Nursing Homes: Provider Resources

Admissions

Facilities should admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was or is present. Facilities should follow the CDC guidance for infection control when COVID-19 is identified or suspected in a resident. Facilities may not require a negative COVID-19 test as a condition of admission.

Newly admitted or readmitted residents who are not up to date with all recommended COVID-19 vaccinations should be educated and offered a COVID-19 vaccine per CDC recommendations and CMS requirements (PDF).

Admissions During a COVID-19 Outbreak

When a suspected or confirmed case of COVID-19 is identified in a facility, the facility may temporarily halt admissions to the facility, at least until the extent of transmission can be clarified and interventions can be implemented. See Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities for more information.

While COVID-19 remains a threat to long-term care residents, a facility may determine that they can safely admit a resident if certain considerations are taken into account. Facility leadership should carefully review CDC's Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic for Nursing Homes and consult with the local public health officer when possible.

Discharges and Transfers

If a resident has been exposed and is being discharged, the discharging facility must inform the facility that is accepting the resident. This will allow the facility that is accepting the resident to ensure the resident uses source control and that any recommended testing is completed.

CDC

• CDC COVID-19 Data Tracker: United States COVID-19 Hospitalizations, Deaths, Emergency Visits, and Test Positivity by Geographic Area
• CDC COVID-19: Wastewater Surveillance
• CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2
• CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
• CDC Similarities and Differences between Flu and COVID-19​
• CDC Stay Up to Date with COVID-19 Vaccines
• CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages
• CDC Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating
• CDC Ventilation in Buildings
• CDC's Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings

CMS

The CMS Quality, Standards, and Oversight Board memos are posted on the Survey and Certification memos website. Filter on nursing home.

• CMS QSO-20-29 (PDF) - Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes (COVID-19 Tags F884 and F885)
• CMS QSO-20-39 (PDF) - Nursing Home Visitation - COVID-19 (Revised)
• CMS QSO-21-19 (PDF) - Interim Final Rule - COVID-19 Vaccine Immunization Requirements for Residents and Staff (COVID-19 Tag F887)
• CMS 23-10 (PDF) - Strengthened Enhanced Enforcement for Infection Control Deficiencies and Quality Improvement Activities in Nursing Homes
• CMS QSO-23-13 (PDF) - Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)
• Updated Guidance for Nursing Home Resident Health and Safety

DHS

• COVID-19: Health Care Providers
• DPH Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities
• Preventing and Managing COVID-19 Outbreaks in Assisted Living and Skilled Nursing Facilities, P-02897 (PDF)
• Infection Preventionist Starter Kit, P-02992 (PDF)
• Additional COVID-19 infection prevention and personal protective equipment fact sheets can be found on the COVID-19: Communication Resources webpage.
• DHS COVID-19: Wisconsin Coronavirus Wastewater Monitoring Network

CMS COVID-19 Reporting Requirements

On May 6, 2020, CMS issued Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes Memo, QSO-20-29-NH (PDF) requiring nursing homes to report COVID-19 facility data to the CDC and also to residents, their representatives, and families. On May 1, 2023, CMS issued Guidance for the Expiration of the COVID-19 Public Health Emergency, QS0-23-13 (PDF) that removed the facility requirement to report COVID-19 information to residents, their representatives, and families. Reporting of COVID-19 facility data to the CDC's NHSN remains in effect. Failure to report COVID-19 facility data may result in an enforcement remedy.

DHS Reporting Requirements

Wisconsin has communicable diseases reporting requirements. Specific reporting requirements are described in Wis. Admin. Code ch. DHS 145 Control of Communicable Diseases. A list of reportable communicable diseases and other conditions is provided in Wis. Admin. Code ch. DHS 145 - Appendix A.

On September 29, 2023, DHS issued Changes to COVID-19 Reporting Requirements in Wisconsin, BCD 2023-05 (PDF) wherein the State Epidemiologist declared effective November 1, 2023, reporting of COVID-19 cases to public health is no longer required unless a confirmed or probable case is associated with a hospitalization or pediatric death.

Outbreak Reporting Requirements

In Wisconsin, confirmed or suspected outbreaks of any disease in health care facilities, including long-term care facilities, are a Category I Disease, meaning they shall be reported immediately by telephone to the patient's local health officer, or to the local health officer's designee, upon identification.

Suspected respiratory disease outbreak, including COVID-19

According to DHS guidance for Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities, a suspected respiratory disease outbreak in a long-term care facility is defined as three or more residents and/or staff from the same unit with illness onsets within 72 hours of each other and who have pneumonia, acute respiratory illness, or laboratory-confirmed viral or bacterial infection (including influenza and COVID-19).

CDC recommendations and CMS guidance (PDF) recommends nursing homes establish a process to provide guidance about screening everyone (all staff, visitors, hospice, clergy, external health care personnel, surveyors and all vendors) entering the facility and what actions they should take for anyone who meets any of the following criteria:

• Tested positive for SARS-CoV-2 with a viral test
• Has symptoms of COVID-19, or
• Had a known exposure to someone with COVID-19 (or a higher-risk exposure for health care personnel).

Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they have met CDC criteria for healthcare settings to end isolation. Visitors who have had close contact with someone with COVID-19 infection should defer non-urgent in-person visitation until 10 days after their close contact if they meet criteria described in the CDC healthcare guidance (e.g., cannot wear source control).

Staff who have a fever or any COVID-19 symptoms prior to or during their shift should be excluded from work. Decisions about when staff can return to work should be made using Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection.

Source control is recommended for individuals in healthcare settings who:

• Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
• Had close contact (residents and visitors) or a higher-risk exposure (health care personnel) with someone with SARS-CoV-2 infection, for 10 days after their exposure

Source control is recommended more broadly as described in the CDC's Core Infection Prevention and Control Practice in the following circumstances:

• By those residing or working on a unit or area of the facility experiencing a SARS-CoV-2 or other outbreak of respiratory infection; universal use of source control could be discontinued as a mitigation measure once the outbreak is over (e.g., no new cases of SARS-CoV-2 infection have been identified for 14 days); or
• Facility-wide or, based on a facility risk assessment, targeted toward higher risk resident populations (e.g., when caring for residents with moderate to severe immunocompromise) during periods of higher levels of community SARS-CoV-2 or other respiratory virus transmission
• Facility-wide when COVID-19 hospital admission levels are high

Anyone with even mild symptoms of COVID-19 should receive a viral test for SARS-CoV-2 as soon as possible.

Asymptomatic residents with close contact and HCP following a high-risk exposure with someone with SARS-CoV-2 infection should have a series of three viral tests for SARS-CoV-2 infection. Testing is recommended immediately, but not earlier than 24 hours after the exposure. If the test is negative, the resident should be tested again in 48 hours. If the second test is negative, the resident should be tested again in 48 hours. If exposure is day 0, testing will typically be on day 1, day 3, and day 5. Source control is recommended for 10 days after their exposure.

Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating

According to the CDC, there is strong scientific evidence that antiviral treatment of outpatients at risk for severe COVID-19 reduces their risk of hospitalization and death. COVID-19 treatment should be considered in residents with mild to moderate COVID-19 who have one or more risk factors for severe COVID-19. Treatment must be started as soon as possible within 5 days of symptom onset to be effective.

On May 6, 2022, the Division of Public Health published BCD Memo 2022-07 (PDF) titled COVID-19 Oral Antivirals Medication for Long-Term Care Residents. The purpose of this memo is to provide an overview of Paxlovid and Lagevrio, outline requirements for maintaining a contingency supply in SNFs, and to describe the medication ordering process for long-term care (LTC) pharmacies. Clinical guidance about the use of COVID-19 therapeutics changes frequently. Links to federal guidance are provided throughout this memo, and clinicians are encouraged to consult these resources for the most up-to-date information.

On November 22, 2022, CMS published CMS QSO Memo 23-03-All (PDF) titled The Importance of Timely Use of COVID-19 Therapeutics that states every patient who tests positive for COVID-19 should be evaluated to determine whether the use of an available therapeutic is appropriate. Nursing homes should ensure residents receive (in consultation with their physician and family) appropriate treatment when tested positive for COVID-19.

Nursing homes, in particular, are encouraged to review the latest updated information from the National Institutes of Health for use of clinically appropriate therapeutics.

DHS offers a Free Virtual COVID-19 Treatment Telehealth Consultation Service for Wisconsinites over the age of 18 and clinicians wanting guidance on prescribing the antiviral treatments.

Improving Ventilation in Buildings:

• To improve ventilation in your building, keep your system operating as designed. Aim for at least 5 air changes each hour and upgrade to MERV-13 filters if able to do so.
• Good ventilation is essential to maintaining a healthy indoor environment and protecting building occupants from respiratory infections.
• Improving ventilation in buildings can help reduce the number of viral particles in the air and lower occupants' risk of exposure to respiratory viruses.
• Implementing multiple infection prevention and control strategies at the same time can increase the overall effectiveness of ventilation interventions.