COVID-19 Checklist for Long-Term Care Facilities

Protecting Against COVID-19

Ohio Department of Health Director Amy Acton, M.D., MPH, is ordering all long-term care facilities in the state to notify residents and their families within 24 hours of a resident or staff member being diagnosed with COVID-19.

The state will provide an online list of long-term care facilities where someone has tested positive for the virus that causes the disease.

Dr. Acton also has ordered that all long-term care facilities suspend visitation.

The order:

• Provides exceptions for visitors of residents in end-of-life care, hospice employees, and clergy members.
   
• Allows access only to personnel who are necessary for the operation of facilities (such as staff, contracted and emergency healthcare providers, contractors conducting critical on-site maintenance, and governmental representatives and regulators and their contractors).
   
• Requires facilities to keep a log of all people who are granted access.

Centers for Medicare & Medicaid Services (CMS) guidance states that nursing homes should continue to admit residents they would normally admit, including residents who have been hospitalized, following the best practice of isolation to the extent possible for 14 days while monitoring for COVID-19 symptoms.

A nursing home can accept a resident diagnosed with COVID-19 and still under precaution as long as the facility can follow CDC guidance for Transmission-Based Precautions. If a nursing home cannot, it must wait until precautions are discontinued.

Dr. Acton also strongly recommends that all long-term care facilities immediately take the following actions:

• To reduce feelings of isolation, use telephone calls, videoconferencing, and other methods to connect residents with family and other former visitors. Consider having a communal laptop that residents can use for video chatting; disinfect between uses.
   
• Allow sick employees to stay home. Screen employees at the start of their shifts and send home anyone who has signs or symptoms of COVID-19. Develop sick leave policies that allow employees to stay home if they have symptoms or a respiratory infection.
   
• Encourage good cough etiquette and hand hygiene. Retrain staff and residents on hand-washing and cough etiquette. Ensure staff wash their hands before and after every interaction with each resident. Consider posting visual reminders of proper hand-washing and cough etiquette. Place alcohol-based sanitizer both inside and outside of patient rooms, and make sure tissues are available.
   
• Cancel all group activities and communal dining.
   
• Remind residents to practice social distancing by staying 6 feet away from others whenever possible.
   
• At least once a day, screen residents for fever and respiratory symptoms, such as cough or shortness of breath.
   
• Separate ill residents to limit spread of disease. Separate residents with respiratory symptoms from other residents; however, do not allow residents with symptoms to interact unless the cause of their illness is confirmed to be the same.
   
• Use a consistent-assignment staffing model to reduce the number of different caregivers each resident encounters.
   
• Increase the frequency of cleaning, especially of shared surfaces, with EPA-registered hospital-grade disinfectants. Limit sharing of medical equipment.
   
• Also review Emergency Preparedness in Long-Term Care Facilities.

For answers to your COVID-19 questions, call 1-833-4ASKODH (1-833-427-5634).

Additional resources:

• CDC COVID-19 Preparedness Checklist for Nursing Homes and other Long-Term Care Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html#interim-guidance.
• CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html.