5 Key Strategies to Prepare for COVID-19 in Long-term Care Settings

COVID-19 has claimed more than 100,000 lives in the United States, and has sickened millions more. While people of all ages can contract the highly infectious disease, older adults are particularly vulnerable. More than 60,000 nursing home residents have COVID-19, according to a June 2, 2020, report released by the Centers for Medicare & Medicaid Services (CMS). Sadly, nearly 26,000 long-term care residents have succumbed to the disease.
Preparation is the key to preventing coronavirus from entering a long-term care facility, curbing the spread of the disease to residents and healthcare personnel, and reducing the mortality rate of COVID-19. While the Centers for Disease Control and Prevention (CDC) and other health protection agencies were quick to provide guidance on strategies to prepare hospitals and other healthcare settings for COVID-19, many long-term healthcare administrators, nurses, healthcare personnel had to develop their own strategies to protect residents, workers, and the community.
Fortunately, the CDC and other agencies now provide guidance on preparing long-term care settings for potential coronavirus infection.

5 Essential Strategies to Prepare Your Long-term Care Setting

1. Prevent COVID-19 from entering your facility
Limit all visitor access except for compassionate care situations, such as end-of-life visits from family members. Restrict access for all volunteers and non-essential healthcare personnel, including hairdressers, barbers and other consultant services.
Implement universal use of source control, such as wearing of face coverings, for everyone in the facility.
Actively screen everyone entering the building, from healthcare providers to ancillary staff and vendors, for fever and other symptoms of COVID-19. Screen nurses, nursing assistants and other healthcare professionals and staff members before the start of each shift; those failing screening or feeling ill should go home or to a doctor, and long-term care facilities should institute flexible and non-punitive sick leave policies
Reschedule all field trips that take residents outside of the facility.

2. Identify infections early
Screen all residence daily for fever and other symptoms of COVID-19, which can include fever, cough and shortness of breath for younger adults. In many cases, older adults may not show these typical symptoms, and instead have atypical symptoms of COVID-19, such as malaise, dizziness or diarrhea. Some older adults with COVID-19 might just seem “off,” sleeping more than usual, eating less, seeming confused, and falling.
Immediately isolate residents who have symptoms of COVID-19 and implement appropriate Transmission-Based Precautions. The CDC recommends reserving Airborne infection isolation rooms (AIIRs), formerly known as negative pressure rooms, but many long-term care facilities do not have AIIRs. These facilities can place residents with suspected or confirmed COVID-19 in private rooms that have private bathrooms as possible, and keep the door to the room closed whenever possible.
Long-term care settings should notify their state or local health departments within 24 hours in the following circumstances:
• A resident experiencing severe respiratory infection resulting in hospitalization or sudden death
• Respiratory infection in three or more residents and/or healthcare personnel
• A suspected or confirmed case of COVID-19 in a resident or healthcare personnel
Health departments can help provide information and guide decisions regarding the testing of asymptomatic residents and healthcare personnel.

3. Prevent the spread of COVID-19
Once inside a facility, COVID-19 can spread rapidly. Swift action on the part of healthcare professionals can curb transmission. Immediate actions can include canceling communal dining and all group activities, and enforcing social distancing among residents and among staff.
Wearing cloth face coverings and personal protective equipment (PPE) can help reduce the spread of COVID-19 within a long-term care setting. It bears noting the cloth face coverings should be used only as source control and not as PPE because their ability to protect the wearer is unknown. Cloth face coverings are not a suitable replacement for a respirator or facemask in situations that require more than just source control.
All residents should wear a cloth face covering for source control whenever they leave their room or are around others; residents should wear a face covering when leaving the facility for essential medical appointments.
Because of the substantial risk of unrecognized infection among residents, nurses and other healthcare personnel should wear a facemask or cloth face covering for source control at all times while in the facility. Healthcare personnel should wear PPE when providing care for all residents – symptomatic and asymptomatic – on the affected unit or facility-wide, depending on the specific circumstance. PPE in these situations should include an N95 respirator or better, eye protection, gown, and gloves. A facemask may be used if a respirator is not available. Healthcare providers should receive training on the donning, doffing, and use of PPE.

4. Assess and optimize the current PPE supply
The CDC offers a PPE “burn rate” calculator to help healthcare facilities calculate their average PPE consumption rate and estimate how many days their PPE supply would last, given a facility’s current inventory and burn rate. Long-term healthcare settings that experience or anticipate PPE shortages can reach out to their local or state health department, which may be able to help residential communities engage with a local healthcare coalition.
To help stretch PPE supply, long-term healthcare communities may authorize extended use of facemasks, respirators, and eye protection, or prioritize the use of gowns for only those resident care activities that involve direct contact with infected residents or present a risk for transmission of coronavirus to the caregiver’s clothing.

5. Monitor for severe illness
Monitor ill residents; document temperature and oxygen saturation at least three times each day to indentify residents requiring transfer to a higher level of care. The condition of older patients with COVID-19 can deteriorate rapidly.

With preparation and persistence, healthcare professionals and administrators can reduce – or in many cases, prevent – the spread of COVID-19 in their long-term care settings.