Skilled Nursing

• Skilled Nursing and Intermediate Care Facilities Code

• CMS QSO-23-13-ALL (Public Health Emergency Ending
• CMS QSO-20-38-NH (Testing Requirements)
• CMS QSO-20-39-NH (Visitation)
• CMS QSO-22-15-NH (Emergency Blanket Waivers)
• CMS QSO-22-25-CLIA (SARS-CoV-2 Tests on Asymptomatic)

• Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (CDC)
• Updated Interim Guidance for Nursing Homes Following the End of The Public Health Emergency Updated 05/25/23 
  • IDPH guidance covering restrictions for nursing homes and other long-term care (LTC) facilities that provide skilled nursing personal care (e.g. skilled nursing facilities).  This guidance also covers infection prevention and control, visitation, communal dining, group activities, beauty/barber services, offsite outings, testing, screening, PPE, etc.

Assisted Living/Supportive Living

• Assisted Living and Shared Housing Establishment Code (AL Only)
• Additional Information for Community Congregate Living Settings (e.g., Group Homes, Assisted Living) (CDC)
• Interim COVID-19 Guidelines for Assisted Living, and other Higher Risk Community Congregate Living Settings (IDPH) Updated 3/9/23 
  • IDPH guidance covering restrictions for assisted living facilities. This guidance also applies to other Illinois non-skilled facilities such as supportive living, shared housing establishments, sheltered care, and specialized mental health rehabilitation facilities (SMHRF), whose staff provide non- skilled personal care, similar to that provided by family members in the home.

General 

• Guidelines for the Prevention and Control of Influenza Outbreaks in Illinois LTC Facilities (IDPH)

Skilled Nursing

• Active screening and taking temperatures before someone enters the facility is no longer required. Instead, facilities must establish a process to inform staff, residents, and visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts.
• Evaluate residents at least daily when community transmission is high or when the facility is in outbreak. Evaluation should include sign/symptom assessment, monitor temperature, and assess respiratory status with pulse oximetry. For residents with COVID, increase evaluations to every 4 hours.
• 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.
• Report all positive cases using the SNF COVID-19 Report Form

• Work restrictions for HCP with SARS-CoV-2 infection and exposures

• CMS is requiring facilities to notify residents, family, and staff when COVID-19 cases are identified within the facility

• 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

• Signage 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 non-healthcare 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.

Skilled Nursing Testing Guidance

1 Testing is not required if a resident or staff member has had COVID in the prior 30 days, unless newly symptomatic
2 Check the CDC Transmission Map to determine transmission levels in your county
3 Day 0 is day of exposure, test on day 1

Assisted Living/Supportive Living Testing Guidance

1 Testing is not required if a resident or staff member has had COVID in the prior 30 days, unless newly symptomatic
2  Day 0 is day of exposure, test on day 1

• Active screening and taking temperatures before someone enters the facility is no longer required. Instead, facilities must establish a process to inform staff, residents, and visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts.
• Evaluate residents at least daily when community transmission is high or when the facility is in outbreak. Evaluation should include sign/symptom assessment, monitor temperature, and assess respiratory status with pulse oximetry. For residents with COVID, increase evaluations to every 4 hours.
  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.
• Report all positive cases using the SNF COVID-19 Report Form

• Work restrictions for HCP with SARS-CoV-2 infection and exposures

• CMS is requiring facilities to notify residents, family, and staff when COVID-19 cases are identified within the facility

• 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

• Signage can be posted as a visual alert to prevent the transmission of COVID-19.

• Active screening and taking temperatures before visitors enter the facility is no longer required. Instead, facilities must establish a process to inform visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts.
• Facilities should provide instructions on hand hygiene, limiting surfaces touched, and use of PPE according to facility policy.

Skilled Nursing

• When community transmission levels are high, staff must wear a well fitted FDA-approved facemask and eye protection while present in resident care areas
• When community transmission levels are not high, a mask must be used in the following circumstances:
  • For individuals who have suspected or confirmed COVID (or other respiratory infections)
  • 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

Assisted Living/Supportive Living

• Resident 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

• Printable PPE education, can be used to post in isolation/quarantine rooms.

• Summary of strategies to optimize PPE supplies in healthcare settings during surge capacity when PPE supplies are stressed, running low, or absent.

• A spreadsheet-based model that will help healthcare facilities plan and optimize the use of PPE for response to COVID-19.

• Guidance focusing on protecting workers from occupational exposure to SARS-CoV-2.

• 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.

• Before wearing a respirator, workers must first be medically evaluated using the medical questionnaire or an equivalent method.

• 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.

• Information ranging from basic respirator facts to more complex subjects on respirator function and performance.

• Instructions on identifying work hazards and conducting hazard assessments.

• 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

• Flyers can be posted in high-traffic areas to inform residents on the new bivalent booster vaccine.

• 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.

• CDC Communities of Practice webinar originally presented on February 9, 2023. This 60-minute call highlights successful strategies to engage older adults, residents, and staff in long-term care settings.

• Information on each type of available COVID-19 vaccine and when are you considered up to date.

• Resources for healthcare providers related to the COVID-19 vaccines, including links to interim clinical recommendations.

• Resources for the general public related to the COVID-19 vaccines, including how to find a vaccine provider.

• Learn more about mRNA vaccines.

• An introduction to motivational interviewing for healthcare professionals.

• 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.

• About List N: Disinfectants for COVID-19 (EPA)
• How to Use List N: find products effective against SARS-CoV-2 (CDPH)
• Cleaning and Disinfecting Guidelines (English) courtesy of King County, WA
• Cleaning and Disinfecting Guidance (Spanish) courtesy of King County, WA
• Sparkling Surfaces: Stop COVID-19's Spread Video (CDC)
  • Keep long-term care and nursing home residents healthy by knowing how and when to clean and disinfect environmental and equipment surfaces.
• Options for Evaluating Environmental Cleaning (CDC)
  • Develop a program to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients.
• CDC Environmental Checklist for Monitoring Terminal Cleaning
  • Checklist evaluating the cleaning of objects in the patient zone.
  • CDC Environmental Checklist Word Document
  • CDC Environmental Cleaning Evaluation Worksheet Excel Document

• Hand Hygiene Guidance in Healthcare Settings (CDC)
  • Hand hygiene recommendations in healthcare settings, includes educational slides.
• FAQ: Use of Alcohol-Based Hand Rubs in Illinois Long-Term Care Facilities (IDPH)
  • Guidance and regulations for alcohol-based hand sanitizer in long-term care facilities.
• Hand Hygiene Program Guide (APIC)
  • The APIC Implementation Guide helps infection preventionists apply current scientific knowledge and best practices to achieve targeted outcomes and enhance patient safety.    
• Hand Hygiene Audit Tools and Apps:
  • Speedy Audit App: Hand Hygiene Auditing
  • Swipe Sense App: Hand Hygiene Observations

• 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
  • Between October 16, 2022-January 31, 2023, the long-term care certification examination will not be available. The exam application will re-open for regular testing on February 1, 2023.