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.

Join the CDPH SNF Team for the COVID-19 Roundtable webinars to learn about any updates related to COVID-19, see side bar for dates and times.

Federal/State Guidance Documents

COVID Data & Reporting

  • SNF Case Reporting Form (CDPH)
    • All staff and residents COVID cases, including those who tested positive via a rapid antigen test, must be reported to CDPH.
  • 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.
  • NHSN Weekly COVID Vaccination Reporting
    • Protocols and training to track weekly COVID-19 vaccination data for residents and healthcare personnel (HCP) through NHSN.
  • Telligen QI Connect
    • NHSN reporting tips and support.
  • FAQ: COVID-19 NHSN Data (CMS)
  • I-CARE Enrollment Packet
    • The I-CARE Registry is an electronic web-based immunization data registry operated by the Illinois Department of Public Health (IDPH), accessible only to enrolled users who have predefined roles.

Testing

Category1 Vaccination Status High or Substantial Transmission Moderate Transmission Low Transmission
Residents (asymptomatic) Not up to date and up to date Not required
Residents (new/readmissions) Not up to date and up to date Upon admission2 day 3, and day 5 post-admission Not required Not required
Residents and Staff (close contact to confirmed case) Not up to date and up to date Day 1, day 3, and day 5 post-exposure3
Residents and Staff (symptomatic) Not up to date and up to date Immediately
Staff Not up to date 2x a week 1x a week Not required
Staff Up to date Not required

1  Testing is not required if a resident or staff member has had COVID in the prior 30 days, unless they begin to experience new signs and symptoms
2  Initial admission testing is not required if the resident has been tested within the 72 hours prior to admission
3  Day 0 is day of exposure, test on day 1 not sooner than 24 hours following exposure


Updated Interim Guidance for Nursing Homes and Other Licensed Long-Term Care Facilities (IDPH) Updated 3/22/22
  • Page 9 details testing requirements for staff.
SARS-CoV-2 Antigen Testing in Long-Term Care Facilities Considerations of Use (CDC)
  • Guidance with interpretation of and response to results of antigen tests used to diagnose new SARS-CoV-2 infections for symptomatic/asymptomatic residents and healthcare personnel.
Abbott Memo: Binax Expiration Dates
  • Product expiry update.
CMS QSO-22-25-CLIA (SARS-CoV-2 Tests on Asymptomatic
  • CMS is rescinding the enforcement discretion that allowed SARS-CoV-2 and antigen Point of Care (POC) tests to be performed on asymptomatic individuals outside of the test’s authorization.
  • Check instructions of use to determine if the brand of antigen tests you are using can be used on asymptomatic and symptomatic individuals. Refer to the IDPH excel document to find FDA authorization for testing use.

Evaluating and Managing Staff and Residents

  • Actively screen all staff for signs and symptoms of COVID-19
  • Request that contractors, students, and volunteers provide documentation of a negative COVID-19 PCR test according to the required frequency outlined by CDPH, IDPH, and CMS
  • Actively screen all residents every shift for signs and symptoms of COVID-19; if symptomatic, immediately isolate, test, and implement appropriate Transmission-Based Precautions
  • Older adults with COVID-19 may not show typical symptoms such as fever or respiratory symptoms. Atypical symptoms may include new or worsening malaise, new dizziness, or diarrhea. Identification of these symptoms should prompt isolation and further evaluation for 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 and continue to test every 3-7 days until there are no more positives for 14 days. The last round of testing should be on or after day 14
  • Report all positive cases using the SNF COVID-19 Report Form
  • Unit (or department) Based approach: a more focused approach and starts the outbreak testing on the unit/department where the positive COVID-19 case was identified
  • Broad Based approach: requires testing of all residents and HCP when a single case of COVID-19 is identified in the facility and the facility must quarantine all not up to date residents
  • Symptomatic (regardless of vaccination status): isolate using transmission-based precautions
  • Asymptomatic/UTD: no need to quarantine or restrict the resident to their room, but the resident should wear source control for 10 days post exposure
  • Asymptomatic/NUTD: quarantine for 10 days even if testing negative
  • Asymptomatic/COVID-19 within last 90 days: no need to quarantine and testing not recommended; but the resident should wear source control for 10 days post exposure

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

QSO-20-29-NH (CMS)
  • CMS is requiring facilities to notify residents, family, and staff when COVID-19 cases are identified within the facility
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

Visitation & Resident Activities

  • Actively screen visitors for signs and symptoms of COVID-19
  • Visitors, regardless of vaccination status, should wear face coverings
  • Visitors should follow the same isolation and quarantine guidance as residents
  • Ensure all residents, regardless of vaccination status, wear a cloth/surgical mask for source control whenever they leave their room or are around others
  • Residents who are not up-to-date should maintain a 6 feet distance from other residents

IDPH Screening Tool 
  • IDPH has created a screening tool for facilities who need a template for visitor screening
CMS Memorandum QSO-20-39-NH on Nursing Home Visitation Updated 3/10/22

CMS Nursing Home Visitation Frequently Asked Questions Updated 3/10/22  

COVID-19 Long-term care Facility Risk Assessment (IDPH)
  • Assessment for determining whether transmission-based precautions should be implemented upon return after a resident leaves the facility

Personal Protective Equipment 

  • Ensure all staff wear a well fitted FDA-approved facemask
  • When community transmission levels are substantial or high, staff must wear eye protection while present in resident care areas
  • Ensure all staff wear the required PPE for all patient care, use the IDPH PPE Requirements Table to determine the necessary PPE

CDC PPE Sequence for donning and doffing
  • Printable PPE education, can be used to post in isolation/quarantine rooms.
CDC Community Transmission Rate Map
  • Map showing community transmission rates by county. If transmission in Cook County, IL is high or substantial, eye protection must be worn when interacting with residents and/or on patient care units. 
Personal Protective Equipment Requirements for Long-Term Care Facility Staff (IDPH)
  • PPE usage for healthcare staff when caring for a resident with suspected/confirmed COVID-19, a unvaccinated resident on quarantine, a vaccinated resident identified as a close contact, and a resident not suspected of COVID-19 or other respiratory illnesses.
Optimizing Personal Protective Equipment Supplies (CDC)
  • Summary of strategies to optimize PPE supplies in healthcare settings during surge capacity when PPE supplies are stressed, running low, or absent.
PPE Burn Rate Calculator (CDC)
  • A spreadsheet-based model that will help healthcare facilities plan and optimize the use of PPE for response to COVID-19.
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.

Vaccinations

  • 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

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.
COVID-19 FAQs for Healthcare Professionals (CDC)

Understanding and Explaining mRNA COVID-19 Vaccines (CDC)
  • Learn more about mRNA vaccines.
Talking with Patients about COVID-19 Vaccination (CDC)
  • An introduction to motivational interviewing for healthcare professionals.
FDA Authorizes Moderna, Pfizer-BioNTech Bivalent COVID-19 Vaccines for Use as a Booster Dose

Therapeutics

EVS/Housekeeping

Hand Hygiene

Travel

Staff Training

  • Project Firstline (CDPH)
    • 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
    • Accepting applications on July 13 through October 3 for beta test examination.

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