The COVID-19 outbreak has taken a grim toll on people of all ages in the United States, but particularly on older adults living in long-term care facilities. More than 60,000 nursing home residents have contracted the disease, according to a June 2, 2020, report released by the Centers for Medicare & Medicaid Services (CMS); nearly 26,000 residents have died.

Preventing the spread of COVID-19 in long-term care facilities is essential for the health and well-being of the residents who live there, the healthcare professionals who work there, and for everyone in the community.

In the early days of the COVID-19 outbreak in the United States, the nation’s eyes were riveted on overwhelmed hospitals, sick passengers stranded on cruise ships, and stay-at-home orders. Long-term care facilities were largely overlooked. Administrators and healthcare professionals seemed to be on their own when it came to finding personal protective equipment (PPE) and making decisions. Fortunately, the Centers for Disease Control and Prevention (CDC) and other healthcare organizations now provide specific guidelines for controlling the spread of COVID-19 in the community and in long-term care facilities.

Tips for Preventing the Spread of COVID-19 in Long-Term Care Facilities

Preventing the spread of COVID-19 in long-term care facilities requires cooperation from everyone, from administrators to healthcare workers and even to visitors.

Administrators

Encourage workers to stay home if they are sick

Consider expanding sick leave policies to allow all workers, even those not directly involved in patient care, to stay home if they are sick. Paid sick leave reduces the rate of people working sick by 4.5 percent.  It can take several days to learn the results of COVID-19 tests, so it is safer to keep sick workers at home while they await the results

Plan for temporary staffing shortages

Planning for temporary staffing shortages can prevent lapses in resident care; the presence of temporary workers can reassure residents that they will continue receiving high quality care.

Long-term care facility administrators can work with staffing agencies to supplement their workforce in the event that multiple workers self-isolate. High quality staffing agencies can supply healthcare personnel who are highly skilled at working in long-term care facilities through the COVID-19 crisis.

Screen workers for signs and symptoms of COVID-19

Actively screen all personnel for symptoms and fever at the beginning of their shift; test anyone who has a positive screen. Sick workers should go home or seek medical care. Those with fever or symptoms should not come to the facility until the test results are back; those who test positive should not come back to work until they meet return to work criteria as specified by the CDC. Immediately implement strategies to overcome temporary staffing shortages.

The most commonly reported signs and symptoms of COVID-19 include:

  • Fever
  • Cough
  • Shortness of breath

Other symptoms may include:

  • Sore throat
  • Diarrhea
  • Muscle aches or body aches
  • Tiredness or fatigue

Outsource screening

Like a wide variety of manufacturers and companies outside the healthcare industry, many long-term care facilities are outsourcing their COVID-19 screening stations because they do not have the training or personnel to take temperatures and otherwise screen workers as they come and go. Outsourcing screening helps long-term care facilities maintain an optimal staff-to-resident ratio by allowing regular staff to focus on what they do best – taking care of residents.

Require the use of PPE

Require the use of PPE among nurses, nursing assistants, and others working in the long-term care facility.

Provide training in infection control

Provide nurses, nursing assistants, and other workers with job- or task-specific education on the identification of infectious agents and training in the prevention of transmission of infectious agents, including training in how to use PPE when caring for residents. Provide PPE, job aids and up-to-date COVID-19 reference materials. Encourage healthcare workers to look for and report suspect COVID-19 cases.

Visitors

Follow CDC guidelines on visitors

The CDC guidelines on visitors include having a plan for implementing visitor restrictions, facilitating videoconferencing and other means of visitation, requiring check-in at the front desk for screening and symptom assessment, and asking visitors to inform the facility in the event the visitor develops fever or other symptoms consistent with COVID-19 within 14 days of the visit.

Residents

Perform baseline and routine testing on all residents, following guidelines set by the CDC. These guidelines include preparing to perform facility-wide testing, planning for specimen collection and date management, and coordinating the reporting of test results between the long-term care setting, laboratory, and health department. Testing should follow the CDC’s Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19).

The number of people present during testing should be limited to only the resident being tested, the individual performing the test, and essential resident support personnel as needed; visitors and bystanders should not be present during specimen collection. Healthcare professionals should perform specimen collection one resident at a time, in the resident’s room with the door closed, and with no other residents present.

Healthcare professionals in the room should wear appropriate PPE, including N95 or higher-level respirator and eye protection. A facemask is acceptable if a respirator is not available. The healthcare professional should wear a single pair of gloves and a gown for specimen collection or if contact with contaminated surfaces is anticipated.

Healthcare workers

Wear masks and practice social distancing outside of work – a recent study published in The Lancet shows that physical distancing and the use of PPE lowers the risk of spreading coronavirus

COVID-19 is changing the way long-term care facilities, nurses, and other healthcare professionals provide care to the residents they serve. Official guidelines will likely change as well, as the number of cases rise and fall. Despite the constantly changing landscape of COVID-19, healthcare professionals working in long-term care facilities will rise to the challenge of keeping their residents, staff, and communities safe.