COVID-19 Aging Care FAQs–Your Questions Answered
As the COVID-19 pandemic evolves, ECRI is closely monitoring the latest information and answering questions to help protect healthcare workers and residents. Get answers to your frequently asked questions relating to aging care facilities.
If we can assist your organization in the battle against COVID-19, whether or not you are a current member, please contact us today at firstname.lastname@example.org.
Staff have already talked about refusing testing. What is suggested to getting the point across of the importance of testing?
Guidelines for staff testing needs to be established in your policy and procedures. These should align with recommendations from your state and local health department. The policy should include obtaining consent to do the test and what occurs in the event an employee refuses to be tested. Consent forms must include the benefits and risks to being tested and any other pertinent information. Employees need to be educated and informed of the policy and procedure beforehand and any consequences that may occur if they chose not to be tested. This allows employees to make an informed decision to be tested or not. The policy should be consistently followed for all employees. Page 16 in the Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes provides a state by state overview on testing requirements for COVID-19.
What to expect when accepting the care of a post COVID-19 patient from acute care.
The following are considerations for treating COVID-19 patients discharged from the hospital:
- Dedicate an area of the facility to care for residents with suspected or confirmed COVID-19
- Place resident in a private room with the door closed and with private bathroom (if possible)
- these residents
- Cloth face coverings are not considered PPE because their capability to protect healthcare personnel (HCP) is unknown. Facemasks, if available, should be reserved for HCP
- Dedicated medical equipment should be used when caring for residents with known or suspected COVID-19.
- Use a multidisciplinary approach to include respiratory therapy and ongoing physical, occupational, and speech therapy for cognitive dysfunction, muscle weakness, and debilitation requiring a combination of physiotherapy and exercise programs
- consultation may be appropriate
- Ensure that environmental cleaning and disinfecting procedures are followed consistently and correctly
- Here is an ECRI clinical evidence assessment regarding Screening and Treatment for Post-intensive Care Syndrome.
Can you provide us with guidance on when to allow a COVID-positive employee return to work and what safeguards to put into place if they have been asymptomatic?
Considerations need to be made for HCP who recovered from a COVID-19 illness and are ready to return to work, as well as, HCP that tested positive for COVID-19 but remain asymptomatic. The following considerations will help communities with guidance for HCP returning to work after a COVID-19 illness, and how to manage HCP that test positive but feel fine. These guidelines align with current public health and CDC recommendations.
- Allow employees to return to the work place after a COVID-19 illness when the fever resolves without fever reducing medication; and, respiratory symptoms improve; and, two consecutive nasopharyngeal swab specimen tests collected ≥ 24 hours apart indicate negative specimens.
- If tests are not available it is suggested that HCP may return to work when at least three days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications; and, improvement in respiratory symptoms; and, at least seven days have passed since symptoms first appeared.
- HCP with laboratory-confirmed COVID-19 who have not had any symptoms should be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test.
- After a COVID-19 illness, upon returning to work, HCP should wear a facemask for source control at all times.
- See the full Ask ECRI | Return-to-Work Considerations for COVID-19-Positive Employees.
How should we address vacuuming in areas with a positive COVID-19 case? Our floors are carpeted and we want to be sure that our cleaning methods don’t aerosolize any virus and cause potential exposure to others.
The areas being described in your question would not be an area where aerosol generation procedures are happening. Therefore, if the vacuum is HEPA filtered in terms of exhaust, and that vacuum and filter are maintained according to manufacturer’s guidelines (routine preventative cleaning etc.) then the risk of spreading infection through routine cleaning should be no different than usual. Routine cleaning/disinfecting and vacuuming with appropriately designed equipment for the application/environment will aide in the reduction of infection risk as a general rule. This link provides further information about HEPA Filtration, Submicron and Nano particulate Matter Removal by HEPA-Rated Media Filters and Packed Beds of Granular Materials.
How to handle an Employee Who Tests Positive for COVID-19 or has a Suspected Case?
- Send the employee home immediately if the employee is at work
- Encourage the employee to contact his or her medical provider for next steps.
- You should not disclose the identity of the employee who has a confirmed or suspected case.
- Do communicate to your residents and staff about the confirmed or suspected case
- Ensure that appropriate cleaning and disinfecting of the work areas take place and reassure staff and residents of the steps taken.
Do you have any suggestions for staff who have skin allergies to N95 or surgical face masks?
- May consider removing the mask periodically and only when able to maintain social distancing, (The more on and off happens the more chance to self-inoculate.)
- Change the mask every 8 to 9 hours. Please follow CDC guidelines.
- Hypoallergenic option
- Homemade is not recommended
Do non-health care team members gown up differently than healthcare provider staff?
Staff who work in areas where PPE is required should follow the guidelines of the PPE required for the containment area. If you have an isolation room, then each person entering the isolation room would need to use the PPE required to enter the room. All staff should don PPE as appropriate for the room or area they are entering, and the procedures or tasks they are undertaking while in the area.
Is it recommended to take temperatures of everyone entering the building every time they enter and exit building or just at beginning and end of each shift?
The CDC’s guidance about what facilities should do now is as follows and can be referenced within Preparing for COVID-19: Long-term Care Facilities, Nursing Homes:
- Screen all HCP at the beginning of their shift for fever and respiratory symptoms
- Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat.
- In accordance with previous Centers for Medicare & Medicaid Services (CMS) guidance, every individual regardless of reason entering a long-term care facility (including residents, staff, visitors, outside healthcare workers, vendors, etc.) should be asked about COVID-19 symptoms and must also have their temperatures checked.
Do you have any suggestions on how to keep Hoyer lifts clean to meet infection control standards when being used for COVID-19 positive residents?
- Observe all manufacturers recommendations for disinfecting lifts and slings and be sure that the disinfectant used is on the EPA’s List N. If the recommended disinfectant is not on the EPA’s List N contact the manufacturer for a substitution product that also appears on EPA’s List N.
- Wipe off (disinfect) the whole machine between each use. It is also recommended that you launder the slings between each use. If you need to wipe down the sling make sure you are using disinfectants approved by the manufacturer and appear on EPA’s List N.
- Make sure you inspect the sling for wear and monitor how the disinfectant is effecting the material of the sling.
Is there a different procedure for handling laundry of a confirmed or suspected COVID-19 positive resident?
No, according to the CDC laundering suspected contaminated linens, clothing, etc. is no different than other type of washing procedures with laundry that is contaminated with potentially infectious waste, see procedure below:
- A temperature of at least 160°F (71°C)
- 25 minutes is commonly recommended for hot-water washing.
- The use of chlorine bleach assures an extra margin of safety.
- Please follow the CDC guidelines.
How can I implement COVID-19 response measures in affordable housing units?
ECRI emphasizes that all residents should first adhere to the recommendations and orders from state and local health authorities, including quarantine and shelter-in-place orders. In the absence of such orders, housing providers must balance residents' rights with following recommendations from the Centers for Disease Control and Prevention (CDC). Providers should educate residents about the appropriate precautions they should be taking and encourage staff to stay home if they are sick; while staff should not ask residents medical questions, they may inquire if residents are sick before entering units. See the full Ask ECRI: Implementing COVID-19 Safety Measures in Affordable Housing Units.
How can we conduct a tabletop preparedness exercise for pandemics?
ECRI recommends several resources that can help organizations conduct drills specific to outbreaks of communicable diseases. Examples include:
How can we ensure safe practices for isolation and return-to-work for staff who may have been exposed to COVID-19?
ECRI emphasizes that, with the situation changing rapidly, organizations should stay abreast of recommendations on return-to-work scenarios from the Centers for Disease Control and Prevention (CDC). Importantly, relying on CDC's guidance helps organizations avoid the stigmatization or discrimination that could be present if they made determinations of risk based on race or country of origin. Likewise, the organization should be sure to preserve the confidentiality of staff or other individuals with confirmed COVID-19. Based on CDC's guidance, ECRI encourages organizations to take the following steps.
- Encourage sick workers to stay home
- Separate sick employees
- Emphasize respiratory etiquette and hand hygiene to all employees
- Enhance environmental cleaning procedures
- Emphasize employee travel precautions
- Manage employees exposed at work or home
- See the full Ask ECRI: Staff Isolation or Quarantine after COVID-19 Exposure response.
How can I safely set up on-site childcare to ensure staff can continue to work while daycare/schools are closed?
Organizations should work with their legal counsel regarding state-specific requirements. In addition, if organizations are considering partnering with third parties (e.g., local churches, who may provide volunteer childcare), they should ensure they understand those third parties' insurance coverages and requirements. The organization should designate an individual who is responsible for program oversight, and that person should consider the following issues in establishing an emergency program.
- Enrollment and daily operations
- Environmental safety
- Testing and /or screening for change in workers’conditions
- Notification from workers who become ill
- See the full Ask ECRI: On-Site Childcare for Employees during COVID-19 Pandemic response.
Should long term care facilities, such as assisted living centers, postpone or cancel marketing dinners and tours?
Yes, all non-essential visits and tours should be postponed. Eliminating or minimizing non-essential group gatherings will decrease risk of transmission. Therefore, all providers, including those across the Aging Services continuum, should include enhanced visitor management policies and guidelines as part of their emergency preparedness and response plans for infection related outbreaks. Where medically-indicated, visitor management plans should be evidence- and fact-based as determined by that particular risk assessment. Depending on the degree of risk and potential harm faced by each individual provider situation, limitations on visitation may need to be implemented. Decision making criteria should include a risk identification process (risks associated with each situation), risk prioritization process, and appropriate measures to help prevent harm and mitigate those risks. Considerations for visitor management related to infection and outbreak related hazards should include:
- Assessment of risks posed to all vested stakeholder groups (persons served, staff, visitors);
- Whether various types of visitation are essential or non-essential in relationship to care and well-being of persons served and persons serving;
- Medically indicated screening needs to promote valid and timely identification in change of condition (if signs and symptoms associated with the outbreak are present;
- Necessary internal and external notification to appropriate persons, agencies, and authorities.
- In addition, limitation in the number of physical points of entrance into the organization should be considered in efforts to increase the effectiveness of screening for change in condition, preventing the spread of infection, and infection control.