Long-Term Care Resource Center

A.	Continued community transmission has increased the possibility that individuals entering LTCFs are potentially exposed. Fever and symptoms screening are ineffective in identifying asymptomatic or presymptomatic individuals entering a facility leading to aggressive universal source control recommendations. All individuals entering LTCFs should be masked.
B.	Executive Orders from the Office of the Governor Doug Ducey  were issued on May 21, 2020: LTCFs shall report through EMResource or alternative form to ADHS every twenty-four hours: 1) Number of COVID-19 positive residents requiring isolation; 2) Current admission criteria related to COVID-19; 3) Number of beds available to new admissions with COVID-19; 4) Number of days of PPE Inventory on hand
C.	2-1-1 Arizona launched a statewide COVID-19 Hotline that offers an entry point to field questions and concerns from Arizona residents about COVID-19.
D.	Arizona Department of Health Services (ADHS) has a newly developed, centralized 24/7 call line to facilitate interfacility transfer of residents to and from hospitals and nursing homes. This system will manage throughput and deter bottlenecks in the emergency department (ED) with four key components:  Expediting resident transfer to a higher level of care  Expediting resident transfer to a lower level of care  Providing a safety net for interfacility transport  Providing critical care and palliative care consultation azhealth.gov/surgeline  Arizona’s recent COVID-19 case counts and mortality are available through CDC and ADHS
E.	CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes, June 1, 2020.
F.	The Centers for Disease Control and Prevention (CDC) has released consolidated recommendations for COVID-19 testing, including interim testing guidelines for nursing home residents (June 13, 2020). Recommendations were added: Testing the same individual more than once in a 24-hour period is not recommended. Clinicians are encouraged to consider testing symptomatic residents for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2.
G.	CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes, June 1, 2020.
H.	The Centers for Disease Control and Prevention (CDC) has released consolidated recommendations for COVID-19 testing, including interim testing guidelines for nursing home residents (June 13, 2020). Recommendations were added: Testing the same individual more than once in a 24-hour period is not recommended. Clinicians are encouraged to consider testing symptomatic residents for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2.

Keeping COVID-19 Out

Policies to prevent the introduction of respiratory germs INTO your facility.

Resident Management

Accepting residents from other facilities, cohorting, and testing procedures.  Managing facility-level needs and preventing spread of virus between facilities.

Employee Management

Source control, education, and return to work criteria for LTCF employees.

Personal Protective Equipment

Optimizing PPE, disinfection protocols, and considerations on usage and types.

Assisted Living & Memory Care

Special considerations and guidance for assisted living and memory care facilities.

Staff and Personal Protective Equipment Requests

Requests for help procuring PPE supplies, medical, and non-medical staff (click the blue buttons on the page linked above).

Resources

Videos, letters, templates, and resources for mental health care and alternative housing for healthcare workers.

LTCFs should notify PCHD when

1. Resident or staff with suspected or confirmed COVID-19
2. Resident with severe respiratory infection resulting in hospitalization or death, and
3. ≥3 residents or HCP with new-onset respiratory symptoms within 72 hours of each other.

Linelist Submissions

• If a resident or staff member tests positive for COVID-19, immediately start the linelist provided by your liaison. 
• You must submit the completed linelist to the Pima County Health Department through the survey form emailed to your primary point of contact. 
• If you have had a case in your facility, these submissions are required every weekday (even if no change has occurred). 
• If your facility has never had a positive case, submissions are optional to support contact tracing and monitoring. 
• Your staff, residents, and residents’ families/guardians should also be notified.

Report COVID-19 cases, facility staffing, and supply information to NHSN weekly

From CDC “Preparing for COVID-19 in Nursing Homes” (June 25, 2020): 

Report COVID-19 cases, facility staffing, and supply information to the National Healthcare Safety Network (NHSN) Long-term Care Facility  (LTCF) COVID-19 Module weekly.

• CDC’s NHSN provides long-term care facilities with a customized system to track infections and prevention process measures in a systematic way. Nursing homes can report into the four pathways of the LTCF COVID-19 Module including:
  • Resident impact and facility capacity
  • Staff and personnel impact
  • Supplies and personal protective equipment
  • Ventilator capacity and supplies
  • Weekly data submission to NHSN will meet the CMS COVID-19 reporting requirements.

Any phased reopening of LTCFs should lag behind community reopening

Aligned with CMS “Nursing Home Reopening Recommendations for State and Local Officials” (May 18, 2020)

Community-level and facility-level factors need to be considered for planning relaxation of restrictions.

Community-level factors

• Trends in case count, hospitalizations, and deaths (TBD – need to assess in the coming weeks)
• Local hospital capacity

Facility-level factors

• Case-status in nursing homes: absence of facility-onset case
• Access to adequate testing: baseline test of all residents and staff; retesting (weekly or biweekly) until all residents negative; then weekly testing of all staff
• Arrangements with laboratories to process quickly
• Laboratory tests with high sensitivity and specificity
• Universal source control (masking of all staff and residents)
• Access to adequate PPE