Best Practices Against COVID-19 in Long Term Care Facilities

29 Jul

By May 11, 2020 COVID-19 had infected more than 153,000 residents at over 7,700 long-term care facilities. Only 11 percent of total US COVID -19 cases had originated at nursing homes, but over 35 percent of the total number of deaths came from long-term care facilities. As of May 26, 2020, nursing homes and their occupants account for more than 43 percent of all coronavirus fatalities in the United States.[1]

Long term care facilities that had in place, or quickly developed enhanced infection control protocols to combat COVID-19 had greater success in reducing infection rates within their resident population. In completing COVID-19 Focus Surveys our investigations have found there are many pathways for the rapid spread of COVID-19 within a residential facility. For example, long-term care facilities that require residents to use multiple use bathrooms or have two or more residents to a room have a higher incidence of rapid spread of COVID-19 once it has found its way into the facility. 

However, there are several approaches that facilities have developed to prevent initial infection and to control the spread of COVID-19.  Facilities that have a designated area, with private rooms for new or readmitted residents from home or the hospital have shown a decrease in the presence of COVID-19 transmission in the facility.  These facilities have developed a plan that if the resident has not had a COVID-19 test completed prior to discharge from the hospital, the long-term care facility immediately obtains the nasal swab. If the swab is negative the resident remains on the designated unit for 14 days at which time another nasal swab is obtained.  If that second test is negative and the resident had no COVD-19 symptoms for the previous three days, the resident is transferred to the general long-term care unit.

Facilities that have also designated certain wings, units, or hallways into phases of COVID-19 prevention and treatment have shown a decrease rate of transfer or death from the infection.  Residents that have any symptoms of COVID-19 or have a positive COVID-19 test result are transferred to a section of the long-term care unit that has been designated as an isolation unit.  Each resident is placed in a private room with private bathrooms.  The door of the resident’s room remains closed but the facility placed a plastic enclosure over the open doorway so the staff can still monitor the resident.  If that resident had a roommate, the roommate is placed on isolation in their room and observed for fourteen days. 

These facilities have also developed a procedure as to when the resident is able to transfer from the isolation unit.  During our investigations, the facilities that have initiated stricter procedures have maintained their facilities at a lower rate of facility transmission of the virus. The facility obtains a nasal swab COVID test at day seven and day 14.  If both tests are negative and the resident has not had any signs or symptoms of COVID-19 for three days, the resident is transferred to a general long-term care unit.

During an investigation one facility was noted to move dialysis residents to rooms next to an exit, so as not to transport residents down the hallways when they went to dialysis outside of the facility. 

On each of these designated units, the staff is consistent and only works their designated unit.  The staff does not only consist of nursing staff, but also housekeeping and dietary as well.  This practice has also shown to decrease the risk of staff transmitting the coronavirus from one unit to other units.  The Centers for Medicare Services COVID-19 Long-Term Care Facility Guidance dated April 2, 2020 revealed, facilities should use consistent staffing teams to care for COVID-19 positive residents to the best of their ability.  This practice can enhance staff’s familiarity with their assigned residents, helping them detect emerging condition changes and decrease the number of different staff interacting with each resident as well as the number of times those staff interact.[2]

Once placed on the new admit or readmission unit or on isolation, the resident is not allowed to leave their room and only designated staff is allowed in their room.  Facilities have also started obtaining their own laboratory blood draws to prevent additional people in the residents’ rooms.  In room physician visits are kept to a minimum and facilities have started using media technology to complete the physician visits. For example, according to the Minnesota Took Kit, although not feasible in all facilities, consider some of the following approaches:

  1. Dedicate a unit or part of a unit as the care location for residents with COVID-19, including those with or without current symptoms of illness. This unit should be used for COVID-19-positive residents that do not require a higher level of care such as hospitalization. Examples include a block of rooms at the end of a hallway, separate wing, or separate floor.
  2. Anticipate ways to close off units to prevent spread of the virus from ill residents to non-ill residents (e.g., for symptomatic COVID-19, recovered COVID-19 residents, non-COVID-19 suspected residents).
  3. Confine symptomatic residents and exposed roommates to their rooms.
  4. Residents with COVID-19 should be placed in a single-person room with private bathroom, with the door closed for those who are symptomatic. If applicable, implement your cohorting plan to use a dedicated space, with dedicated staff, for COVID-19-positive residents.[3]

These facilities had several residents that were positive for COVID-19 and their tracking investigation could not identify how the residents were exposed to COVID but once they were identified, the facilities initiated these strict guidelines and had no further positive cases of COVID.  Long-term care facilities cannot prevent all incidents of exposure to COVID, but placing these strict guidelines regarding the location and staff involvement of the residents in their facilities have shown, in our investigations, to decrease the rate of transmission in the long-term care facilities.

About Ascellon Corporation: Ascellon Corporation is a small minority-owned company. Our organization employs health care professionals whose expertise and knowledge will be applied to the COVID-19 Focus Survey. Our record of performance includes surveying long term care facilities, renal dialysis, assisted living, hospice, and home health companies for the requirements under the Centers for Medicare and Medicaid Services (CMS) and Veterans Affairs (VA) Long-Term Care and Domiciliary facilities standards.

For more information, contact:

Ascellon Corporation

[1] “The Federalist” Copyright 2020, a wholly independent division of Federalist Media

[2] “Centers for Medicare Services” dated April 2, 2020

[3] “Minnesota Department of Health COVID-10 Toolkit” dated 6/5/2020

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