related side effects to take sick time if needed
  • Have a clear plan in place to evaluate and document religious or medical exemptions
  • Ensure staff documentation of vaccination status and required testing are in accordance with CMS and executive orders
  • Up-to-date requirements can change, check the CDC Immunization Schedule for the latest dosage requirements
CDPH Booster Staff Recognition Posters
  • Posters feature real healthcare staff from Chicago LTC facilities and can be posted in high-traffic areas to promote booster clinics in your facility. Each poster has a dedicated box at the bottom where you can add the dates to upcoming clinics or additional information specific to your facility.
CIMPAR Vaccination Services Chicago
  • CIMPAR can provide education services and vaccination clinics to Chicago facilities, to request services click the following link.

About COVID-19 Vaccines (CDC)
  • Information on each type of available COVID-19 vaccine and when are you considered up to date.
COVID-19 Vaccination Clinical & Professional Resources (CDC)
  • Resources for healthcare providers related to the COVID-19 vaccines, including links to interim clinical recommendations.
COVID-19 Vaccine (City of Chicago)
  • Resources for the general public related to the COVID-19 vaccines, including how to find a vaccine provider.
Talking with Patients about COVID-19 Vaccination (CDC)
  • An introduction to motivational interviewing for healthcare professionals.
IDPH Stay Up to Date Signage
 

Therapeutics

  • Treatment has been shown to reduce the risk of severe COVID-19 disease and hospitalization, especially in the elderly.
  • As soon as a resident is diagnosed with COVID-19, contact the resident’s medical provider to assess whether treatment is warranted.
  • COVID-19 Therapeutics and Prophylaxis (CDPH)
    • Overview of COVID-19 therapeutics and prophylaxis for non-hospitalized patients. 
  • COVID-19 Outpatient Treatment (IDPH)
    • Over of monoclonal antibody and oral antiviral medications for COVID-19 made available under emergency use authorization for non-hospitalized patients.
  • TREAT COVID-19 Flyer / TREAT COVID-19 Flyer (Spanish version)
    • CDPH in partnership with the Chicago Internal Medicine Practice and Research are offering the rapid response evaluation and treatment of COVID-19 program, an added resource to help respond quickly to large outbreaks.

EVS/Housekeeping

Hand Hygiene

Staff Training

 
  • CDC’s Project Firstline is a collaborative of diverse healthcare and public health partners that aims to provide engaging, innovative, and effective infection control training for millions of frontline U.S. healthcare workers as well as members of the public health workforce.
  • Infection Prevention Training for Long-term Care Facilities (CDC TRAIN)
    • The CDC training course is designed for infection prevention and control (IPC) programs in nursing homes. The course is made up of 23 modules and sub-modules and can be completed in multiple sessions. 
  • APIC Infection Preventionist
    • Infection preventionist developmental path using the APIC competency model.
  • CBIC Long-term Care Certification
    • Applications are now open. The LTC-CIP provides a standardized measure of the basic knowledge, skills and abilities expected of professionals working in the long-term care field. The LTC-CIP is offered worldwide. The exam is an objective, multiple-choice examination consisting of 150 questions.

Other Diseases

Influenza
Guidelines for the Prevention and Control of Influenza Outbreaks in Illinois LTC Facilities (IDPH)
  • The purpose of this memorandum is to provide long-term care facilities (LTCF) and other residential health and living facilities with current guidance for preventing and controlling influenza cases and outbreaks and with information on the reporting requirements in the event of a suspected or confirmed influenza outbreak. 
Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SAR-CoV-2 and Influenza Viruses are Co-circulating (CDC)
  • The following practices should be considered when SARS-CoV-2 and Influenza viruses are found to be co-circulating based upon local public health surveillance data and testing at local healthcare facilities. While these considerations are specific to care of residents residing in nursing homes, some practices could be adapted for use in other long-term care settings (e.g. assisted living communities).
CDPH Influenza Outbreak Report Form
  • Report influenza outbreaks within 24 hours. An influenza outbreak is defined as 2 or more cases of influenza-like illness occurring within 72hrs among RESIDENTS in a unit of the facility with at least one lab-confirmed for influenza. An outbreak must start with residents but should include staff once it has started.
Administrative Code Section 956.30
  • Facilities should ensure that all staff are provided education on influenza and are offered the opportunity to receive the influenza vaccine during the influenza season (between September 1 and March 1 of each year). Sample Declination Form
CDC Seasonal Flu-Who Needs a Vaccine Page
  • Everyone 6 months and older should get a flu vaccine every season with rare exceptions. Vaccination is particularly important for people who are at higher risk of serious complications from influenza.
CDPH Respiratory Illness Prevention Posters (English|Spanish)
  • Print and post in high traffic areas to provide respiratory illness prevention guidance to visitors and staff.
Summary of Influenza Vaccine Recommendation 2023-2024 (ACIP)
  • ACIP recommends adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). If none of these three vaccines are available then any other age- appropriate influenza vaccine should be used. 

Scabies
Scabies FAQ (CDC)
  • Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite is spread by prolonged skin-to-skin contact with a person who has scabies. Crusted scabies (Norwegian scabies) is a severe form of scabies that can occur in some persons who are immunocompromised, elderly, disabled, or debilitated. Persons with crusted scabies have thick crusts of skin that contain large numbers of scabies mites and eggs. Persons with crusted scabies are very contagious.
Scabies Guidelines for Insitutional Settings (CDC)
  • Resources for developing guidelines for preventing, detecting, and responding to a single case, multiple cases, and crusted scabies cases.
Scabies Treatment (CDC)
  • Guidance on medications for the treatment of classic scabies and crusted scabies.
Scabies Fact Sheet (CDC)
  • Printable flyer with general scabies information.
How to Examine for Scabies (CDC)
  • Printable resource with visual examples of scabies lesions.

Invasive Group A Streptococcus (iGAS)
Diseases Caused by Group A Strep (CDC)
  • Bacteria called group A Streptococcus (group A strep) can cause many different infections these infections can be grouped into two general categories — invasive and non-invasive. These infections range from minor illnesses to very serious and deadly diseases.
Investigating 1 Case of iGAS Infection (CDC)
  • Use this strategy in a long-term care facility (LTCF) when one invasive case of group A Streptococcus (GAS) infection is identified among long-term care facility (LTCF) residents.
  • Invasive GAS infection is defined by a culture or molecular test of GAS from either a normally sterile site (e.g., blood, cerebrospinal fluid) or a wound culture in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome.
Antibiotic Regimens for Group A Streptococcus Carriage (CDC) 
  • GAS carriage is the presence of GAS in the throat or on the skin of a person who has no signs or symptoms of infection (also called colonization). During an outbreak identify and treat asymptomatic carriers
GAS Invasive Fact Sheet (CDPH)
  • Fact sheet with GAS and iGAS information, includes guidance when iGAS cases are identified.
GAS Enhanced Surveillance Tracking Sheet
  • Use this excel spreadsheet to maintain active surveillance for additional invasive or noninvasive cases among LTCF residents for 4 months from onset of most recent GAS case

Respiratory Syncytial Virus (RSV)
  • RSV in Older Adults (CDC)
  • RSV infections can be dangerous for certain adults. Each year, it is estimated that between 60,000-160,000 older adults in the United States are hospitalized and 6,000-10,000 die due to RSV infection.
  • RSV Outbreak Line List Template
    • Use this excel document to document and report all cases
RSV vaccine (CDC)
  • Vaccines are available to protect older adults from severe RSV. Adults 60 years of age and older may receive a single dose of RSV vaccine using shared clinical decision-making.
CDPH RSV Poster
  • Flyers can be posted in high-traffic areas to inform residents on the new RSV vaccine.
Gastroenteritis
  • Norovirus (CDC)
    • Noroviruses are a group of viruses that cause gastroenteritis, an inflammation of the lining of the stomach and intestines, causing an acute onset of severe vomiting and diarrhea. Young children, the elderly, and people with other medical illnesses are most at risk for more severe or prolonged infection.
  • Norovirus Key Infection Control Recommendations (CDC)
    • Guidance for isolation, hand hygiene, PPE use, testing, and environmental cleaning.
  • Clostridioides difficile (CDC)
    • C. diff is a spore-forming bacteria that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea. Any surface, device, or material that becomes contaminated with feces could serve as a reservoir for the C. diff spores. C. diff spores can also be transferred to patients via the hands of healthcare personnel who have touched a contaminated surface or item.
  • List K: Antimicrobial Products Registered with EPA for Claims Against Clostridium difficile Spores
    • List K products are registered for use against Clostridium difficile spores (C. diff). Find the EPA registration number on the product label-look for “EPA Reg. No.” followed by two or three sets of numbers and search the registration number exactly as it appears on the label.
  • Gastroenteritis Outbreak Line List Template 
    • Use this excel document to document and report all cases during an outbreak.

Legionella

Tuberculosis (TB)
TB screening and Testing of Health Care Personnel
  • All U.S. health care personnel should be screened for TB upon hire. The TB screening should include a baseline individual TB risk assessment, TB symptom evaluation, a TB test (e.g., TB blood test or TB skin test), and any additional evaluation for TB disease as needed.
Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019
  • Updated recommendations to the 2005 CDC guidelines.

Additional Resources

Transmission-based Precautions
Appendix A: Guideline for Isolation Precautions (CDC)
  • Appendix A consists of an alphabetical list of most infectious agents and clinical conditions for which isolation precautions (contact, droplet, airborne) are recommended. The type and duration of recommended precautions are presented with additional comments with the use of adjunctive measures or other relevant considerations to prevent transmission of the specific agent.
A Toolkit for Implementing PPE in Nursing Homes to Prevent the Spread of Multidrug and Extensively Drug-Resistant Organisms
  • (For Skilled Nursing Facilities Only) This toolkit aims to provide nursing homes with the necessary tools and resources to implement Enhanced Barrier Precautions (EBP) for residents with wounds requiring dressings or indwelling medical devices and successfully admit and care for those residents with an XDRO or epidemiologically important MDRO. This document summarizes best practices and assists with decision making when deciding whether to place a resident on contact precautions or EBP.

Implementation of PPE Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (CDC)
  • (For Skilled Nursing Facilities Only) This document provides guidance for PPE use and room restriction in nursing homes for preventing transmission of MDROs.
The following are examples of signs for Enhanced Barrier, Contact, Droplet, and Airborne Precautions that should be posted outside resident rooms when indicated.

LTCF Reporting

How to Report COVID-19 Cases to CDPH:


**NEW**  Updated CDPH SNF Case Report Form

1. Report lab-confirmed resident and staff cases within 24 hours.
2. Facilities with no new cases must report at least once a week, by Thursday 12 pm (Noon).
3. Effective immediately facilities should not longer submit weekly facility summary reports, enter cases in the Case & Cluster form, or enter cases into the Breakthrough Case Report Form.

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LTCF Contact

For COVID-19 Long-term Care Guidance and Support:

312-744-1100