COVID-19: Assisted Living

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.

Newly admitted or readmitted residents who are not up to date with all recommended COVID-19 vaccine doses should still be quarantined for evidence of COVID-19.

For more information on managing new admissions visit CDC’s Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes.

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 in Wisconsin, 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 to Prevent SARS-CoV-2 Spread in 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 resident requires quarantine at the receiving facility. Therefore, you must inform the facility that is accepting the resident. If the facility is unable to meet transmission-based precautions and quarantine for the appropriate length of time, then the resident cannot be transferred.

The strategies used to limit the spread of COVID-19 are especially difficult for residents with dementia. Due to their decreased cognitive ability, residents with dementia will require additional assistance adhering to quarantine and isolation. In particular, residents with dementia may have an impaired ability to follow or remember these instructions and may require additional assistance and reminders from staff:

• Refraining from touching face
• Handwashing
• Wearing a mask
• Refraining from placing things in their mouth
• Social distancing - staying in a particular area
• Other interventions requiring individual follow-through or accountability

Pursuant to Wis. Admin. Code ch. DHS 145 the local health department should be notified about residents or staff with suspected or confirmed COVID-19, residents with severe respiratory infection resulting in hospitalization or death, or three (3) or more residents or staff with new-onset respiratory symptoms within 72 hours of each other.

ALFs should screen anyone entering the facility, regardless of their vaccination status. The screening includes all staff, visitors, hospice, clergy, external health care personnel (HCP), surveyors, and all vendors.

Anyone who meets any of the following three criteria should not enter the facility:

• 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 HCP).

Visitors who have met community criteria to discontinue isolation or quarantine should not visit the facility until they have met the same criteria used to discontinue isolation and quarantine for residents.

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.

Infection control assessment and response

CDC's COVID-19 Infection Control Assessment and Response (ICAR) tool was developed to help facilities take steps to assess and improve their preparedness for responding to COVID-19. The ICAR tool should be used as one tool to develop a comprehensive COVID-19 response plan.

Facilities can request an ICAR evaluation by the Healthcare-Associated Infections (HAI) Prevention Program Regional Infection Preventionists (IPs) which involves a more detailed phone-based or on-site infection control assessment of elements for COVID-19 readiness. The Regional IPs are also available to:

• Answer infection prevention questions on a variety of topics (for example, appropriate PPE use, environmental infection control, bloodborne pathogens, multidrug-resistant organisms, quarantine and isolation).
• Participate in outbreak and infection control breach technical assistance.
• Provide infection prevention and control education.

See highlights and common recommendations the IPs make during ICAR calls or visits on the HAI Infection Prevention Education webpage.

Guidance

As health care facilities, ALFs are responsible for following general infection prevention and control guidance. For current guidance, information on mitigation strategies and infection prevention best practices, regularly review CDC's Infection Control Guidance for Healthcare Personnel During the COVID-19 Pandemic and Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes. Educate residents, staff, and visitors about COVID-19, current precautions being taken in the facility, and actions they should take to protect themselves.

Maintaining appropriate staffing is essential to providing a safe work environment for facility staff and safe resident care. Facilities must be prepared for potential staffing shortages and have plans and processes in place to mitigate them. Facilities should also communicate with staff about actions the facility is taking to address shortages and maintain resident and staff safety, and provide resources to assist staff with anxiety and stress.

Develop a contingency staffing plan

Develop a contingency staffing plan that identifies the minimum staffing needs and prioritizes critical services based on residents' needs.

• Assign a person to conduct a daily assessment of staffing status and needs during a COVID-19 outbreak.
• Contract with staffing agencies, local hospitals, and clinics to fill roles as appropriate.
• Explore all state-specific emergency waivers or changes to licensure requirements or renewals that may allow for hiring and staffing flexibility.

Strategies to lesson staffing shortages

As a facility deviates from their standard recruitment, hiring, and training practices, there may be higher risks to the staff and residents. Facilities should carefully review their emergency plans and cautiously move from one staffing strategy to the next, balancing risk and benefits with each decision.

For more information on implementing strategies to mitigate staffing shortages, see CDC’s Strategies to Mitigate Healthcare Personnel Staffing Shortages and Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure.

Wisconsin Emergency Assistance Volunteer Registry (WEAVR)

Facilities may reach out for assistance from the Wisconsin Emergency Assistance Volunteer Registry (WEAVR). WEAVR is a web-based online registration system for Wisconsin's health professional volunteers willing to serve in an emergency. WEAVR facilitates health and medical response through identification, credentialing and deployment of volunteers. Facilities who may be in need of WEAVR support should work with local public health and emergency management to identify needs and available resources. Facilities can submit their request directly to DHSWEAVRMail@wisconsin.gov. We ask that you copy your local public health agency on the submission.

Information from facilities that would expedite this process includes:

• Contact information at the facility.
• A brief description of the situation at the facility.
• The skill set(s)/profession(s) that are needed.
• The duration of time you will need the volunteers for.
• A brief description of duties.
• Information on whether you will compensate people or are looking for volunteers.
• The date you need people to start.

Additional resources and training to help nursing homes hire and retain the best possible workforce can be found on the WisCaregiver Careers webpage.

• Wis. Admin. Code ch. DHS 83
• Wis. Admin. Code ch. DHS 88
• Wis. Admin. Code ch. DHS 89
• Wisconsin Assisted Living Waivers, Approvals, Variances, and Exceptions

For questions regarding this information or for technical assistance, providers should contact the Division of Quality Assurance (DQA), Bureau of Assisted Living (BAL) regional offices.

When staff with COVID-19 are identified (regardless of whether the staff member is showing symptoms or not), they should be excluded from work until they have met the criteria set by CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. Exceptions to this recommended practice will increase the risk of COVID-19 transmission to residents of long-term care facilities, but may be necessary in a crisis situation.

After exhausting all other opportunities, if the facility still does not have adequate staff to provide the care, treatment and services to the residents, RCACs, CBRFs and AFHs should coordinate with their local/Tribal public health department (LTHD) regarding the intent to utilize COVID-19 positive staff who are asymptomatic or who have mild to moderate illness with improving symptoms. CBRFs and AFHs should submit a waiver request to the Division of Quality Assurance (DQA) Bureau of Assisted Living (BAL) regional office. RCACs should also notify their DQA BAL regional office but do not require a formal waiver per code.

If you have questions about this information, please contact your Division of Quality Assurance Bureau of Assisted Living Regional Office.

Following the core principles of COVID-19 infection prevention and control, facilities should support indoor and outdoor visitation for all residents, regardless of vaccination status or condition. However, outdoor visitation is preferred when a resident and/or visitor are not up to date with all recommended COVID-19 vaccine doses.

Additional information on responding to outbreaks is available, including the Preventing and Managing COVID-19 Outbreaks in Assisted Living Facilities and Skilled Nursing Facilities, P-02897 (PDF) and Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities.

While adhering to federal and state infection prevention and control recommendations, communal activities, including dining and group activities, may occur.

Who should not participate in communal activities?

• Residents with SARS-CoV-2 infection regardless of vaccination status, until they have met criteria to discontinue transmission-based precautions.
• Residents in quarantine until they have met criteria for release from quarantine.

Facilities should consider approaches to decrease the number of different staff interacting with each resident as well as the number of interactions among those staff and residents.

• Facilities should use separate staffing teams for COVID-19 positive residents, to the best of their abilities.
• To the extent possible, facilities should consider making consistent assignments throughout the facility, regardless of COVID-19 status. This may include the assignment of staff to specific residents. When feasible, staff should not work across floors, units, or wings.
• Consistent staff assignments also serve to enhance staff's ability to detect emerging condition changes among residents, which staff with less familiarity may not notice.

When multiple cases are identified and if feasible, facilities should consider dedicated wings or units, or a group of rooms at the end of a wing or unit for residents with known or suspected COVID-19, ensuring that they are separate from other residents. Facilities must maintain strict infection prevention and control practices in these dedicated areas.

Smaller assisted living settings should consider the following steps to increase separation:

• Residents with known or suspected COVID-19 should stay in one room, away from other people, as much as possible. Have the sick person use a separate bathroom. If a separate bathroom is not available, staff should clean and disinfect the bathroom after each use by the sick person.
• If feasible, move regularly used furniture and other household items to maintain a 6-foot distance between people in any shared space.

For information on testing related to who to test, what type of test, when to test, and outbreak testing, see the CDC’s Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 and Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.

See the How to obtain a CLIA Certificate of Waiver (PDF) document from CMS for information and resources on obtaining a CLIA certificate.

• COVID-19 results are reportable according to state and federal statute. Updated April 4, 2022, a Certificate of Waiver (CoW) laboratory or testing site must report all POSITIVE Covid-19 diagnostic test results to the local, state, Tribal, or territory health department in accordance with Public Law 116-136, § 18115(a) and the CARES Act (PDF).
• WLR should be used to report COVID-19 results to public health. With a single upload to WLR, the information is received by state and local public health through the WEDSS and by the CDC and U.S. Department of Health and Human Services (DHHS). See BCD Memo 2022-04 for additional information on COVID-19 reporting.
• Note: Outbreak reporting requirements are different than test reporting requirements. Phoning or emailing positive cases to local or Tribal public health departments does not meet the CLIA lab test reporting requirements. Additionally, test results entered manually into Wisconsin Electronic Disease Surveillance System (WEDSS) are not forwarded to Department of Health Services (HSS) by the state and therefore the HHS reporting requirement is not met.
• CLIA Resources: DHS WI CLIA Homepage or Email: DHSDQACLIA@dhs.wisconsin.gov

Based on this information, facilities should develop plans to:

• Ensure testing of residents or staff with symptoms of COVID-19 and any residents or staff who have had contact with someone who tested positive for COVID-19.
• Ensure notification to coordinate facility wide testing if an outbreak occurs (defined as one or more staff or residents that tests positive). To prepare for the possibility of outbreak testing, facilities should review the asymptomatic testing information outlined in the CDC webpages above. Facilities may also contact their local or Tribal public health department to identify community resources if they anticipate they will need assistance with sample collection or testing.

• See guidance and information for vaccinators on the DHS website.
• Information on COVID-19 vaccines and how to get one are also available.