Resident Management

<<< Back to LTC Resource Center

Symptomatic Criteria

Criteria Defining “symptomatic” as having any one of these symptoms:

  • Fever or chills 
  • Cough 
  • Shortness of breath or difficulty breathing 
  • Fatigue 
  • Muscle or body aches 
  • Headache 
  • New loss of taste or smell 
  • Sore throat 
  • Congestion or runny nose 
  • Nausea or vomiting 
  • Diarrhea 
This list does not include all possible symptoms. Public Health will continue to update this list as we learn more about COVID-19. 

**If a resident is tested by both PCR and serology while they are symptomatic, use PCR results to determine isolation.

For more information, see the ADHS Release from Isolation Guidance.

Screen and Monitor Residents

  • Actively screen all residents, at least daily, and at time of admission, for fever and respiratory symptoms.
  • Residents may not show typical symptoms, fever may be absent.
  • Use standard PCHD linelist to track symptoms for ill residents.
  • Immediately isolate residents who are symptomatic.
  • Residents should wear a facemask or cloth face covering (if tolerated), or use tissues to cover their mouth and nose when staff are in their room and when leaving the room, including for procedures done outside of the facility.
  • Coordinate offsite medical appointments with the offsite medical facility to avoid potential spread of COVID-19.
  • Residents will have potential COVID-19 exposure when returning from any off-site locations, including dialysis facilities, and should be quarantined in their rooms using COVID-19 isolation precautions for 14 days after admission or readmission to a long-term care facility from an acute care facility. 
    • Residents who go off-site from an LTCF may have unknown COVID-19 status, due to potential exposure while off-site, and should be quarantined to private room for 14 days, as per ADHS.
  • Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.

Residents Testing Positive

From ADHS “Appendix: Long-term Care Facility Post-testing Public Health Recommendations” (Accessed May 21, 2020):
  • Cohort COVID-19 positive residents by room or isolate to a private room with a bathroom until they are no longer infectious (fever free for at least 3 days (72 hours) without the use of medicine that reduces fevers AND other symptoms have improved AND at least 10 days have passed since symptom onset). 
  • COVID-19 positive residents should be on standard, contact, and droplet precautions with eye protection throughout their entire infectious period. 
  • Appropriate PPE includes gloves, gown, eye protection, and a face mask. 
  • Perform appropriate monitoring of ill residents (including documentation of oxygen saturation via pulse oximetry) at least 3 times daily to quickly identify residents who require a higher level of care. 
  • Roommates of residents with COVID-19 should be considered exposed and potentially infected and, if at all possible, should not share rooms with other residents unless they remain asymptomatic for 14 days after their last exposure (e.g., date their roommate was moved to the COVID-19 care unit). 
  • Exposed residents may be permitted to room share with other exposed residents if space is not available for them to remain in a single room.

Residents testing negative

From ADHS “Appendix: Long-term Care Facility Post-testing Public Health Recommendations” (Accessed May 21, 2020)
  • Residents who have symptoms consistent with COVID-19, but test negative should be placed on standard, contact, and droplet precautions with eye protection, and isolated away from both COVID-positive and COVID-negative residents until no fever for at least 72 hours without the use of fever-reducing medication and other symptoms have improved. 
  • If your facility has cases of COVID-19: 
  • All healthcare workers should wear all recommended PPE (i.e. standard, contact, and droplet precautions with eye protection) for care of all residents. 
  • All residents testing negative for COVID-19 should be considered exposed and quarantined for 14 days.

Recommendations after Receiving Test Results

  Symptomatic Asymptomatic
  Positive Negative Positive Negative
PCR/antigen testing Isolation* Isolation** Isolation* No isolation
Serology (without PCR/antigen testing) Isolation* Isolation** No isolation No isolation
Serology positive with PCR/antigen testing Isolation* Isolation** Isolation* No isolation

* Stay home away from others or under isolation precautions until you have had no fever for at least 3 days (72 hours) without the use of medicine that reduces fevers; AND other symptoms have improved; AND at least 10 days have passed since symptoms first appeared.

**Stay home away from others or under isolation precautions until you have had no fever for at least 3 days (72 hours) without the use of medicine that reduces fevers; AND other symptoms have improved.

Accepting residents from hospitals or other higher-acuity facilities

Aligned with MCDPH COVID-19 Guidance for Long-term Care Facilities (updated 5/15/20):
When accepting/discharging residents from hospitals or other higher acuity facilities, per the Governor’s Executive Order 2020-22, the following apply: 
  • Residents should be discharged from higher acuity care based on their clinical needs, not based on the isolation period for COVID-19 or additional testing. 
  • Residents who have tested positive for COVID-19 AND require ongoing isolation should be isolated for 14 days after initial admission or readmission to a long-term care facility with COVID-19 isolation precautions. 
  • Residents with symptomatic COVID-19 require ongoing isolation if they have not completed the following time periods of isolation while in a higher acuity facility:
  • At least 10 days have passed since symptoms first appeared; -AND- 
    • At least 3 days (72 hours) have passed since resolution of fever (including fever, chills,  rigors, and body/muscle aches) without the use of fever-reducing medications; -AND- 
    • Improvement in respiratory symptoms (including cough, shortness of breath/difficulty breathing, sore throat, and loss of taste or smell). 
  • A resident without symptoms who tested positive for COVID-19 requires ongoing isolation if they have not completed the following time periods of isolation while in a higher acuity facility: 
    • At least 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not developed symptoms since that test. 
  • However, if there is active transmission of COVID-19 in a receiving long-term care facility, the discharged resident should be placed in isolation. 
  • Residents with unknown COVID-19 testing should be quarantined in their rooms using COVID-19 isolation precautions for 14 days after admission or readmission to a long-term care facility from an acute care facility. 
  • Per CMS guidance released on April 2, “When possible, all long-term care facility residents, whether they have COVID-19 symptoms or not, should cover their noses and mouths when staff are in their room. Residents can use tissues for this. They could also use cloth, non-medical masks when those are available. Residents should not use surgical facemasks unless they are COVID-19-positive or are assumed to be COVID-19-positive.”
  • For more information, see ADHS Guidance for Accepting Admissions and Readmissions from Higher Acuity Facilities and ADHS Long-term Care Facility Guidance (Accessed May 14, 2020)

Relocating Residents

From ADHS “Appendix: Long-term Care Facility Post-testing Public Health Recommendations” (Accessed May 21, 2020)
  • If, after mass testing, there is only a small number of residents identified in each cohort, consider relocating this minority to another facility. 
  • Residents testing negative: 
    • Consider relocating this group to another facility without cases of COVID-19. 
    • When relocating this group to another facility, they should be placed into quarantine at the receiving facility for 14 days. 
  • Residents testing positive: 
    • When relocating this group to another facility, the receiving facility should be either a dedicated COVID-19 facility or have a dedicated COVID-19 unit.

Cohorting Residents

From ADHS “Appendix: Long-term Care Facility Post-testing Public Health Recommendations” (Accessed May 21, 2020):
  • Residents who test positive for COVID-19 should be separated from residents who test negative for COVID-19. General cohorting strategies: 
    • Place residents together by COVID-19 status: 
    • COVID-19 negative residents with other COVID-19 negative residents. 
    • COVID-19 positive residents with other COVID-19 positive residents. 
    • A dedicated room, wing, unit, floor, or building for each cohort is ideal. Cohorting should be done with as much separation as possible between residents. 
    • The cohorting areas should be physically separate from other patient care areas within the facility. If there is no way to separate cohorting areas, then temporary physical barriers with clear signage posted should be used. 
    • COVID-19 positive and COVID-19 negative cohorts should not share common areas or bathrooms. 
    • Staff and equipment should be dedicated to each cohort and should not be shared.

Dialysis Facilities

The CDC has a COVID-19 Outpatient Dialysis Facility Preparedness Assessment Tool as well as interim guidance for hemodialysis facilities. The guidance is focused on infection prevention and control measures for the care of patients with a respiratory illness or with known or suspected COVID-19, including recommendations for cohorting. Dialysis patients are at high risk for acquiring the COVID-19 virus. This is likely due to both inherent immunocompromise in this population as well as possible exposures encountered during transport to/from as well as within the dialysis center itself. 

Aligned with AMDA Frequently Asked Questions Regarding COVID-19 and PALTC (published May 6, 2020):
  • Residents who are going to dialysis should wear a facemask for the entire time they are out of the LTC facility. 
  • Upon the resident’s return, staff should assist the resident with thorough hand washing and changing of clothes. 
  • Place these residents in a single room with standard, contact, and droplet precautions. 
  • Staff should give special attention to surveillance for influenza-like illness and should have high level of suspicion for COVID-19 in these residents. 
  • The LTC facility should communicate with the dialysis facility if one of its residents is suspected or tested positive for SARS-Cov-2. 
  • Residents with potential COVID-19 exposure when returning from any off-site locations, including dialysis facilities, should be quarantined in their rooms using COVID-19 isolation precautions for 14 days after admission or readmission to a long-term care facility from an acute care facility.

Ending Isolation

From ADHS “‘Release from Isolation’ Guidance” (Published June 3, 2020)

Residents who test positive for COVID-19 can be removed from the COVID-19 designated cohort area after they are considered no longer infectious. Recommendations for discontinuation of isolation precautions, based upon a patient’s symptoms and clinical testing are below.
  • If a person is symptomatic* and awaiting COVID-19 test results: 
    • Stay home away from others or under isolation precautions until results are available. If results are delayed, follow guidance for symptomatic and tested positive for COVD-19. Once results are available, follow the recommendations below based on results. 
  • If a person is symptomatic* and tested positive for COVID-19 by PCR, antigen testing, or serology**: 
    • Stay home away from others or under isolation precautions until you have had no fever for at least 3 days (72 hours) without the use of medicine that reduces fevers; AND 
    • Other symptoms have improved; AND 
    • At least 10 days have passed since symptoms first appeared. 
  • If a person is symptomatic* and tested negative for COVID-19 by PCR, antigen testing, or serology**: 
    • Stay home away from others or under isolation precautions until you have had no fever for at least 3 days (72 hours) without the use of medicine that reduces fevers; AND 
    • Other symptoms have improved. 
  • If a person is symptomatic* and has not been tested for COVID-19 by PCR, antigen testing, or serology**: 
    • Stay home away from others or under isolation precautions until you have had no fever for at least 3 days (72 hours) without the use of medicine that reduces fevers; AND 
    • Other symptoms have improved; AND 
    • At least 10 days have passed since symptoms first appeared. 
  • If a person is asymptomatic and awaiting COVID-19 test results: 
    • No isolation is required while waiting for test results. Take everyday precautions to prevent the spread of COVID-19. Once results are available, follow recommendations based on results. 
  • If a person is asymptomatic and tested positive for COVID-19 by PCR or antigen testing (even if person met time and symptom-based strategy for release from isolation after being symptomatic and tested positive for COVD-19): 
    • Stay home away from others or under isolation precautions until 10 days have passed since specimen collection of the first positive COVID-19 PCR/antigen testing while asymptomatic. 
    • If symptoms develop, follow guidance for symptomatic and tested positive for COVD-19. 
  • If a person is asymptomatic and tested positive for COVID-19 by serology: 
    • No isolation is required since there is a low likelihood of active infection. 
    • Take everyday precautions to prevent the spread of COVID-19. 
  • If a person is asymptomatic and tested negative for COVID-19 by PCR, antigen testing, or serology: 
    • No isolation is required. Take everyday precautions to prevent the spread of COVID-19. 
  • If a person has other non-compatible symptoms and has not been tested for COVID-19:
    • Stay home away from others or under isolation precautions until you have had no fever for at least 24 hours without the use of medicine that reduces fevers; AND 
    • Other symptoms have improved.

Educate Residents

  • Educate all residents on the prevention of respiratory viruses, including COVID-19.
  • Ensure education includes basic hand washing and respiratory hygiene.
  • Enforce physical distancing (at least 6 feet) between residents.
  • Ensure residents are up-to-date on vaccinations, including their seasonal influenza vaccination.
  • Ask residents to report and assess for symptoms.
  • Explain actions the facility is taking to protect them.
  • Cancel all group activities, communal dining, and non-medically necessary trips outside of the facility.
  • Residents should wear a facemask or cloth face covering (if tolerated) or use tissues to cover their mouth and nose when leaving the room for medically necessary purposes and when staff are in their room.

Mental Health and Coping with Stress

See CDC guidance for coping with stress and taking care of your emotional health
  • Please consider the mental health of your residents when implementing isolation precautions and recommendations. 
  • Doctors may be more likely to miss mental health concerns among:
    • People with disabilities due to a focus on treating underlying health conditions, compared to people without disabilities.
    • Older adults because depression can be mistaken for a normal part of aging.

If/when a resident has new-onset of suspected or confirmed COVID-19 

Aligned with CDC guidance for responding to COVID-19 in Nursing Homes (accessed May 20, 2020):
  • Facilities should notify PCHD immediately and follow CDC infection prevention and control recommendations for residents with suspected or confirmed COVID-19.
  • Maintain universal source control measures; visitor restrictions; screening of residents and staff; and promptly notify the Pima County Health Department about any of the following:
  • Resident or staff with suspected or confirmed COVID-19; 
  • Resident with severe respiratory infection resulting in hospitalization or death, and
  • ≥3 residents or HCP with new-onset respiratory symptoms within 72 hours of each other.
  • These situations should prompt further investigation and testing for COVID-19.
  • Ensure the resident is isolated and cared for using all recommended COVID-19 PPE. 
  • Place the resident in a single room if possible pending results of testing.
  • Cohorting residents on the same unit based on symptoms alone could result in inadvertent mixing of infected and non-infected residents (e.g., residents who have fever, for example, due to a non-COVID-19 illness could be put at risk if moved to a COVID-19 unit).
  • If cohorting symptomatic residents, care should be taken to ensure infection prevention and control interventions are in place to decrease the risk of cross-transmission.
  • If the resident is confirmed to have COVID-19, regardless of symptoms, they should be transferred to the designated COVID-19 care unit.
  • Please consider the mental health of your residents when implementing isolation precautions and recommendations. 
  • Roommates of residents with COVID-19 should be considered exposed and potentially infected and, if at all possible, should not share rooms with other residents unless they remain asymptomatic and/or have tested negative 14 days after their last exposure (e.g., date their roommate was moved to the COVID-19 care unit).
  • Exposed residents may be permitted to room share with other exposed residents if space is not available for them to remain in a single room.
  • Consider temporarily halting admissions to the facility, at least until the extent of transmission can be clarified and interventions can be implemented.
  • Increase monitoring of ill residents, including assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exam, to at least 3 times daily to identify and quickly manage serious infections.
  • Consider increasing monitoring of asymptomatic residents from daily to every shift to more rapidly detect any residents with new symptoms.
  • Counsel all residents to restrict themselves to their room to the extent possible.
  • Staff should use all recommended COVID-19 PPE for the care of all residents on affected units (or facility-wide if cases are widespread); this includes both symptomatic and asymptomatic residents.
  • If staff PPE supply is limited, implement strategies to optimize PPE supply, which might include extended use of respirators, facemasks, and eye protection and limiting gown use to high-contact care activities and those where splashes and sprays are anticipated. Broader testing could be utilized to prioritize PPE supplies (see section on using testing).
  • Notify staff, residents, and families and reinforce basic infection control practices within the facility (e.g., hand hygiene, PPE use, environmental cleaning).
  • Promptly (within 12 hours) notify HCP, residents, and families about identification of COVID-19 in the facility 
  • Provide educational sessions or handouts for staff, residents, and families
  • Maintain ongoing, frequent communication with residents, families, and HCP with updates on the situation and facility actions
  • Monitor hand hygiene and PPE use in affected areas
  • Maintain all interventions while assessing for new clinical cases (symptomatic residents):
  • Maintain Transmission-Based Precautions for all residents on the unit at least until there are no additional clinical cases for 14 days after implementation of all recommended interventions.
  • If testing is available, asymptomatic residents and HCP who were exposed to the resident with COVID-19 (e.g., on the same unit) should be considered for testing
  • The incubation period for COVID-19 can be up to 14 days and the identification of a new case within a week to 10 days of starting the interventions does not necessarily represent a failure of the interventions implemented to control transmission
  • The decision to lift these isolation precautions should be made in partnership with public health.
Follow Us Share this page

Health Department

3950 S. Country Club Road
Ste. 100
Tucson, AZ 85714

(520) 724-7770

Department Home
Department News
Department Directory
Feedback
Meetings
Calendar
Maps
Volunteer

phab logo