The Department of Human Services issued updated COVID-19 guidance for personal care homes, assisted living residences, and private intermediate care facilities covering screening and surveillance testing for residents and staff, expanding visitation, and circumstances when and how facilities can safely relax mitigation tactics. The guidance reflects Pennsylvania and facilities’ evolving knowledge of and experience facing COVID-19 and current best practices to protect residents and staff of long-term care facilities.
“Changes to policies and procedures at long-term care facilities are necessary to keep residents and staff safe from COVID-19, but as situations evolve in communities around the commonwealth, we must have a plan to safely allow facilities to ease certain restrictions and operate under a new normal that continues to prioritize COVID-19 safety,” said DHS Secretary Teresa Miller. “We will continue to provide guidance and updated best practices for long-term care facilities so we may all work together to keep staff of these facilities and residents as safe as possible.”
The guidance primarily adds and updates guidance for screening testing of residents and staff, compassionate care visitation policies, easing certain mitigation efforts, and lifting restrictions within these facilities.
Screening testing: Frequency of screening residents and staff of COVID-19 should be determined based on the level of COVID-19 activity in the community where the long-term care facility is located. If an outbreak is identified at the facility, universal testing should begin, prioritizing units, wings or floors where cases are identified but ideally of all residents and staff. Recommended testing intervals for residents and staff of LTCFs not experiencing an outbreak are as follows:
– Low level of community COVID-19 activity (less than 5 percent county positivity): Routine testing of asymptomatic residents is not recommended; testing is encouraged of all staff members every 4 to 6 weeks
– Moderate level of community COVID-19 activity (between 5 and 10 percent county positivity): Weekly testing is encouraged of all residents with outside contact in the last 14 days, if they have not otherwise been tested during that period; testing is encouraged of all staff that have not been tested in the past 30 days and repeat testing every 30 days
– Substantial level of community COVID-19 activity (more than 10 percent county positivity): Weekly testing is encouraged of all residents with outside contact in the last 14 days, if they have not otherwise been tested during that period; testing is encouraged of all staff members once per week
LTCFs should monitor the county positivity rate every other week and implement screening testing recommendations based on their community’s most recent positivity rate.
Compassionate care visitation policies: Prolonged isolation may significantly affect a resident’s mental, emotional and physical health. Facilities must respect residents’ rights and prioritize their well-being by safely facilitating visitation between residents and loved ones as a means of Compassionate Care. A Compassionate Care visit may be needed if a significant change in a resident’s health or emotional well-being is noted. This can include a change in health status and bereavement due to loss of a loved one, among others. Residents and their loved ones should work with the LTCF to document circumstances in which Compassionate Care visits will be necessary. LTCFs must permit visitation by family, friends, clergy and others identified by a resident during end-of-life situations.
Compassionate Caregivers should be tested for COVID-19 within a maximum of seven days prior to beginning duties and must receive a negative test result before entering the LTCF. Caregivers are subject to the same screening testing guidance as facility staff.
All visitors must adhere to universal masking protocols and other COVID-19 mitigation efforts like hand washing and sanitizing. LTCFs should diligently monitor and log identities of all who visit, date and time visited, and contact information for each visitor if contact tracing becomes necessary.
Resuming communal activities and lifting LTCF restrictions: Restrictions on visitation and limitations on communal activities like meals have been restricted in LTCFs since the spring in order to help limit risk of COVID-19 exposure for residents. There is a direct connection between the level of community spread of COVID-19 and outbreaks in a facility. If the level of community spread surrounding the LTCF is low enough and a facility has no active cases or outbreaks, safe visitation should resume.
The guidance updates the previously-issued three-step reopening process to clarify timelines facilities should follow and what is necessary to move between each step and screening processes that should be implemented for residents who leave the facility.
Facilities must also continue to follow all guidance from the Pennsylvania Department of Health and the Centers for Disease Control and Prevention. Guidance will continue to be updated in the future to account for changes in federal policy and Pennsylvania’s needs.
