COVID-19: Long-Term Care Facilities and Services

This guidance is for all long-term care facilities, assisted living facilities, 1–2 bed adult family homes, supported living apartments, and facilities serving people with developmental disabilities in Wisconsin caring for patients who are elderly and/or have chronic medical conditions that place them at higher risk of developing severe complications from COVID-19. By helping facilities improve their infection prevention and control practices in order to prevent the transmission of COVID-19, together we can flatten the curve.

Recommendations will change as we move through Wisconsin's roadmap to reopen using public health principles of testing, tracing, and tracking the new coronavirus to decrease COVID-19 cases and death. 

DHS recommends the following actions in accordance with Wis. Stat. chs. 50 and 252, Wis. Admin. Code ch. DHS 145, and Centers for Medicare & Medicaid Services (CMS) guidance.

If a health care worker or resident of a facility is diagnosed with COVID-19, immediately contact your local public health department to receive further guidance on infection control.

 Visitors to Facilities

Restrictions on visitors:

  • Facilities should restrict all visitors and nonessential health care personnel, except for certain compassionate care situations, such as an end-of-life scenario. Facilities should notify potential visitors of the need to defer visitation until further notice (through signage, calls, letters, etc.).
  • In compassionate care situations, visitors will be limited to a specific room only. Facilities should require visitors to perform hand hygiene and use personal protective equipment (PPE), such as face masks. Decisions about visitation during an end-of-life situation should be made on a case-by-case basis, which should include careful screening of the visitor (including clergy, bereavement counselors, etc.) for fever or respiratory symptoms.
  • Individuals with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations).
  • Visitors that are permitted to enter must wear a face mask while in the building and restrict their visit to the resident’s room or other location designated by the facility. Facilities should also remind visitors to frequently perform hand hygiene, especially after coughing or sneezing.

Health care workers. Facilities should follow CDC guidelines for restricting access to health care workers.

  • Other health care workers, such as hospice workers, EMS personnel, or dialysis technicians, who provide care to residents should be permitted to enter the facility as long as they meet the CDC guidelines for health care workers.
  • Facilities should contact their local health department for questions, and frequently review the CDC COVID-19, website for health care professionals.

Surveyors. All nonessential survey activities are suspended, in accordance with CMS direction.

For other ongoing survey activities, CMS and state survey agencies are constantly evaluating their surveyors to ensure they don’t pose a transmission risk when entering a facility. For example, surveyors may have been in a facility with COVID-19 cases in the previous 14 days, but because they were wearing PPE effectively per CDC guidelines, they pose a low risk of transmission in the next facility, and must be allowed to enter. However, there are circumstances under which surveyors should still not enter, such as if they have a fever.

 Guidance for all Facilities

Facilities should:

  • Cancel communal dining and all group activities, such as internal and external group activities.
  • Implement active screening of residents and staff for fever and respiratory symptoms.
  • Remind residents to practice social distancing and perform frequent hand hygiene.
  • Screen all staff at the beginning of their shift for fever and respiratory symptoms. Actively take their temperature and document the presence of a fever and respiratory symptoms including: new or worsening cough, unexplained myalgia, and sore throat.
  • If employees develop signs and symptoms of a respiratory infection while on the job they should:
    • Immediately stop work, put on a face mask, and self-isolate at home.
    • Inform the facility’s infection preventionist.
    • Contact their local health department for next steps.​
  • Facilities should communicate through multiple means to inform individuals and nonessential health care personnel of the visitation restrictions, such as signage at entrances and exits, letters, emails, phone calls, and recorded messages for receiving calls.
  • Communications with residents and families should be proactive and clearly explain the reasons for these changes. References able to be shared with residents and families are available through links in this memo and on the DHS COVID-19 website.

In lieu of visits, facilities should consider:

  • Offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.).
  • Creating and/or increasing listserv communication to update families, such as advising them to not visit.
  • Assigning staff to serve as the primary contact to families for inbound calls, and conducting regular outbound calls to keep families up to date.
  • Offering a phone line with a voice recording updated at set times (for example, daily) with the facility’s general operating status, such as when it is safe to resume visits.

When visitation is necessary or allowable (end-of-life scenarios), facilities should make efforts to allow for safe visitation for residents and loved ones. Facilities should suggest that visitors:

  • Refrain from physical contact with residents and others while in the facility.
  • Practice social distancing with no handshaking or hugging, and remain at least 6 feet apart.

Facilities should create dedicated visiting areas (for example, “clean rooms”) near the entrance to the facility where residents can meet with visitors in a sanitized environment, if possible. Facilities should disinfect rooms after each resident-visitor meeting.

For individuals allowed in the facility (end-of-life scenarios):

  • Before visitors enter the facility and residents’ rooms, provide instruction on hand hygiene, the importance of limiting surfaces touched, and the proper use of PPE according to current facility policy while in the resident’s room.
  • Individuals with fevers, other symptoms of COVID-19, or who are unable to demonstrate proper use of infection control techniques should be restricted from entry.

Facilities should advise visitors, and any individuals who entered the facility (for example, hospice staff), to monitor for signs and symptoms of respiratory infection for at least 14 days after exiting the facility. If symptoms occur, advise them to self-isolate at home, contact their health care provider, and immediately notify the facility of the date they were in the facility, the individuals they were in contact with, and the locations within the facility where they visited. Facilities should immediately screen the individuals of reported contact, and take all necessary actions based on their findings.

Facilities should identify staff who work at multiple facilities (for example, agency staff, regional or corporate staff) and actively screen and restrict them appropriately to ensure they do not place individuals in the facility at risk for COVID-19.

Facilities should review and revise how they interact with vendors and delivery drivers, agency staff, EMS personnel and equipment, transportation providers (for example, when taking residents to offsite appointments), and other non-health care providers (for example, food delivery), and take necessary actions to prevent any potential transmission. For example, do not have supply vendors transport supplies inside the facility. Have them dropped off at a dedicated location (loading dock). Facilities can allow entry of these visitors, if needed, as long as they are following the appropriate CDC guidelines for Transmission-Based Precautions.

Residents should still have the right to access the Ombudsman program. Ombudsman access should be restricted per the guidance above (except in compassionate care situations). However, facilities may review this on a case-by-case basis. If in-person access is not available due to infection control concerns, facilities need to facilitate resident communication (by phone or other format) with the Ombudsman program or any other entity listed in 42 CFR § 483.10(f)(4)(i).

Nursing Home Infection Prevention

Nursing homes and other long-term care facilities should prepare now to care for residents with COVID-19. A facility self-assessment tool is available to evaluate current readiness and guide development of a COVID-19 plan that addresses communications, supplies, resident management, visitors, occupational health, training, and surge capacity. Facilities can start by performing the self-assessment and direct questions about their results or necessary elements to dhswihaipreventionprogram@dhs.wisconsin.gov. DHS infection preventionists recorded a 30-minute overview of the self-assessment tool to explain each section. Long-term care facilities can also request a tele-infection control assessment and response (ICAR) evaluation by the HAI Prevention Program, which involves a more detailed phone-based infection control assessment of elements for COVID-19 readiness. The tele-ICAR is estimated to be 30 to 60 minutes in length.

All nursing homes should prepare their facilities by implementing the following five priorities.

  • Keep COVID-19 from entering your facility:
    • Restrict all visitors except for compassionate care situations (for example, end of life).
    • Restrict all volunteers and nonessential health care personnel (HCP), including consultant services (for example, barber).
    • Actively screen all HCP for fever and respiratory symptoms before starting each shift; send them home if they are ill.
    • Cancel all field trips outside of the facility.
    • Have residents who must regularly leave the facility for medically necessary purposes (for example, residents receiving hemodialysis) wear a face mask whenever they leave their room, including for procedures outside of the facility.
  • Identify infections early:
    • Actively screen all residents at least daily for fever and respiratory symptoms; immediately isolate anyone who is symptomatic. Long-term care residents with COVID-19 may not show typical symptoms, such as fever or respiratory symptoms. Atypical symptoms may include new or worsening malaise, new dizziness, diarrhea, or sore throat. Identification of these symptoms should prompt isolation and further evaluation for COVID-19 if it is circulating in the community.
    • Notify the health department if severe respiratory infection, clusters (≥3 residents and/or HCP) of respiratory infection, or individuals with known or suspected COVID-19 are identified.
  • Prevent spread of COVID-19:
    • Cancel all group activities and communal dining.
    • Enforce social distancing among residents.
    • When COVID-19 is reported in the community, implement universal face mask use by all HCP (source control) when they enter the facility. If face masks are in short supply, they should be prioritized for direct care personnel. All HCP should be reminded to practice social distancing when in break rooms or common areas.
    • If COVID-19 is identified in the facility, restrict all residents to their room and have HCP wear all recommended PPE for all resident care, regardless of the presence of symptoms. Refer to strategies for optimizing PPE when shortages exist.
      • This approach is recommended to account for residents who are infected but not manifesting symptoms. Recent experience suggests that a substantial proportion of long-term care residents with COVID-19 do not demonstrate symptoms.
      • When a case is identified, public health can help inform decisions about testing asymptomatic residents on the unit and in the facility.
  • Assess supply of personal protective equipment (PPE) and initiate measures to optimize current supply. For example, extended use of face masks and eye protection or prioritization of gowns for certain resident care activities.
  • Identify and manage severe illness. Facility to perform appropriate monitoring of ill residents (including documentation of pulse oximetry) at least three times daily to quickly identify residents who require transfer to a higher level of care.
Suspension of On-Site Home and Community-Based Settings Rule Compliance Assessments

The Wisconsin Department of Health Services (DHS) has suspended on-site home and community-based settings rule compliance assessments until further notice. DHS has implemented significant social distancing measures in response to the rising number of COVID-19 cases in Wisconsin, and this measure is to protect against widespread community transmission.

This temporary change applies to both heightened scrutiny and nonresidential settings.

DHS reviewers will continue to review documents submitted by providers as part of this process. Reviewers may be contacting providers for additional information during this time.

 Outdoor Visitation Guidance for Nursing Homes

The safest approach to prevent COVID-19 exposure to nursing home residents and staff is to not conduct indoor or outdoor visitation. However, if an organization wishes to proceed with outdoor visitation, recommendations for safer outdoor visits are listed below. Nursing homes may choose to wait longer before implementing outdoor visitation. Because the pandemic is affecting communities in different ways, facilities should use their best clinical judgment, regularly monitor the factors for outdoor visitation, work with local and tribal public health departments, and adjust their plans accordingly. 

The Wisconsin Department of Health Services (DHS) recognizes that the effects of isolation can have serious impact on the health and well-being of residents in nursing homes. This guidance contains recommendations that we strongly encourage nursing homes to follow and implement. To prevent outbreaks of COVID-19 in nursing homes, the Centers for Medicare & Medicaid Services (CMS) provided direction related to restricting visitation. See CMS QSO-20-14-NH.

Facility criteria

  • Establish a schedule for visitation hours. Facilities should work with prospective visitors individually to schedule an appointment to visit a resident, and should discuss in advance the length of the appointment. 
  • Have adequate staff present to allow for help with outdoor transition of residents, and to assist with cleaning and disinfecting any visitation areas as necessary. 
  • Clean and disinfect the visitation area, including tables, chairs, and other shared surfaces between visits.  
  • Clearly communicate and supervise each visit to ensure the use of face masks or cloth face coverings by visitors, and social distancing of 6 feet between residents and all visitors. 
  • Staff should maintain visual observation but provide as much distance as necessary to allow for privacy of the visit conversation. 
  • Have a system to ensure all visitors are prescreened for fever and any other symptoms of COVID-19 not more than 24 hours in advance. Ill visitors must not visit.
  • Have a system to screen visitors on arrival for fever and any other symptoms of COVID-19 at a screening location designated outside the building, and exclude those with these symptoms from visiting.
  • Have a system to ensure residents and visitors wear a face mask or other cloth face covering at all times, as tolerated.   
  • Outdoor visitation may take place under a canopy or tent with not more than two walls.
  • Outdoor visitation spaces must be designed to be accessible without visitors having to walk through the facility. 
  • Outdoor visitation spaces must ensure that a minimum distancing of at least 6 feet between the visitors and resident is achievable in the outdoor space when determining the maximum number of residents and visitors who can simultaneously occupy the outdoor space.  
  • Provide alcohol-based hand sanitizer to people visiting residents and provide signage and verbal reminders of correct use. 
  • Establish additional guidelines as needed and as determined by the facility to ensure the safety of visitations and their facility operations. These guidelines must be reasonable and must take into account the individual needs and wishes of residents. 

Resident criteria

  • Current COVID-19 positive residents, residents with COVID-19 signs or symptoms, and residents in a 14-day quarantine or observation period due to their admission or re-admission status are not eligible for outside visits. 
  • Residents who have had COVID-19 must no longer require transmission-based precautions as outlined by the CDC and DHS guidelines to be eligible for outside visits.
  • Residents must wear a mask (or other face covering to prevent spread of respiratory secretions when they are talking, sneezing, or coughing) at all times, as tolerated.

Visitor criteria

  • Visitors must wear a mask (or other face covering to prevent spread of respiratory secretions when they are talking, sneezing, or coughing) during the entire visit unless they are unable to do so for medical reasons. 
  • Visitors must use alcohol-based hand sanitizer upon entering and exiting the visitation area. 
  • Visitors must be prescreened and actively screened for fever and any other symptoms of COVID-19, and must attest to COVID-19 status if known. This should be done during prescreening and again upon arrival at a designated location outside the building. Any individual with symptoms of COVID-19 should be excluded from visitation.  
  • Any gifts or packages for the resident should be dropped off with staff to give to the resident.  
  • Visitors should not walk through the facility to get to the outdoor visitation area. 
  • Visitors must sign in and provide contact information. 
  • Due to the risk of exposure, holding hands, hugging, kissing, or other physical contact is not allowed during family visits. Physical distancing of 6 feet must be maintained for the duration of the visit. 
    • Visitors under age 12 years must be in the control of adults who bring them and must also comply with physical distancing requirements. Visitors under age 12 years must wear a mask.  
  • Pets must be under the control of the visitor bringing them. 
  • Visitors must stay in designated visitation locations. 

Weather

Visits should occur only on days when there are no weather warnings that would put either the visitor or resident at risk.


Facilities that meet the criteria above and elect to permit outdoor visits must make this option available to all residents unless they believe:

  1. Circumstances pose a risk of transmitting COVID-19 to the facility because the resident or visitor does not comply with infection prevention and control guidance, or 
  2. The resident or visitor is at risk of abuse/harm. 

Residents and their loved ones may contact providers with questions about outdoor visits. Facilities should ensure residents, and their loved ones, have access to the Ombudsman Program at the Board on Aging and Long Term Care at 1-800-815-0015.

 Safer Visits in Assisted Living Facilities

Purpose

To provide guidance to assisted living facilities regarding safer visits to residents during COVID-19. This guidance is intended for facilities with no known or suspected COVID-19 cases. The guidance includes preventative measures to reduce the chances of the introduction of COVID-19 into the facility, while mitigating the unintentional consequences of social isolation from family and loved ones. For purposes of this document, facilities include community-based residential facilities, licensed adult family homes, and residential care apartment complexes.

Rationale

COVID-19 is a serious viral infection and based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19 (HHS, 2020). This increases the need for vigilance in avoiding the introduction and transmission of COVID-19 into congregate living settings, such as assisted living facilities. 

Safe visiting practices are already in place in assisted living facilities but are designated for “compassionate care situations” such as end-of-life visits. Recommended infection prevention and control practices can provide an opportunity for expanded visitation for residents, specific to their person-centered plan, while maintaining the goal of avoiding introduction and/or transmission of COVID-19 to our most vulnerable citizens.

Guiding Principles

This guidance is intended for assisted living facilities that are able to develop and implement a Safer Visiting Policy, that includes effective infection prevention and control measures and addresses the psychosocial needs of the resident. Facilities’ practices must be consistent with current CDC and local/tribal public health departments. (See Key Strategies to Prepare for COVID-19 in Long-Term Care Facilities (LTCFs); CDC Assisted Living Guidance; contact for local health departments.)

Physical distancing and use of cloth face coverings have proven to be a significant infection prevention and control practice to prevent the spread of COVID-19. These can be accomplished by providing a 6-foot distance or other barriers between individuals, and ensuring that all individuals wear either a face mask or cloth face covering.

However, there are valid concerns that may prevent an individual from wearing one safely. Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the covering without assistance. Medical considerations, including respiratory conditions, as well as traumatic personal experiences, mean some individuals are not able to wear a face covering safely. Wearing a cloth face covering may be dangerous or stressful for individuals with disabilities and young children. Individuals may also fear racial profiling or discrimination based on wearing—or not wearing—a face covering. Access to clean, multiple, or appropriate face coverings may also be a barrier. 

Similarly, facilities should consider the unique needs of people who are hard of hearing when developing and implementing policies to adopt the use of cloth face coverings. 

Screening of visitors and staff have shown to provide an early detection and surveillance method to impede the spread of COVID–19 in assisted living facilities. This screening allows for the prohibition of individuals entering assisted living facilities with even minor changes in health status.

Education of residents and families is important to ensure all parties understand the need to follow infection prevention and control practices. Education should include: 

  • Information about COVID-19. Information about the disease, how to protect yourself, and to learn about transmission in the community can be found at the DHS COVID-19 website.
  • Actions the assisted living facility is taking to protect all residents and all who enter the facility, including visitor restrictions.
  • Actions residents and visitors can take to protect themselves emphasizing the importance of social distancing, hand hygiene, respiratory hygiene and cough etiquette, and wearing a facemask or cloth face covering.
Recommendations for Safer Visits
  1. Each facility should develop a procedure that takes into consideration the recommendations for infection prevention and control measures and management of safer visits, as desired or needed by residents. 
  2. Assisted living facilities should develop policies on visitation based on the following considerations: 
    • Expressed or observed desires and needs of the individual resident for whom visits are being considered.
    • Current CDC guidance, local/tribal public health requirements and based on care team review.
    • Safe visits are listed in a hierarchy of most safe visits to least safe visits as follows:
      • Virtual visits, such as Skype, Zoom, etc.
      • Outside visits, maintaining physical distancing and face covering. If inclement weather is present, the outside visit should be rescheduled rather than moving the visit into the facility.
      • Inside visits if dedicated room is available and only if the resident is unable to visit virtually or by an outside visit. 
      • Resident room visits if the resident has single room and only if the resident is unable to visit in any of the above-noted ways.
  3. Care team (as required under applicable regulations that must include the resident or resident’s surrogate decision maker) determines the safest type of visit based on resident’s need and/or desire.
  4. Assisted living facilities should provide educational information about COVID-19, such as CDC’s How to Protect Yourself & Others, to potential visitors and residents.
    • Make sure the signs use plain language and imagery to convey their messages. Provide signs in English, Spanish, and other languages your residents, their families, and those in the community primarily speak. 
  5. Infection prevention and control measures should include: 
    • Screening prior to visitation for any COVID-19 symptoms.
      • CDC guidance for COVID -19 symptoms according to current federal, state, or local public health guidelines. 
      • Implement active screening of visitors for fever and respiratory symptoms. Actively take their temperature and document the presence of a fever and respiratory symptoms including: new or worsening cough, unexplained muscle weakness or pain, and sore throat.
      • If screening discovers signs and symptoms for fever and respiratory infection, visitation should be cancelled. The visitor should self-isolate at home and inform their medical provider.
    • Limit the distance a visitor travels in the assisted living facility. This may be accomplished by:
      • Having a separate visiting room close to the entrance that is disinfected between each visit.
      • Developing paths that avoid walking through care areas.
      • Asking visitors to avoid interacting with anyone other than the resident they are visiting.
    • Ensure physical distancing between the visitor and resident by designating a 6-foot distance, such as using plexiglas barriers, outdoor visits with 6-foot distance, placing taping or signage to identify 6-foot clearances. Consider environmental changes such as hard surface furniture with 6-foot spacing and removing all extraneous items such as magazines and books from visiting areas. 
    • Ensure visitor and resident complete frequent hand hygiene by using hand sanitizer with at least 60% alcohol before, during, and after their visit.
    • Ensure visitor and resident are using source control measures such as cloth face covering or face mask for the entire visit, even if social distancing. Ensure visitor and resident use cloth face coverings and/or PPE as required per facility policy and resident need.
    • Between each visit, the visitation area must be disinfected according to current guidelines.
  6. Administrative controls to monitor compliance and provide instruction:
    • The assisted living facility should continually review its visitation policy based on local transmission of COVID-19 and adjust as needed to ensure maximum protection for residents. This includes temporarily stopping all inside visitation when a COVID-19 case is identified in a staff member or resident. 
    • Consider prescribing date and time limitations on the number of visitors in the setting at any one time, limit the number of visitors per resident and limit length of the visit. 
    • The visits should occur at scheduled times when there are adequately trained staff available to provide education on COVID-19 mitigation procedures and facility expectations. 
    • The length of visits should be established by the assisted living facility policy to ensure continuous compliance with infection prevention and control procedures. 
    • The facility should develop and implement an ongoing self-monitoring system to ensure staff, residents, and visitors are complying with all procedures for safer visitations. 
    • The facility should revise visitation plans based on resident responses, the facility’s data, the facility’s and the local community’s COVID-19 status, and current local, state and federal guidelines.
  7. Visitor and resident education shall be conducted prior to each visit and include: 
    • Facility’s procedure for visitation. 
    • Screening process for COVID-19 symptoms per CDC guidelines
    • Education to self-monitor after the visit for 14 days and report any symptoms of illness to the assisted living facility immediately as well as notifying their Medical Provider, if they have one, and local/tribal Public Health Department. 
    • Reminder that subsequent visits must be pre-arranged and will not occur if the setting experiences any incidence of COVID-19.

Assisted living facilities will need to determine whether they can follow these guidelines to ensure they can provide safer visitations. Due to PPE availability, staffing patterns, and facility lay-out and/or location, every facility may not be able to meet the guidance requirements necessary to offer all of the safer visit options, nor will the options available at each facility necessarily be available at all times.

References

 New Admissions, Transfers, and Discharges

CMS’ Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes provides the following guidance about new admissions:

When should a nursing home accept a resident who was diagnosed with COVID-19 from a hospital?

  • A nursing home can accept a resident diagnosed with COVID-19 as long as the facility can follow CDC guidance for transmission-based precautions. If a nursing home cannot, it must wait until these precautions are discontinued. CDC has released Interim Guidance for Discontinuing Transmission-Based Precautions or In-Home Isolation for Persons with Laboratory-confirmed COVID-19.
  • Information on the duration of infectivity is limited, and the interim guidance has been developed with available information from similar coronaviruses. CDC states that decisions to discontinue transmission-based precautions in hospitals will be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. Discontinuation will be based on multiple factors (see current CDC guidance for further details).

Note: Nursing homes 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. Also, if possible, dedicate a unit or wing exclusively for any residents coming or returning from the hospital. This can serve as a step-down unit where they remain for 14 days with no symptoms (instead of integrating as usual on short-term rehab floor, or returning to long-stay original room).  
 
Discharge
If the resident has to be discharged and has been exposed, the resident requires a 14-day quarantine. Therefore, you must inform the facility that is accepting the resident. If the facility is unable to meet transmission-based precautions for those 14 days, then the resident cannot be transferred.

 Testing Criteria

Wisconsin Nursing Home and ICF/IID Testing Opportunity

In appreciation and support of the challenging work that nursing home and ICF/IID staff do every day to protect some of our most vulnerable individuals, Wisconsin is moving forward with a plan to test every nursing home resident and staff member in the state for COVID-19 by the end of May. This testing is necessary because growing evidence suggests that persons with COVID-19 become infectious days prior to developing symptoms, and many develop only mild symptoms or no symptoms at all. This means that in congregate living settings like nursing homes where physical distancing is difficult to maintain, moving beyond only symptom-based screening is unlikely to detect all cases. In order to accomplish this goal, please reference the following:

If you have questions about the nursing home and ICF/IID testing process, please email WI COVID-19 SNF Testing.

Retesting Staff and Residents—Guidance for COVID-19 Retesting Following an Initial Point Prevalence Survey (PPS)

Many nursing homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) have completed a Point Prevalence Survey (PPS) to test all residents and staff for COVID-19 using molecular assay testing. A PPS establishes a baseline of infection prevalence in a population and is used by facilities to appropriately isolate/cohort positive residents, restrict positive staff from work, and inform contact investigations so that quarantine instructions can be given to people who have been in close contact with infected cases. A PPS should include testing of all residents and all staff, including both direct care staff and support staff. 

Testing only provides information for a given point in time, and residents and staff with negative test results can become infected in the future. Following an initial PPS, nursing homes and ICF/IIDs should implement a plan for retesting as a way to continue to identify infections early and limit infection spread.

Retesting Staff and Residents

A facility’s plan for regular retesting of staff and residents should be based on the results of its initial PPS, and with awareness of the level of COVID-19 transmission in the surrounding community, per the following guidelines:

If the initial PPS does not identify any positive staff or residents, the facility should:

  • Retest all staff on a regular basis, at a minimum every two weeks. Staff are one of the most likely sources to introduce infection into a facility; regular staff retesting helps to continue to identify infections early.
  • Retest those residents who leave and return to the facility (for example, hospital transfers, dialysis patients, etc.). These residents are at a higher risk for coming into contact with COVID-19 and introducing infection into the facility.  
  • Test residents when they are admitted or transfer into the facility. 
  • Retest all residents on a regular basis (such as every 14 days) if testing capacity allows, especially when visitor restrictions are relaxed. However, facilities should prioritize regular retesting of staff ahead of regular retesting of residents.   

If the initial PPS identifies positive staff or residents, the facility should:

  • Exclude positive staff from work and use symptom-based, time-based, or test-based return to work strategies.
  • Collaborate with the local public health agency to conduct a contact investigation to identify all people who were in close contact with confirmed cases within the facility and in the community.
  • Retest all staff on a regular basis, preferably every 7 days in accordance with CMS guidance.
  • Retest all residents on a regular basis in accordance with CMS guidance if testing capacity allows.
    • At a minimum, after 7 days, retest those residents within the units on which positive staff worked in the prior 14 days and/or within the units on which other residents tested positive. Continue to retest those residents every 7 days until no additional positive residents are identified. 
  • When a positive case is identified, facilities should implement transmission-based precautions, which includes the use of the following PPE:
    • Gown
    • Gloves
    • Mask (respirator if involved in aerosol generating procedure)
    • Eye protection (face shield/goggles)

Retesting Symptomatic Residents or Staff

As soon as possible, facilities should test any resident or staff member who develops symptoms of COVID-19. The CDC’s website lists symptoms of COVID-19. If a resident or staff member develops symptoms, the facility should: 

  • Follow the above guidelines for retesting those residents within the units on which a symptomatic staff member worked and/or within the units on which a resident was symptomatic.    
  • Continue to retest all staff on a regular basis, preferably every 7 days in accordance with CMS guidance.

Retesting Positive Residents and Positive Staff

A facility should retest positive residents and positive staff if the facility is using a test-based strategy to inform release from isolation or return to work. A test-based strategy is likely to be the safest approach and is recommended if local resources allow. A symptom-based strategy (i.e. discontinue isolation if symptoms have resolved for 72 hours and 10 or more days have elapsed from the day of symptom onset) is acceptable if testing resources are limited.

Other Long-Term Care Facilities

To enhance surveillance and quickly identify residents who may be infected with COVID-19, DHS is requesting that long-term care facilities who meet the definition of an outbreak collect clinical specimens from ill residents and send them to the Wisconsin State Laboratory of Hygiene (WSLH) instead sending them to private laboratories. Up to three (3) specimens will be tested for: influenza, a respiratory virus panel, and COVID-19 free of charge.

Follow these procedures to submit specimens:

  1. Notify your local public health department when a respiratory outbreak is suspected.
  2. Collect up to three nasopharyngeal (NP) or oropharyngeal (OP) swabs in viral transport media (VTM) or universal transport media (UTM).

Wisconsin State Laboratory of Hygiene
2601 Agriculture Drive
Madison, WI 53718

See the Testing Criteria for Patients Under Investigation section on the DHS Health Care Providers page.

 Planning for Staffing Shortages

Maintaining appropriate staffing in healthcare facilities is essential to providing a safe work environment for healthcare staff and safe resident care. As the coronavirus disease 2019 (COVID-19) pandemic progresses, staffing shortages will likely occur due to healthcare staff exposures, illness, or need to care for family members at home. Nursing homes and assisted living facilities must be prepared for potential staffing shortages and have plans and processes in place to mitigate these, including communicating with staff about actions the facility is taking to address shortages and maintain resident and staff safety and providing resources to assist staff with anxiety and stress. Nursing homes and assisted living facilities can take steps to assess and improve their preparedness for responding to COVID-19.

Plan

The plan should include, at a minimum, surge capacity related to staffing as follows:

  • Developing a contingency staffing plan that identifies the minimum staffing needs and prioritizes critical and non-essential services based on residents’ health status, functional limitations, disabilities, and essential facility operations.
  • Assigning a person to conduct a daily assessment of staffing status and needs during a COVID-19 outbreak.
  • Contracting with staffing agencies, local hospitals, clinics, and health insurance companies to fill professional and nonprofessional roles.  
  • Exploring all state-specific emergency waivers or changes to licensure requirements or renewals that may allow for staffing flexibility.

Resource: CDC facility preparedness checklist

Strategies to Mitigate Staffing Shortages

As an organization deviates from their standard recruitment, hiring, and training practices, there may be higher risks to the staff and residents. Nursing homes and assisted living facilities should carefully review their emergency plans and cautiously move from one staffing strategy to the next, balancing risk and benefits with each decision.  

Consider implementing strategies to mitigate staffing shortages including the following:

  • Over-communicate with staff. Staff need to know what is happening and what to expect.  
  • Understand your staffing needs and the minimum number of staff needed to provide a safe work environment and resident care.
  • Communicate with local healthcare coalitions; federal, state, and local public health partners; and Wisconsin Healthcare Readiness Coalition (HERC) to identify additional local staff.
  • Make sure all staff are working to their full scope of licensure.
  • Work with staffing agencies to bring in temporary staff.
  • Hire additional staff by recruiting retired staff, students, or volunteers when applicable.
  • Cross-train staff so that they are able to work in multiple roles.
  • Adjust staff schedules.
    • Create flexible schedules with 4-, 8-, 10-, or 12-hour shifts.
    • Vary shifts depending on responsibilities. For example, shorter shifts could be set aside for duties such as performing assessments or dispensing medications, while longer shifts could be used for cleaning and disinfecting the facility. 
  • Address barriers and social factors that might prevent staff from working. Examples include:
    • Transportation—Provide ride service to and from work. Provide a rental vehicle. Provide zero or low interest loans to purchase a used vehicle.
    • Housing—Provide temporary housing to staff who live with vulnerable individuals. This could be a hotel, local dormitories that are not being utilized, recreational vehicles (RVs) on the premises, or a live-in model in unoccupied wings of the facility.
    • Mental well-being—Provide resources to ensure individuals are able to cope with working in nursing homes and assisted living facilities during a pandemic. This may include counseling, online resources such as COVID-19: Resilient Wisconsin, or other resources for coping with stress.
    • Compensation—Consider providing additional pay for working in a COVID unit or in a COVID-positive facility (for example, increasing hourly pay for every hour worked during the pandemic or providing a bonus for staff that work during the pandemic). Consider paying staff who may need to be quarantined following an exposure at work.
    • Recognition—Find non-monetary ways to recognize staff for their efforts and boost morale.
    • Provide uniforms that can be left at work.
    • Provide meals and snacks to staff.
  • For nursing homes and assisted living facilities with multiple facilities or that are part of health systems, consider redeploying staff to the areas with the most critical needs. Facilities will need to ensure these staff have received appropriate orientation and training to work in these areas that are new to them.

If other options listed above are exhausted, explore 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. 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.

Resources:

Regulations and Memorandums of Understanding (MOUs)

Review current regulations related to emergency preparedness and MOU templates to establish a mutual understanding of how and to what extent organizations will respond to and support each other during an emergency or pandemic. Current resources include:

Additional Resources

Questions

For questions regarding this information or for technical assistance, nursing home providers should contact The Division of Quality Assurance (DQA), Bureau of Nursing Home Resident Care (BNHRC) regional offices. Assisted living facilities should contact Bureau of Assisted Living (BAL) regional offices.

 Return to Work Guidance for Asymptomatic Health Care Workers who Tested Positive for COVID-19

Purpose: To provide additional information and guidance regarding CDC’s healthcare worker crisis staffing plan for long-term care facilities (LTCFs), specifically around the recommendation to let asymptomatic, COVID positive healthcare workers return to work before finishing the recommended isolation. This guidance describes the steps that must be taken prior to implementing this practice and precautions that must be in place within the facility prior to allowing asymptomatic positive staff to return to work.

  1. Education, planning and communication are key components necessary for continued successful LTCF operations during a COVID -19 outbreak. 
    • Utilizing CDC and DHS COVID-19 resources, develop educational communications for internal and external use. This involves frequent communication with residents, families, staff and legal representatives on COVID-19 and the facility’s plan to manage COVID-19.
    • Prior to any COVID-19 positive residents or staff being identified in the facility or any facility-wide COVID testing, LTCFs should be reviewing and revising their emergency staffing plans to ensure adequate staffing in the event positive staff are identified.
    • Facilities should also identify how the facility can establish a COVID-19 unit within their facility and how that would impact their staffing plan.
  2. When COVID-19 positive staff 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 DHS and CDC for discontinuation of isolation. Making exceptions to this recommended practice will increase the risk of COVID-19 to residents of long-term care facilities, but may be necessary in a crisis situation.
  3. As COVID-19 positive staff are identified and additional staffing resources need to be found, the facility should work through their emergency staffing plan, as well as the crisis staffing plan outlined above. The facility should work with DQA through the rapid assistance and support team process (RAST).
  4. *After exhausting all other opportunities the facility would submit a variance request to DQA to utilize asymptomatic COVID-19 positive staff. As soon as the facility feels they have exhausted all resources described above in the DQA crisis staffing plan and still does not have adequate  staff to provide the care, treatment and services to the residents, they should submit a variance request to their DQA regional office.
    • The variance request should include the code reference (SNF, DHS 132.42(4), CBRF, DHS 83.17(2)c, AFH, DHS 88.03(2)g(2) and all steps the provider has taken prior to arriving at this phase. 
    • Upon receipt of the variance request, the DQA regional office will consult with the LHD, DPH, and Bureau/Deputy Director. If the requests contains sufficient information the request will be approved for a limited time period with reporting to the DQA regional office. DQA regional office will share reporting with LHD and DHS. The following criteria should be met if this is allowed.
      • Asymptomatic COVID-19 positive staff would only be allowed to work on the COVID-19 unit. There needs to be a separate entrance and break area for staff. To prevent transmission between staff, only asymptomatic COVID-19 positive staff should be working on this wing once it is allowed, and should not leave the unit for any reason.
      • The facility should have enough of the proper personal protective equipment to prevent transmission of the virus, including facemask, gowns, gloves, and face shields.
      • Facemasks must be worn by asymptomatic COVID-19 positive staff at all times including as they walk in the building and other non-patient care areas in the facility.
      • Strict symptom monitoring (prior to and during their shift) of these staff needs to be implemented. If they develop even mild symptoms consistent with COVID-19 including fever, chills, cough, shortness of breath, fatigue, muscle/body aches, headache, new loss of taste or smell, sore throat, congestion or running nose, nausea, vomiting, or diarrhea the employee should immediately be excluded from work.
         
  5. Facility representatives should meet daily with their LHD to assess current staffing levels to determine when allowing asymptomatic COVID staff to return to work prior to completion of isolation should be discontinued.

*If any agency (DQA, DPH, LHD) is made aware of a facility that is allowing asymptomatic positive COVID staff to return to work prior to completion of isolation without having gone through the approval process, a meeting should be scheduled to obtain approval ASAP.

Resources

 Memory Care Individuals

The strategies used to “flatten the curve” and limit the spread of COVID-19 are especially difficult for memory care individuals. Due to their decreased cognitive ability, residents in memory care will require additional assistance adhering to quarantine and isolation. In particular, residents in memory care may have an impaired ability to follow or remember instructions regarding:

  • 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
General Guidance

Everyone living with a dementia will respond to this situation differently. Be prepared to try a variety of approaches to help residents feel safe and reassured and to comply with best practice guidelines related to COVID-19. Residents in memory care are at an increased risk for agitation, frustration, and even “catastrophic” reactions during a crisis situation as they are less able to negotiate changes in their environment. Therefore, it is highly recommended that any changes in routine, environment, and daily structure for residents in memory care be kept to a minimum. If agitation or aggression occurs, respond by using standard calming techniques, such as distract and redirect, play personalized music, taking the person for a walk outside, or ask the person to complete a favorite task.

If residents express concern about the pandemic, memory care staff should:

  • Provide simple, truthful answers to their questions, explaining that everyone is doing all they can to help.
  • Break down required tasks and guide residents step-by-step through the process.
  • Prompt with words or pictures.
  • Encourage and cultivate a sense of accomplishment.

Inability to follow quarantine or isolation. If memory care residents are unable to follow quarantine or isolation measures, caregivers should redirect their attention to an appropriate activity.

Adherence to Infection Control Procedures

It is difficult for people in memory care to cooperate with prevention measures, such as instructions not to touch their eyes, nose, and mouth. Therefore, staff may need to provide memory care residents with additional support and closer supervision to ensure infection control procedures are followed.

Hand Hygiene (includes use of alcohol-based hand rub or handwashing). People living in memory care facilities may require extra supervision and support to perform appropriate hand hygiene.

  • Place residents on a supervised “hand hygiene schedule.” Have staff stand with the resident and wash their own hands to provide encouragement. Staff can also give demonstrations of thorough handwashing techniques.
  • Put dementia-friendly instructional signs with pictures on the bathroom window or wall reminding everyone to wash their hands with soap for 20 seconds.
  • Encourage residents to sing a song to remind them to wash their hands for at least 20 seconds.
  • If the resident is unable to complete handwashing to this extent on their own or with prompting, wear gloves and use soap and a washcloth to perform this task for the person.
  • Use an alcohol-based hand sanitizer if there is concern that good hygiene is not being practiced, or if staff or the memory care resident cannot get to a sink to wash their hands. Alcohol-based hand rub is the preferred method of hand hygiene when indicated. Handwashing with soap and water is indicated when hands are visibly dirty and after using the toilet.
  • Be sure to use moisturizer on clean hands after repeated washing to ensure they do not get dry and irritated.

Refrain from touching face

  • Ensure the skin on the resident’s face is clean and moisturized, not dry and irritated.
  • Ensure eyeglasses are clean and comfortable.
  • Ensure men are shaven, if they shave regularly.
  • Ensure there are no sores or other causes of pain within the mouth, and that regular oral hygiene is completed.
  • Ensure lips are adequately hydrated, and not chapped or dry.
Keeping Individuals in Particular Areas

Wandering can cause residents in memory care to leave a safe environment. The risk for wandering increases when residents become upset, agitated, or face stressful situations.

  • Provide residents with safe spaces to wander. Consider placing familiar items around residents who wander to reduce any anxiety caused by unfamiliar environments.
  • Use visual prompts to remind residents of restricted access.
  • Secure the perimeter of unsafe areas with security personnel or other security systems.
  • Provide distraction through supervised and structured daily activities, including some form of daily exercise, such as individual walks outside with staff members.
Communication

Memory care residents may possess a limited ability to understand the information they are receiving about COVID-19, which could lead to a range of responses, including fear and anxiety.

  • For those who are aware of what is going on and concerned about it, provide information from authoritative sources (such as the Department of Health Services or the CDC). Take the time to listen to the person and their concerns, validate their feelings, and provide reassurance.
  • Consider minimizing the flow of media information by turning off the 24-hour news cycle on TV in shared areas. Ask news watchers to do so in their rooms.
  • Staff should not discuss their own anxieties and opinions in front of residents.
Restricting Unnecessary Visitors

It is essential to follow CMS guidance restricting visitation except for certain compassionate care situations, such as end-of-life. Any visitors that enter facilities in such situations should be required to perform hand hygiene and use personal protective equipment. Anyone exhibiting symptoms of a respiratory infection should not be permitted to enter a facility at any time, even in end-of-life situations.

Staying Connected
  • The use of available technology, such as online and smartphone options, to facilitate family interactions is encouraged. Instead of visiting in person, families can schedule a telephone call to keep connected and/or leave notes for the resident to read along with photos. It is important for facilities to ensure that adaptive devices are available to the resident where necessary, for example, hearing aids and eyeglasses.
  • Consider creating a buddy system between residents or between residents and staff to strengthen support networks.

 1-2 Bed Adult Family Homes and Supported Living Apartments

This guidance applies to providers of 1-2 bed adult family homes (AFH) and their residents, as well as supported living apartments and their household members. The guidance also applies to the staff (live-in and periodic) who work there.  

The purpose of this guidance is to provide the best information currently available to help providers prevent the spread of COVID-19 and additional guidance for responding to a suspected, probable, or confirmed case of COVID-19 in your home or facility. One and two-bed AFHs and supportive apartments should follow all appropriate provisions in the following sections on this page:

  • Visitors to Facilities
  • Guidance for all Facilities
  • Resources
Prevention strategies include:  

Preparedness

  • Assure residents, household members and staff have access to adequate supplies of soap, paper towels, tissues, hand sanitizers, cleaning supplies, and garbage bags and a supply of disposable gloves and face masks or face coverings.
  • Follow DHS guidance regarding the appropriate use of personal protective equipment (PPE), and consider strategies to best conserve PPE, when it is available.
  • Place alcohol-based hand sanitizer and trash containers throughout the home. Make sure tissues are available and any sink is well-stocked with soap and paper towels for handwashing.  
  • Monitor the temperatures of residents and staff and check for signs and symptoms of COVID-19 each day when individuals come into the home. 
  • Anyone who has a fever of 100.4 or above, or other signs of illness, should notify their physician. 
  • Notify your local public health department if a resident, household member or staff is suspected of having COVID-19. 
  • Ensure there is a backup plan if staff members become ill. 
  • Ask staff who become ill at work to immediately stop work, put on a face mask, and go home and self-isolate. 
  • Identify space within the home or apartment where a resident or household member may be isolated. If the home has more than one bathroom, be prepared to limit the use of one bathroom to anyone in the household who becomes ill.
  • Put communication plans in place with family members and legal guardians to ensure transparency and understanding of new safety protocols, including timely communication about new COVID-19 cases involving residents or staff. Communication with residents, families and/or guardians should be proactive and clearly explain the reasons for any changes to normal practices.
  • Identify methods of support for those residents who may require specialized understanding or who are likely to experience increased emotional or behavioral impact.

Infection Prevention and Control

Post signs and fact sheets. Social stories and visual task lists may be helpful for some individuals. See infographics and print materials.

  • Coronavirus disease
  • Please do not visit
  • Wash your hands!
  • Tips for staying safe
  • How to make a face cloth covering 
  • How to protect yourself
  • And more

Cleaning and Disinfecting Your Facility

  • Routinely, during the day, clean and disinfect surfaces and objects that are frequently touched in common areas (e.g., door handles, faucets, toilet handles, light switches, handrails, countertops, chairs, tables, remote controls, and shared electronic equipment).
  • Use all cleaning and disinfection products according to the directions on the label. 

Hygiene

  • You can spread COVID-19 to others even if you do not feel sick, so you should follow these hygiene practices.
  • Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • CDC recommends wearing cloth face coverings in public settings where it is difficult to stay 6 feet away from others. Some people cannot wear a cloth face covering safely. Others with sensory or other disabilities may not be able to comply.  Cloth face coverings should not be placed on children under age 2, anyone who has trouble breathing, or anyone who is unable to remove the covering without assistance. In addition to medical considerations, individuals may fear racial profiling or discrimination based on wearing—or not wearing—a face covering. Businesses requiring cloth face coverings should allow for exceptions based on health and safety concerns of individuals. Accommodations due to disability should be made when appropriate. This does not apply when household roommates are together or for owners and residents in an owner-occupied AFH. 
  • Cover coughs and sneezes with your elbow, even if wearing a cloth face covering. 

Going out into the community

  • Discourage nonessential outings into the community. 
  • Every effort should be made to allow an individual to maintain their paid employment.
  • Follow WEDC guidance for outdoor gatherings.
  • Train residents if possible to follow appropriate social distancing and hygiene routines if they leave the home for work, day programs, or if they use public transportation. Follow specific guidance for Wisconsin businesses and transportation
  • Follow these recommendations for all outings into the community
    • Everyone should wear a cloth face covering when they have to go out in public, for example, to the grocery store or to pick up other necessities.
      • Staff should strongly encourage residents to comply with social distancing (i.e., remaining at least 6 feet part). This does not apply to household roommates who are living together.
      • The cloth face covering is not a substitute for social distancing.
      • The number of staff who support individuals who require personal cares, job coaching or other supports that don’t allow for social distancing should be limited.
      • The ability of someone to comply with wearing a mask should not mean they cannot interact with the community. Every effort should be made to ensure all residents are able to get outside, see family and friends while engaging in social distancing when possible, and engage in safe activities outside of the home that do not involve direct contact with the public. 
    • More information can be found at CDC Website: 
With suspected, probable, or confirmed case of COVID-19 follow these additional recommendations:  
  • Continue to follow all the recommendation above including monitoring family/residents/household members (member) and anyone entering the home for symptoms of COVID-19, including fever, cough, or shortness of breath. 
  • If you are concerned that you or a household member may have COVID-19, you may call your doctor or visit Wisconsin Health Connect, an online screening tool that can connect you with clinicians who can answer your care questions. More information can be found on the DHS website.

If an individual is suspected of, or has been confirmed to have COVID-19, follow these steps: 

  • Isolate the individual immediately.
  • Establish contact with the individual’s primary care physician and plan for check-ins as necessary, including through telehealth. 
  • Notify the local public health department.
  • Limit any visitors to the home to only those who are essential. 
  • Ensure regular communication with family, legal guardian, and care team about the individual’s health status. 
  • Educate all household members and any essential visitors about COVID-19 and the risks.  
  • Individuals with known or suspected COVID-19 should stay in one room, away from other people, including staff, as much as possible. 
  • Obtain testing for staff and residents when appropriate and applicable. 
  • If the individual requires personal cares, limit the specific staff who support that person and ensure use of appropriate PPE at all times. Establish strategies to conserve the use of PPE.
  • If possible, have the sick person use a separate bathroom. If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by the sick person. 
  • Closely monitor roommates and other residents who may have been exposed to an individual with COVID-19 and, if possible, avoid placing unexposed residents into a shared space with them. Support both the sick person and other residents to understand importance of mask-wearing and social distancing when in shared spaces, if sharing of space cannot be avoided. 
  • Ensure guardians and family members are all informed of proper protocols to take with residents who are not sick, but live in a facility with confirmed cases of COVID, and provide additional communication methods if visits are not possible.
  • Move regularly used furniture and other household items to maintain 6-feet distance between people in any shared space. 
  • Wash laundry of COVID-19 patient thoroughly. If laundry is soiled, wear disposable gloves and keep the soiled items away from your body while laundering. Wash your hands immediately after removing gloves.
  • CDC - Cleaning & Disinfecting Your Home When Someone is Sick 

Continually monitor sick individual

  • Increase monitoring of sick individuals to at least three times daily in order to identify and quickly manage any serious infections. If exhibiting emergency warning signs, including trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face, call 911 and seek medical attention immediately.
  • Keep the resident’s family, legal guardian, and care team informed at all times. Communications with residents, families and/or guardians should be proactive and clearly explain the reasons for any changes to normal practices.
  • If individuals must leave isolation for any reason, they should wear a cloth face covering (if tolerated), perform hand hygiene, and stay at least 6 feet away from others wherever possible. 
  • If the individual requires additional care beyond what the usual staff can provide, staff should seek medical attention from the individual’s health care provider. 

 Adult Day Services, Adult Day Care Centers, Adult Day Programs, and Adult Pre-Vocational Programs

Adult day services, adult day care centers, adult day programs, and adult pre-vocational programs are at increased risk for COVID-19 transmission because there is increased risk when multiple people gather and interact. Careful considerations should be made related to capacity, spatial separation, physical distancing, infection control practices, and staffing. Facilities/programs should follow all appropriate provisions in the COVID-19: Long-Term Care Facilities and Services accordion/dropdown/section on this page for:

  • Visitors to facilities
  • Guidance for all facilities
  • Resources

Develop a COVID-19 prevention and response plan

  • Develop or review business continuity plans to help prevent the spread of disease and to keep critical services functional if staffing levels drop due to illness, or taking care of ill family members, friends, or children that may be temporarily out of child care or school settings. A “delegation of authority” clause should be developed to ensure organizational leadership is clearly defined in the event current leadership is personally impacted. Employers or facility/program leadership are encouraged to provide support for staff/employees/volunteers such as time off, scheduling flexibility, or assurance that a job won’t be lost if work is missed due to illness or caring for others who are ill or children that are out of child care or school settings. Additional information on Emergency Paid Sick Leave rights for eligible employees through December 2020 is available,

Prepare your setting

  • Each group setting should assess the number of participants they serve who are at greatest risk of COVID-19, including those with underlying conditions, disabilities, and/or who are older than age 65 using CDC guidelines.
  • Each group setting should determine the number of people who can safely socially distance given the square footage and layout of the facility. Consider adding visual markings throughout the facility to assist with social distancing and to indicate where allowed seating and standing may take place. Consider staggered scheduling and/or identify small groups of individuals that can receive services together and remain with the same staff member, to the extent possible, in an effort to limit exposure.
  • Provide “this is what 6 feet is” signs throughout facilities to offer a visual of the physical distance expectation. Individuals with visual impairments should be offered additional assistance and support to ensure proper physical distancing.
  • Design common areas to maintain physical separation among participants whenever possible. Consider limiting seating options by removing unnecessary chairs in reception/meeting areas, lunch rooms, and other areas where people ordinarily congregate.
  • Identify a location in the facility to isolate an individual if they develop symptoms of COVID-19, including fever, cough, or shortness of breath during the day until they are able to safely return home.
  • Design activities and schedules to limit movement throughout spaces; the fewer surfaces or areas an individual person comes into contact with helps to lower the risk of spread or exposure to both participants and staff.
  • Consider controlled entrance into buildings to manage visitors. Consider locking entrances and installing wireless doorbells, etc.
  • Ensure you have adequate supplies of soap, paper towels, tissues, hand sanitizers, cleaning supplies, and garbage bags, as well as a sufficient supply of disposable gloves, facemasks or face coverings, or other necessary personal protective equipment are available for both program participants and program/facility staff, volunteers, and essential visitors. Have a process in place for ensuring the cloth face covering is changed and/or laundered should it become visibly soiled or wet.
  • Place alcohol-based hand sanitizer and trash containers throughout the facility. Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.
  • Hand hygiene stations should be set up at the entrance of the facility, so that people can clean their hands before they enter. If a sink with soap and water is not available, provide hand sanitizer with at least 60% alcohol. If feasible, establish one door to be the facility entrance and one door to be the exit. If possible, place sign-in stations outside, and provide sanitary wipes for cleaning pens between each use.
  • Utilize hands-free systems as much as possible, for example, install foot operated trash containers, hands-free soap and paper toweling dispensers.
  • Use signage, posters and fact sheets to educate staff, family, friends, visitors, designated representatives, and participants of ways to protect themselves and others. Materials should be offered in the languages used among participants, staff, and the community that the program/facility serves. See the following infographics and print materials.
    • Coronavirus disease
    • Please do not visit
    • Wash your hands!
    • Tips for staying safe
    • How to make a face cloth covering
    • How to protect yourself

Develop infection prevention policies and procedures

  • Designate a staff person to be responsible for responding to COVID-19 concerns. Staff, volunteers, participants and family or guardians should know who this person is and how to contact them. Consider an internal COVID Taskforce comprised of a cross-section of employees to continually review policy and practices and to respond to changing recommendations from the CDC and other sources.
  • Have a process in place to notify your local/tribal public health department if a participant or staff member is suspected of having COVID-19. In addition, notify the participant’s primary residence if they live in a congregate setting.
  • Create communication systems for staff and families for self-reporting of symptoms and notification of exposures and closures.
  • CDC recommends wearing cloth face coverings in public settings where it is difficult to stay 6 feet away from others. Some people cannot wear a cloth face covering safely. Cloth face coverings should not be placed on anyone who has trouble breathing, who is unable to remove the covering without assistance, or who expresses unmanageable discomfort wearing a mask. In addition to medical considerations, individuals may fear racial profiling or discrimination based on wearing – or not wearing – a face covering. Businesses requiring cloth face coverings should allow for exceptions based on health and safety concerns of individuals.
  • Routinely, during the day, clean and disinfect surfaces and objects that are frequently touched in common areas (e.g., door handles, faucets, toilet handles, vending machines, telephones, light switches, handrails, countertops, chairs, tables, remote controls, and shared electronic equipment). Document all cleaning activities.
  • Use all cleaning and disinfection products according to the directions on the label.
  • Develop and provide regular personal hygiene and infection control training for staff and program participants.
  • Create a communication plan for keeping participants, families/guardians, residential staff, and care teams informed of most up to date practices.

Prepare for daily operations

  • Consider cross-training personnel to perform essential functions so the facility is able to operate even if key staff are absent. Cross-training is an essential part of business continuity plans and should be an area of focus in response to a wide variety of emergency situations.
  • Develop plans to monitor absenteeism of staff and participants in the facility in order to identify if there is a cluster of illness associated with the program.
  • Ensure staffing levels are adequate to maintain physical distancing of six feet between people during meals, activities, and daily routines.
  • Have a process in place for designated representatives to take each staff, volunteers and participant’s temperature and to check for signs and symptoms of COVID-19 every day before arriving to the facility. Individuals who have a fever of 100.4F or above, or other signs of illness should not attend the day program until cleared by a healthcare professional.
  • Develop policies, following CDC guidelines, for the safe return of individuals who demonstrate symptoms of COVID-19.
  • Follow DHS guidance regarding the appropriate use of personal protective equipment (PPE), and consider strategies to best conserve PPE, when it is available.

Prepare and support participants

  • Participate in person centered planning with the individual and their legal guardian, family or care team to create back up plans should the setting experience a COVID-19 outbreak.
  • Every effort should be made to allow an individual to maintain their paid employment. See Employment and Financial Rights document from the Board for People with Developmental Disabilities for additional information.
  • Encourage family, legal guardians, and providers to proactively introduce the use of a cloth face mask to the individual, photos of people wearing masks and shields, informal exercises to practice standing on 6-foot “circles” at the setting. Consider employee use of photo badges or pins with photos of themselves without masks to assist participants in identification of staff behind cloth masks.
  • Alternative ways to provide a service should be implemented for individuals who have disability-related reasons making compliance with COVID-19 rules difficult, such as sensory issues or breathing challenges that interfere with wearing a mask, have difficulty understanding or following instructions to successfully socially distance, exhibit challenging behaviors, or need a greater level of personal care—assistance toileting, feeding, cleaning of ports etc.; these individuals are still entitled to receive services. • Consider developing and offering a virtual platform that will allow options for individuals to continue to meaningfully engage and receive services, particularly for those that are unable to return to congregate settings at this time.
  • Create or access credible COVID-19 educational materials and information for participants and staff to support them during the day.
    • You can spread COVID-19 to others even if you do not feel sick, so you should follow these hygiene practices.
    • Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
    • Avoid touching your eyes, nose, and mouth with unwashed hands.
    • Cover coughs and sneezes with your elbow, even if wearing a cloth face covering.

Transportation

  • For those programs that are also involved with transportation of participants see guidelines for people who provide Medicaid transportation. Here are some additional recommendations from the CDC:
    • Institute measures to physically separate or create distance of at least six feet between all occupants to the extent possible. This may include closing every other row of seats and reducing maximum occupancy and increasing the number of pick up/drop off routes. If it is not possible to meet the six-foot distancing requirement, DHS recommends that all vehicle occupants wear face masks or cloth face coverings during transport to the extent feasible.
    • Promote healthy hygiene practices.
    • Intensify cleaning and disinfection. Clean and disinfect frequently touched surface. Ensure safe and correct application of disinfectants. Follow CDC guidance for disinfecting non-emergency transport vehicles. Ensure safe and correct application of disinfectants.
    • Ensure that ventilation systems operate properly and increase circulation of outdoor air as much as possible such as by opening windows and doors. Do not open windows and doors if they pose a safety risk to passengers or employees, or other vulnerable individuals.

Guidance during drop off and pick up

  • Consider staggering arrival and departure times and plan to limit direct contact with family/friends as much as possible. If this isn’t possible, put tape on the ground, signage, or some other indicator for 6 feet of distance so a line/crowd doesn’t form while people are waiting to wash hands/sign-in/get their temp checked, etc.
  • Have anyone entering the site utilize the entrance with hand hygiene station and screening stations.
    • If conducting temperature screening facility staff should take temperatures of employees, volunteers, participants on site with a no-touch thermometer each day before they enter the facility. Health checks should be conducted safely and respectfully and in accordance with any applicable privacy laws and regulations. The most protective methods involve maintaining a distance of six feet from others and/or physical barriers to minimize close contact with employees. If you screen employees, please follow these CDC guidelines, and develop written policies or procedures.
    • If not conducting temperature screening on site, staff, volunteers, and participants should take their own temperature before entering the facility daily. Normal temperature should not exceed 100.4 degrees Fahrenheit.
    • If staff member, volunteer or participant has a positive symptom screen or a fever they should not attend or enter the day program. Staff may need to consult with a supervisor for proper next steps if the positive symptom screen is a participant.
    • If someone is identified as ill, follow your response plans for isolating ill persons and sending individuals home. See below for additional information.
  • Create a process to assist individuals with cloth face coverings prior to entrance to the building and when exiting the building. Individuals should be frequently reminded not to touch their face covering and to wash their hands frequently. Information should be provided to individuals and caregivers on proper use, removal, and washing of cloth face coverings.

Going out into the community

  • Day programs should discourage nonessential outings into the community. When outings are essential, follow WEDC guidance for outdoor gatherings.
  • Ensure proper physical distancing inside vehicles; ensure vehicles are large enough to meet physical distancing standards.
  • Assist individuals to follow appropriate social distancing and hygiene routines if they go to work, volunteer sites, or if they use public transportation. Follow specific guidance for Wisconsin businesses and transportation.
  • Follow these recommendations for all outings into the community:
    • Everyone should wear a cloth face covering when they have to go out in public, for example, to the grocery store or to pick up other necessities.
    • Staff should strongly encourage residents to comply with social distancing (i.e., remaining at least 6 feet part).
    •  The cloth face covering is not a substitute for social distancing.
    • The number of staff who support individuals who require personal cares, job coaching or other supports that don’t allow for social distancing should be limited.
    • The ability of someone to comply with wearing a mask should not mean they cannot interact with the community. Every effort should be made to ensure all residents are able to get outside, see family and friends while engaging in social distancing when possible, and engage in safe activities outside that do not involve direct contact with the public.
    •  More information can be found at CDC Website:

Response strategies include:

Respond when an individual has symptoms

  • Do not allow symptomatic people to come to work or the program site. Send individuals home if they arrive at the site, and do not allow them to return until they meet one of the CDC strategies to discontinue isolation and have consulted with a health care provider or health department.
  • If you identify someone who is ill throughout the day, isolate the individual immediately and send them home.
  • Establish contact with the individual’s family, legal guardian, or care team immediately.
  • If you identify multiple individuals who are ill and have had close contact, contact your local or tribal health department for guidance. Cooperate fully with state or local health department contact tracing efforts.
  • Closely monitor staff and other individuals who may have been exposed to an individual with suspected or confirmed COVID-19 for symptoms of COVID-19, including fever or chills, cough, shortness of breath, headache, sore throat, congestion, and more.
  • Implement the previously developed COVID-19 response and communication plan. For additional information, please see Wisconsin Economic Development Corporation’s guidance for employers.
  • Ensure guardians and family members are all informed of proper protocols to manage a situation if a suspected or confirmed COVID-19 exposure occurs.
  • Ensure all documentation and reporting is done in a manner that protects the confidentiality of the person infected.
  • If an individual or employee is suspected or confirmed to have COVID-19, in most cases, you do not need to shut down your facility. Close off any areas used for prolonged periods of time by the sick person. Use CDC cleaning and disinfection recommendations if an employee has been diagnosed with COVID-19 and has used the facility in the last six days. Only properly trained individuals should perform the required cleaning and disinfection.
    • Wait 24 hours before cleaning and disinfecting to minimize potential exposure. If waiting 24 hours is not feasible, wait as long as possible
    • During this period, open outside doors and windows to increase air circulation in these areas.
    • Clean dirty surfaces with soap and water before disinfecting them.
    • Always wear gloves and protective clothing appropriate for the chemicals being used when you are cleaning and disinfecting.
  • This information is constantly evolving, so please continually check the DHS COVID-19 webpage for updated information.

Resources

 Home Care Providers

This guidance applies to home care providers and staffs, including home health agencies, in-home hospice providers, personal care agencies, and supportive home care agencies. The purpose of this guidance is to provide the best information currently available to help home care providers prevent the spread of COVID-19 to the clients and/or patients they serve and to the staff who deliver their care.

The COVID-19 situation is constantly evolving and home care providers and workers should monitor the CDC, CMS, and Wisconsin DHS website for the most current information and resources related to COVID-19 and contact their local health department when needed.  See the links under “Additional Resources” for more information.

Regulatory and Policy Changes

DQA Waivers/Variances
The DHS Division of Quality Assurance (DQA) will notify providers through its existing notification process if any blanket waivers of Wisconsin Administrative Code are issued. Home care providers can apply for an individual waiver or variance to Wisconsin Administrative Code by completing the Waiver or Variance Request form (F-02527) and following the submission instructions on the DHS website. Home care providers are encouraged to notify the managed care organizations with which they contract if they receive DQA approval for an individual waiver or variance.  

DSPS Waivers/Variances
The Wisconsin Department of Safety and Professional Services (DSPS) is responsible for licensing requirements for registered nurses (RNs) and other health care professionals. Please watch the DSPS website for the most current information on waivers, etc.

ForwardHealth (Medicaid) Policy Changes
Home care providers should review the ForwardHealth Portal for information on ForwardHealth (Medicaid) policies that may have changed as a result of the COVID-19 outbreak. Please review ForwardHealth alerts to see which providers they pertain to. For specific questions about COVID-19 as it relates to ForwardHealth (Medicaid) coverage and policy, please contact DHS.

Federal Regulation Waivers
The Centers for Medicare & Medicaid Services (CMS) has issued blanket waivers of some federal regulations. Federal requirements without a blanket waiver remain in effect. In order to request a waiver of a federal requirement not covered under a blanket waiver, a provider must submit a request for a “Section 1135” waiver on an individual basis to CMS. In order for CMS to expedite their review of an individual waiver request, providers should review CMS’ 1135 waiver guide to ensure their request contains all necessary information and elements. Questions regarding Section 1135 waivers should be sent to CMS 1135 Waiver. For more information, please see the CMS webpage. Home care providers are encouraged to notify the managed care organizations with which they contract if they receive CMS approval for an individual waiver.  

Note: A federal waiver does not necessarily waive Wisconsin Administrative Code. Providers should review state policy pertaining to the services rendered.   

Infection Prevention and Control

Older individuals, individuals with disabilities, and medically vulnerable individuals have significantly increased risk of severe illness and death from COVID-19, necessitating that all reasonable efforts are taken to prevent introduction and spread of this infectious disease into each client’s or patient’s home. Health care workers, visitors, and others interacting with this population are the most likely sources of introduction of COVID-19 into client or patient residences.

Home care providers should review, implement, and reinforce infection prevention and control interventions for preventing communicable disease among all home care workers, staff, and clients or patients.

If one of your home care workers, staff, or clients or patients is diagnosed with COVID-19, immediately contact your local public health department to receive further guidance on infection prevention and control.

Staffing
All home care providers should immediately implement procedures for evaluating home care workers for symptoms of respiratory illness before every visit involving direct client or patient care. Monitoring should include temperature monitoring and query of symptoms of COVID-19-like illness, which include any of the following:

  • Measured temperature >100.0 F (37.8C) or subjective fever
  • New or worsening cough, new or worsening shortness of breath, unexplained muscle or body aches, and/or sore throat.

Monitoring may be performed either by designated staff at the providers’ office or remotely by employees themselves with allowances for documentation of the symptoms screen to supervisors (for example, via text, email, or other methods).  

Refer to DHS guidance for recommendations on when health care personnel without symptoms who were exposed to COVID-19 can return to work.

Any staff that develop signs and symptoms of a respiratory infection while on the job should:

  • Immediately stop work, put on a face mask, and self-isolate at home.
  • Inform the clinical manager of information on individuals, equipment, and locations the person came in contact with.
  • Contact their local health department for next steps.

Home care providers should take additional staffing precautions with any staff who work in multiple settings or multiple facilities as they pose a greater risk for contributing to intra- and inter-facility spread of COVID-19.  Home care providers should schedule or assign staff appropriately to ensure they do not place individuals in the facility at risk for COVID-19. Staff who work in multiple locations should be encouraged to tell facilities if they have had exposure to other settings with recognized COVID-19 cases.

Home care providers should have a contingency plan for continuing client or patient care if a large proportion of staff become sick. The contingency plan should identify minimum staffing needs and priorities for critical and nonessential services based on the health status, functional limitations, disabilities, and essential needs of their clients and patients.

Client/Patient Care
Home care providers should:

  • Consider limiting the number of in-person home care visits to prevent the introduction of the virus into the client or patient’s home, if appropriate, based on their care needs.  
  • Consider substituting telehealth (consultation by phone or video chat) for an in-person visit. While telehealth may not be appropriate for many types of visits, telehealth may be an alternative for certain visits, such as those done by personal care worker’s RN supervisors, social workers, etc. Providers should refer to federal and state guidance regarding telehealth.

Home care workers should:

  • Continue to follow all standard infection prevention and control protocols, including but not limited to, hand hygiene (handwashing or use of alcohol-based hand rub), cough etiquette, appropriate use of personal protective equipment (PPE), when available, etc.  
  • When not performing direct care, limit contact as much as possible with the client or patient and other individuals in the household by identifying ways to avoid direct contact and maintain physical distancing (6 feet or more).  
  • Limit contact with surroundings through measures such as placing a barrier between equipment and the object the equipment will rest on, placing a barrier on furniture before sitting down, etc.
  • Only bring in necessary supplies, equipment, and materials.
  • Wear the recommended PPE that is appropriate for the given situation. Due to PPE shortages, home care providers should identify ways to preserve PPE supplies and should develop protocols for managing clients or patients with limited or no PPE. If N95s or face masks are not available, home care providers should implement use of universal cloth face coverings by all home care workers (source control) when they enter the client or patient’s residence.  

Home care providers and/or workers should screen clients or patients before or immediately upon arrival to the home. Providers and/or workers should ask the client or patient if they or anyone who is in the residence currently, or in the past seven days, have new onset of fever OR cough OR shortness of breath OR sore throat that cannot be attributed to an underlying or previously recognized condition (for example, asthma, emphysema).  

  • If NO, then COVID-19 may be less of a risk. If the client or patient reports other illness, home care providers should manage as per their organization’s usual protocols.
  • If YES, then providers should manage per their organization’s COVID-19 protocols:
    • If the client or patient is sick and needs immediate medical attention (for example, difficulty breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face) call 911 for transport to a hospital and inform 911 that the client or patient may have COVID-19 to ensure appropriate infection control is implemented.
    • Notify the client or patient’s medical provider. If staff are unable to enter the residence and rescheduling the appointment may not be an acceptable option, the medical provider and your organization may need to evaluate whether the client or patient can still safely receive home care or should be transferred to a hospital or other health care facility. Also notify the client or patient’s managed care organization or other care coordinator, if applicable.
    • If direct care is not required, remember to maintain a distance of 6 feet or more from the person who is sick and any other persons in the residence.
    • When appropriate, postpone the visit for a time when the person who is ill has had at least seven days following onset of illness and 72 hours after being consistently afebrile without use of antipyretics and with resolving respiratory symptoms. If not possible, and it is the client or patient who is sick, prepare to manage them with appropriate PPE and in accordance with your organization’s COVID-19 protocols.
    • In some cases, telehealth (consultation by phone or video chat) may be substituted for an in-person visit.  

Home care providers should contact their local health department for questions and frequently review the CDC website dedicated to COVID-19 for health care professionals.  

Client/Patient Rights and Wellbeing

All clients and patients should continue to be made aware of their rights. If a client or patient’s visitation with family and friends is limited, efforts should be made to support them to continue their relationships through means such as phone calls.

Additional Resources

CDC Resources

CMS Resources

DHS Resources

 Guidance for Providing On-Site Hair Salon and Barber Services

In accordance with CDC guidance, long-term care facilities have closed onsite hair salons and barber services in their facilities to reduce the risk of spreading of COVID-19.  Minimizing resident contact with outside individuals remains the best approach to prevent introduction of COVID-19 into long-term care settings. This guidance provides information to long-term care providers regarding resumption of on-site hair salon and barber services in the safest way possible. Facilities may resume onsite cosmetology services while ensuring the health, safety and welfare of residents and staff. In order to resume services safely, facilities should consider the following guidance.

Policies, Procedures, and Supplies

The facility should:

  • Follow facility policies and procedures as well as guidance from the Centers for Disease Control (CDC) regarding cleaning and disinfecting protocols as well as employee screening.
  • Develop and implement procedures that address infection control measures and the management of safe salon services.
  • Implement an ongoing facility monitoring system for compliance with the facility’s policies and procedure for safe salon services.
  • Limit contact of the cosmetologist with other residents and staff as much as possible. This may be accomplished by having a separate area for salon services close to the entrance of the facility but is not required.  Try to develop a path that avoids walking through resident care areas.  
  • Have an adequate supply of PPE and essential cleaning and disinfection supplies for facility staff and cosmetologists.  
  • Develop a process for cleaning cosmetology equipment (scissors, comb, brushes, etc.) 
  • Have adequate staff. 

Licensed Cosmetologist Services

The cosmetologist should: 

  • Not be employed at another salon other than the facility or another care facility on the grounds of the facility.
  • Receive COVID-19 infection control training from the facility.
  • Test negative for COVID-19 prior to resuming services in the facility, and follow any ongoing testing guidance specific to facility-type.  
  • Be screened for signs and symptoms of illness before each visit including no signs or symptoms of COVID -19, such as cough, fever or chills, shortness of breath or difficulty breathing or any other respiratory symptoms. Also, verify that they have had no contact with individuals with suspected or confirmed COVID-19. 
  • Wear proper PPE including a facemask, gown, and gloves provided by the facility upon entering and for the duration of their time in the facility.  
  • Be trained to self-monitor after each visit and report any symptoms of COVID-19 to the facility promptly as well as notifying healthcare providers and the local/tribal public health department. 
  • Sign a statement attesting that he or she will follow all facility policies and procedures regarding salon and barber services to ensure facility safety.
  • Clean and disinfect the area and equipment between resident appointments.

The cosmetologist should not:

  • Dry hair using a hand held hair dryer.

The facility should:

  • Verify that the resident is well with no signs or symptoms of COVID -19, such as cough, fever or chills, shortness of breath or difficulty breathing or any other respiratory symptoms before coming to their appointment.   
  • Ensure that each appointment is prescheduled, no walk-ins.  
  • Keep a record of the name, time and date of each resident that visits the salon.
  • Based on the resident’s abilities, escort the resident by a staff member to the salon at the designated appointment time and back to their room after the appointment.  The resident’s arrival time should not coincide with the departure time of any resident exiting the salon, schedule in enough time in between the end and start of appointments to avoid residents congregating at the salon or in hallways. 
  • Call each resident to the salon area individually, only one resident in the salon at a time.
  • If the salon has doors, keep the salon doors closed unless a resident is entering or exiting the salon. Do not establish or use a waiting room or area or allow congregate gathering in or around the salon at any time. 
  • Ensure that each resident wears a face covering (preferably a face mask rather than a cloth face cover) while in transit to and from the salon and while in the salon at all times, including during  washing, cutting, perming, and coloring.  
  • Clean and disinfect the salon at the end of the day. 

Facilities will need to determine whether they can follow these guidelines to ensure they can provide salon and barber services safely. This may not be a safe option for all facilities due to availability of PPE, staffing patterns and facility layout and/or location as outlined in the above guidance.

 Resources

DHS Resources
CDC Resources

 

CMS Resources
BOALTC Resources
The Society for Post-Acute and Long-Term Care Medicine

Ways to keep your residents engaged

What we know

  • Residents in long-term care and other residential facilities are experiencing reduced opportunities to connect with family and friends due to “no visitor” rules.
  • Meal sites and other community engagement opportunities are now closed or otherwise unavailable.
  • Staffing patterns at long-term care and other residential facilities are experiencing reduced workforce for multiple reasons.
  • Staff and facility infrastructure can create physical and interactional barriers to communication and connection with society.
  • Resident barriers to communication may include hearing loss, vision loss, learning and cognition disabilities, dementia, physical and dexterity disabilities, and speech disabilities. This is not an all-inclusive listing.

Facility and infrastructure barriers

  • Resident access to external windows based on room floor and location.
  • Resident access to direct phone lines in individual rooms (along with appropriate electrical access).
  • Facility provision of free wireless internet.
  • Staff availability and knowledge to provide one-to-one assistance for communication support for residents.
  • Lighting and electrical access.
  • Not recognizing the impact that the use of PPE may have on residents; for example, the use of face masks will impact communication with residents who are deaf or hard of hearing.

Ways to address isolation

  • Technology (communication devices and other assistive technology)
    • Tablets, laptops, and smartphones capable of connecting to WIFI
    • Smarthome visual devices (Amazon Echo/Alexa, Facebook Portal, Nest Hub)
    • Smarthome control technology (thermostats, doorbells, lights)
    • Simplified tablets (GrandPad for example – see resources section)
    • Amplified telephones
    • Personal listening devices
    • Handheld or desktop style magnifiers
    • Tablet holders and cases
    • Wheelchair trays
    • Walker bags
    • Recreational assistive technology, such as card holders, pencil grips, or other needs for participation in activities
    • Remote volunteers to facilitate communication and skill building
    • Video meetings (Zoom, Facetime, Facebook Messenger, Google Meet/Hangouts, Skype)
    • Apps for communication (Facebook, Instagram, text messaging, email, Skype, TIkTok)
    • Apps specific for disabilities (Glide and Marco Polo for consumers who are deaf for example)
    • Apps for creative ideas (Facebook, Instagram)
    • Apps for mental health (meditation guidance, soothing sounds, drawing apps)
    • Account setup tips: When creating accounts, keep written documentation in multiple places or online in Google Drive or similar. This includes user name, password, and security questions. If help is needed, either in person or remote, the consumer or caregiver has access to the needed information.
  • Nontechnology strategies (programming, structural, and instructional)
    • Face-to-face visits via windows and signs
    • Creativity with activities (Pinterest for ideas)
    • Mailing cards and letters
    • Sending books, photos, photo albums, puzzles, games
    • Ordering groceries and meals to be delivered
    • Communication Board (printable)

Donation requests (technology)

Ensure all donations power up, function, and include a power source so that it does not become a waste burden or issue that requires disposal.

  • Tablets, laptops, and smartphones capable of connecting to WIFI
  • Amplified telephones
  • Personal listening devices
  • Handheld or desktop-style magnifiers
  • Tablet holders and cases
  • Wheelchair trays
  • Walker bags
  • Recreational assistive technology such as card holders, pencil grips, or other needs for participation in activities
  • UV Wands
  • Cleaning wipes and hand sanitizer
  • Remote volunteers to facilitate communication and skill building
  • Donation of video conferencing services (Zoom for example)

Cleaning recommendations for donated devices (technology)

Facility solutions

  • Activation of individual telephone lines within rooms as needed or requested.
  • Provision of sitewide wireless internet access.
  • Review of activities to introduce modifications in programming structure. Examples might include hallway bingo where residents each sit within their respective doorways to play group bingo to ensure social distancing.
  • Subscription and provision of paid video conferencing applications such as Zoom for resident access.
  • Provision of free video conferencing applications such as Zoom, FaceTime, Skype, and others to residents and family and friends to encourage distance communication.
  • Emergency Preparedness should be evaluated. The Council for Physical Disabilities has an Emergency Toolkit.
  • Ensure availability of simple communication boards in resident rooms for those with communication disabilities. Download and print a communication board from Temple University Institute on Disabilities to assist those who cannot speak.
  • Provision of assistive technology solutions, where needed and available, to support communication and participation in activities. DHS WisTech staff can assist with this.

 

Funding options

  • Telecommunications Equipment Purchase Program (TEPP). This fund is available to assist with the acquisition of basic and essential telecommunications for distance communication for people who are hard of hearing, deaf, combined hearing and vision loss, a speech disability, or a mobility impairment. The disability must prevent the use of regular telecommunications equipment. Copayments and specific equipment is eligible. Program specific rules apply and staff from the Independent Living Centers and DHS WisTech staff are available to answer questions or assist with applications.
  • Telecommunications Assistance Program (TAP). This fund is available to assist with the acquisition of basic and essential telecommunications for distance communication for people who are hard of hearing, deaf, or have a combined hearing and vision loss that prevents the use of regular telecommunications equipment. Program specific rules apply and staff from the Independent Living Centers and DHS WisTech staff are available to answer questions or assist with applications.
  • iCanConnect (ICC). This fund is available to assist with the acquisition of technology needed for distant communication for people with combined hearing and vision disabilities. Financial eligibility must also be met. Staff from the Center for Deaf-Blind Persons can provide information, assist with applications, and provide assessments.

Family tips

  • Send cards and letters (consider sanitization and wait time for delivery as COVID19 can remain on paper).
  • Send books or other small, random gifts from Amazon or other online stores.
  • Assist with online grocery or person item orders for residents isolated in apartments.
  • Send photos from an online service; could also be photo book, calendar, or other photo mug for example.
  • Keep in mind that staff at these facilities are operating under extraordinary circumstances and that they may be leaving their own families behind to care for yours. It is okay to ask for help connecting with your parent and to ask for updates on their well-being.
  • Set up accounts for your family member or friend who is a resident in a long-term care facility.
  • Write down account login details, including “secret questions” responses and leave with the resident so that if login support is needed, staff and the resident have access to the necessary information. Please keep confidentiality in mind; however, and do not set up accounts with common user names and passwords used for other accounts.

Example scenario

Long-term care facility:

  • Identifies residents without access to telecommunications or other mechanisms for communication with family and friends. Who has a tablet, smartphone, laptop or room telephone and who does not.
  • Identifies residents who are without these methods of communication but have the interest and capability to use technology. Capability includes independent use, supported use, and passive use.
  • Identifies staff and other residents and/or their family members who can provide training and support or assistance to residents in the use of communication technology.
  • Determines types and numbers of devices needed to meet resident needs.
  • Solicits donations from family and the community for tablets, smartphones, laptops, and telephones (amplified if possible). This includes isolated donation location to ensure sanitization can occur prior to distribution or use.
  • Accesses training resources available online and through the Wisconsin Department of Health Services. Remote training and assistance is available for residents and staff.
  • Conducts thorough cleaning of technology prior to distribution. See recommendations.
  • Determines match of device to resident based on interest, skills, and needs.
  • Reviews activity modifications that will allow for engagement and participation by residents while adhering to protocols for social distancing. DHS staff may be available to discuss alternatives and solutions.

Resources

Last Revised: August 7, 2020

 RESPONSE RESOURCES FOR WISCONSINITES — www.dhs.wisconsin.gov/covid-19/help.htm