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COVID-19 101 for Nursing Homes
Updated: 05/11/2020
This resource provides information on key requirements and recommendations related to COVID-19. The document will be updated regularly to provide the most current information available.
Required & Strongly Recommend Actions
What should be done first?
The CDC offers resources to create a plan for dealing with COVID-19. Tools will help with the development of a plan or can be used to ensure the current plan covers necessary areas.
Create a plan. Read Linn Community Nursing Home's Emergency Preparedness Plan. View their COVID-19 Policy.
4-27-2020 KDHE Long-Term Care Facility COVID-19 Readiness Self-Assessment Checklist
Who do I need to communicate with about our plans?
If you have a suspected or confirmed case, there are reporting requirements that MUST be followed. These requirements and other helpful communications resources are described in the What Needs to be Done if There is a Confirmed or Suspected Case in Your Building tool.
What do I need to know about visitors and guests?
- No visitors – Restrict all visitors, with the exceptions for compassionate care, such as end-of-life situations. For compassionate care situations, visitors should be screened, and the use of PPE is required.
- If visitors enter the building, they should be educated on use the of PPE and handwashing. They should be encouraged to avoid or limit physical contact. Visitors should be advised to self-monitor for symptoms for 14 days. If symptoms occur, they should self-isolate at home, notify their physician and contact you with the date they were in the facility, individuals they where they were in contact with and where they were the building.
- Rooms must be disinfected after each resident-visitor meeting.
- Additional guidance on visitors is available through CMS
- Essential staff only in the building. Suspend volunteer programs and non-essential services like hairstylists.
- Post signage to notify visitors of the visitor ban - See example. Communications Templates.
- CMS has offered additional discussion on who should enter the building during the COVID-19 Pandemic in Q 6 & Q7 of the FAQ document in the 4/24 Memorandum.
Can we still have group activities and communal dining?
Who needs to be screened for COVID-19 symptoms and what should it include?
Staff, visitors and delivery persons
Residents
- EVERY resident should be checked for symptoms and have their temperature checked EVERY day per CDC guidance.
What should we be doing for infection prevention and control?
What PPE should be used when?
Staff Use
Resident Use
- Residents that regularly leave the building for medical services should wear a mask in the building when out of their room.
- When possible, residents cover their mouth and nose when staff are in the room providing care. A Kleenex or cloth mask may be used. Residents should not wear medical masks unless they have COVID-19 symptoms or have tested positive.
- Tissues and mask should be available for people who are coughing.
- Utilize this sign as an example.
What do I need to know about PPE supply?
- Develop a plan for inventorying, monitoring, optimizing and obtaining necessary equipment and supplies for infection prevention and control. Consider designating a small team of staff members to be PPE stewards in the organization. They can develop plans, monitor proper use and oversee supply.
- Things to consider include:
- Internal controls to prevent misuse or theft.
- Distribution of PPE by worker types and exposure risk.
- LeadingAge Kansas PPE Information
How can we promote the use of alcohol-based hand sanitizer & handwashing?
- Provide continuous training and reinforcement on the importance of handwashing and proper procedure.
- Handwashing video
- Alcohol-based sanitizer is available in every resident room (ideally inside and outside). Sanitizer should be 60-95% alcohol content.
- Alcohol-based sanitizer is in other resident care areas, common areas, dining hall, gym, etc. Sanitizer should be 60-95% alcohol content.
- Trash bins available near handwashing stations, work areas, resident room exits, and public/staff restroom exits.
- Ensure adequate supply of hand soap and paper towels at all handwashing stations.
What do I need to know about staffing?
Organization of Staff:
- Lessen staff rotation and work to have consistent individuals taking care of the same residents regardless of symptom status. The goal is to reduce the total number of staff members interacting with each resident.
- Divide the team to ensure the staff taking care of those with COVID-19 or suspected COVID-19 are not the staff taking care of those without.
- Develop a plan for additional staffing, should it be necessary. The plan should, to the extent possible, limit the use of outside staffing or staff members that work in multiple buildings. Consider strategies that offer enough hours that staff members don’t need or want to work in multiple places. Member examples.
Multi-building Staff and Other Outside Staff:
How can staff be supported and engaged during this time?
- Communicate with staff daily about COVID-19. The meetings should include plans, updates, changes and encouragement.
- Review employee sick leave policies/procedures and educate staff on the policies/procedures. Remind staff they should NOT come to work if they are ill.
- Compile a list of local resources to support staff members with things like childcare, health/wellness, food and financial support. Work to create supports where there are community gaps.
What are key some training topics that should be covered with the team?
- Train, re-train and reinforce on infection prevention and infection control procedures including handwashing, cleaning/disinfecting, cough etiquette, use of PPE, isolation procedures, etc.
Without visitors and group activities, how can we support resident engagement?
- Develop alternative visit options for family and friends – Services like Skype and Zoom work well to facilitate these interactions. With many family members and residents having Facebook, the chat features within are an option too. Don’t forget to sanitize devices after each use.
- Setting up virtual family visits
- Example virtual visit log
- More provider suggestions for virtual visits
- Develop a plan for providing additional 1:1 activity and/or plans to provide group activity in new ways that do not require in-person contact. Alternative group activity might include doorway activities led by staff members in the hallway, the use of closed-circuit broadcasts, etc.
- Sample Care Plan
- Residents are not required to remain in their rooms and can use outdoor spaces. Educate residents on the organization’s current policies on the use of indoor and outdoor spaces.
- CMS has offered some additional clarification on communication with family members in Q2 of the FAQ document in the 4/24 Memorandum.
What can residents do to help with infection prevention and control?
- Encourage social distancing practices in the community for staff and residents.
- CDC Website definition Social Distancing – Social distancing is the practice of increasing the space between individuals and decreasing the frequency of contact to reduce the risk of spreading a disease (ideally to maintain at least 6 feet between all individuals, even those who are asymptomatic). Social distancing strategies can be applied on an individual level (e.g., avoiding physical contact), a group level (e.g., canceling group activities where individuals will be in close contact), and an operational level (e.g., rearranging chairs in the dining hall to increase distance between them). Although social distancing is challenging to practice in correctional detention environments, it is a cornerstone of reducing transmission of respiratory diseases such as COVID-19.
- Encourage residents to practice good hand hygiene practices and to cough into their sleeve or a tissue.
- CDC Handwashing Information
- Happy Birthday Handwashing
- Review policies related to resident outings with family/friends and nights away from the organization.
Should we take new admissions and what should happen if we do?
- You are NOT required to accept new admissions at this time from the community or the hospital. The decision to accept new admissions should be, as always, based on your ability to provide the needed care. Add a third sentence that says you ARE required to take prior residents back when they are being discharged from the hospital.
- If possible, residents being admitted to the building should be tested for COVID-19. Medicare now pays for the testing when done by approved laboratories. A 14-day in room isolation is encouraged for all new and readmissions, regardless of COVID-19 diagnosis or lack of.
What do I need to know about the mail and other deliveries?
Vendors
- Consider developing alternative delivery arrangements with vendors. Outdoor drop-offs, phone check-in's, suspension of non-essential vendor services will lessen the number of individuals coming into the building.
- Communicate with vendors to determine what prevention practices they are putting in place.
Mail and Items Brought by Family/Friends
- Develop a procedure for receiving mail. Work with mail delivery person/post office to reduce exposure. Member examples.
- Hold mail deliveries in a no/low traffic area for three days before distribution.
- When possible, hold items delivered by a family in a no/low traffic area for three days before distribution.
How do I handle linens, clothing, and other items that go in the laundry?
- The person handling the laundry that might have bio-hazard materials should have PPE protection including mask and gloves. Only that person that should have anything to do with the linens from the time the come in until they are ready to come out of the dryer.
- Ideally, the contaminated linens should come to the wash are bagged and should be dumped into the washer from the bag without being handled directly if at all possible.
- In order to minimize the possibility of dispersing virus through the air, do not shake dirty laundry.
- Once washed the linens should be removed from the washer wearing a clean pair of gloves , put into the dryer.
- When the linens come out of the dryer another person should be responsible for removing them and doing the folding and transporting unless the person doing the washing is completely cleaned up between the wash and the dry process for each load.
- Wash items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry that has been in contact with an ill person can be washed with other people’s items.
- Clean and disinfect hampers or other carts for transporting laundry according to guidance above for hard or soft surfaces.
- CDC Guidance on Cleaning and Disinfecting
My question wasn’t addressed. How can I get it answered?
How can I share things that are working well for us?
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