COVID-19: Nursing Homes

Do you need outbreak support? Contact the DHS Rapid Assistance and Support Team (RAST) (PDF).

RAST offers a multidisciplinary approach to problem solving during a COVID-19 outbreak in nursing homes. DHS team members hear an overview from the facility or local/tribal health department, ask questions about the outbreak, provide technical assistance and make recommendations. Please contact for more information or to schedule a RAST call.

NOTE: If the assistance your facility seeks is solely related to a significant staffing shortage, please review the recommendations under the Planning for Staff Shortages heading below. If you have exhausted all of those recommendations, contact your Regional Director for further assistance.


This guidance is for Wisconsin nursing homes and intermediate care facilities for individuals with intellectual disabilities (ICF/IID). Nursing homes and ICF/IIDs care for residents who are elderly and/or who have chronic medical conditions that place them at higher risk of developing severe complications from COVID-19.

This guidance is designed to assist facilities to improve their infection prevention and control practices, to prevent the transmission of COVID-19, and keep residents and the health care personnel (HPC) who care for them safe from infection.

Based on guidance from the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC), the Department of Health Services (DHS) recommends the following actions in accordance with Wis. Stat. chs. 50 and 252, Wis. Admin. Code chs. DHS 132, DHS 134, and DHS 145. CMS and CDC continue to provide guidance for nursing homes and other long-term care facilities.

Facilities are encouraged to routinely check the CMS and CDC websites for additional guidance. In addition to reading and understanding the guidance offered here, it is important to review the information highlighted in the hyperlinks and in the Resources section. Facilities are also encouraged to use the COVID-19 Provider Self-Assessment Worksheet, F-02669 (Word) as a tool to guide their overall preparedness.

Caring For Residents with Dementia

The strategies used to limit the spread of COVID-19 are especially difficult for residents with dementia. Due to their decreased cognitive ability, residents with dementia will require additional assistance adhering to quarantine and isolation. In particular, residents with dementia may have an impaired ability to follow or remember 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 with dementia 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 with dementia be kept to a minimum. If agitation or aggression occurs, respond by using standard calming techniques, such as distract and redirect, play personalized music, take the person for a walk outside, or ask the person to complete a favorite task.

CDC Guidance:

CDC guidance for facilities caring for residents with dementia can be found in Considerations for Memory Care Units in Long-term Care Facilities.

Adherence to Infection Control Procedures:

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

Residents with dementia may require extra supervision and support to perform appropriate hand hygiene (alcohol-based hand sanitizer or handwashing):

  • 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.
  • 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.
  • 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 resident cannot get to a sink to wash their hands.
  • Be sure to use moisturizer on clean hands after repeated washing to ensure they do not get dry and irritated.

Residents with dementia may also need assistance to refrain from touching their faces.

  • 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 with dementia 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 and redirection through supervised and structured daily activities, including some form of daily exercise, such as individual walks outside with staff members.


Residents with dementia 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. If residents express concern about the pandemic, facility staff should:

  • For those who are aware of what is going on and concerned about it, provide information from authoritative sources (such as DHS or the CDC.) Take the time to listen to the person and their concerns, validate their feelings, and provide reassurance.
  • Provide simple, truthful answers to their questions, explaining that everyone is doing all they can to help.
  • 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.

COVID-19 Variants and Wisconsin's Efforts to Increase COVID-19 Vaccination

The Wisconsin Department of Health Services updates the COVID-19: Therapeutics Distribution and COVID-19: Treatments and Medications with the latest recommendations and information. If you are experiencing any COVID-19 symptoms, don't delay and get tested today!

Please visit the CDC's COVID-19 website for additional resources.


Federal COVID-19 Reporting Requirements

On May 6, 2020, CMS issued Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes Memo, QSO-20-29-NH (PDF). This requires nursing homes to report COVID-19 facility data to the CDC and to residents, their representatives, and families of residents in facilities. The memo states that failure to report in accordance with 42 CFR § 483.80(g) can result in an enforcement action. CMS will begin posting data from the CDC National Healthcare Safety Network (NHSN) for viewing by facilities, stakeholders, or the public. The COVID-19 public use file will be available at COVID-19 Nursing Home Data. The memo includes updated COVID-19 focus survey forms and regulatory tags.

Infection Prevention

Do you need outbreak support? Contact the DHS Rapid Assistance and Support Team (RAST) (PDF).

RAST offers a multidisciplinary approach to problem solving during a COVID-19 outbreak in nursing homes. DHS team members hear an overview from the facility or local/tribal health department, ask questions about the outbreak, provide technical assistance and make recommendations. Contact for more information or to schedule a RAST call.

NOTE: If the assistance your facility seeks is solely related to a significant staffing shortage, please review the recommendations under the Planning for Staff Shortages heading below. If you have exhausted all of those recommendations, contact your Regional Director for further assistance.

Nursing homes and assisted living facilities should maintain preparations to care for residents with COVID-19. CDC's COVID-19 Infection Control Assessment and Response (ICAR) tool was developed to help facilities prepare for COVID-19. Facilities can take steps to assess and improve their preparedness for responding to COVID-19. The ICAR tool should be used as one tool to develop a comprehensive COVID-19 response plan.

DHS infection prevention specialists recorded a 30-minute overview of the self-assessment tool to explain each section. Facilities can complete the self-assessment and direct questions about their results or necessary elements to the Healthcare-Associated Infections (HAI) Program. Facilities can also request a tele-ICAR evaluation by the HAI 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.

The HAI Program has also released a series of ICAR Lessons Learned:

The HAI Lessons Learned are sent via email to providers that have subscribed to receive DQA Notifications & Updates through the DQA Email Subscription webpage. Providers are highly encouraged to subscribe to receive these messages and other important information from the Division of Quality Assurance.

Wisconsin HAI Prevention Program recently added five full-time, experienced Infection Preventionists (IP) to provide additional infection prevention support to each public health region. Regional IPs are available to help with the following:

  • Answering infection prevention questions on a variety of topics (for example, appropriate PPE use, environmental infection control, bloodborne pathogens, multidrug-resistant organisms, quarantine and isolation).
  • Performing infection control assessments of health care facilities, particularly long-term care facilities.
  • Participating in outbreak and infection control breach technical assistance.
  • Providing infection prevention and control education.

Universal Screening

Nursing homes should actively screen and anyone entering the facility for fever and symptoms of COVID-19 or known exposure to someone with COVID-19.

  • The required screening includes, all staff, visitors, hospice, clergy, external health care personnel, surveyors, and all vendors. Every individual should be asked about COVID-19 symptoms (for example, fever (measured temperature at 100.0°F or higher, or subjective fever), cough, shortness of breath, sore throat, or muscle aches, and must have their temperature checked daily). Emergency medical service (EMS) staff responding to an urgent medical need are exempt and do not need to be screened since they are typically screened separately.
  • Visitors who have a fever and/or are symptomatic for COVID-19 should not be allowed to enter the facility.
  • Staff who have a fever and/or are symptomatic for COVID-19 prior to or during their shift, should be excluded from work. Decisions about when staff can return to work should be made using Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection.
  • Facilities should limit access points and ensure that all accessible entrances have a screening station.
  • Facilities should contact their local health department for questions and frequently review the information in Preparing for COVID-19 in Nursing Homes.
  • Pursuant to Wis. Admin. Code ch. DHS 145 the local health department should be notified about residents or staff with suspected or confirmed COVID-19, residents with severe respiratory infection resulting in hospitalization or death, or three (3) or more residents or staff with new-onset respiratory symptoms within 72 hours of each other.

Educate residents, staff, and visitors about COVID-19, current precautions being taken in the facility, and actions they should take to protect themselves

  • Provide information about COVID-19 from Get the Facts About Coronavirus (including information about signs and symptoms) and strategies for managing stress and anxiety.
  • Regularly review CDC's Infection Control Guidance for Healthcare Professionals about COVID-19 for current information and ensure staff and residents are updated when this guidance changes.
  • Educate and train staff, including facility-based and consultant personnel. Including consultants is important, since they commonly provide care in multiple facilities where they can be exposed to and serve as a source of COVID-19.
  • Educate residents and families on topics including information about COVID-19, actions the facility is taking to protect them and/or their loved ones, any visitor restrictions that are in place, and actions residents and families should take to protect themselves in the facility, emphasizing the importance of hand hygiene and source control.
  • Have a plan and mechanism to regularly communicate with residents, families and staff, including a communication plan in the event confirmed cases of COVID-19 are identified in the facility.

Implement Source Control Measures

  • Staff should wear a facemask at all times while they are in the facility. When available, facemasks are generally preferred over cloth face coverings for staff as facemasks offer both source control and protection for the wearer against exposure to splashes and sprays of infectious material from others. Guidance on extended use and reuse of facemasks is available in Strategies for Optimizing the Supply of Facemasks. Cloth face coverings should NOT be worn by staff instead of a respirator or facemask if PPE is required.
  • Residents should wear a cloth face covering or facemask (if tolerated) whenever they leave their room, including for procedures outside the facility. Cloth face coverings should not be placed on anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. In addition to the categories described above cloth face coverings should not be placed on children under age two.
  • Visitors, if permitted into the facility, should wear a cloth face covering while in the facility.

Implement Social Distancing Measures

Implement aggressive social distancing measures (remaining at least 6 feet apart from others).

  • Cancel communal dining and group activities, such as internal and external activities.
  • Remind residents to practice social distancing, wear a cloth face covering (if tolerated), and perform hand hygiene.
  • Remind staff to practice social distancing and wear a facemask (for source control) when in break rooms or common areas.

Provide Supplies Necessary to Adhere to Recommended Infection Prevention and Control Practices

  • Hand hygiene supplies:
    • Put alcohol-based hand sanitizer with 60-95% alcohol in every resident room (ideally both inside and outside of the room) and other resident care and common areas (for example, outside dining hall, in therapy gym). Unless hands are visibly soiled, an alcohol-based hand sanitizer is preferred over soap and water in most clinical situations.
    • Make sure that sinks are well stocked with soap and paper towels for handwashing.
  • Respiratory hygiene and cough etiquette: Make tissues and trash cans available in common areas and resident rooms for respiratory hygiene, cough etiquette, and source control.
  • Personal protective equipment (PPE): Perform and maintain an inventory of PPE in the facility.
  • Make necessary PPE available in areas where resident care is provided.
    • Consider designating staff responsible for stewarding those supplies and monitoring and providing just-in-time feedback promoting appropriate use by staff.
    • Facilities should have supplies of facemasks, respirators (if available and the facility has a respiratory protection program with trained, medically cleared, and fit-tested staff), gowns, gloves, and eye protection (for example, face shield or goggles).
  • Position a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room or before providing care for another resident in the same room.
  • Implement strategies to optimize current PPE supply even before shortages occur, including bundling resident care and treatment activities to minimize entries into resident rooms. Additional strategies might include:
    • Extended use of respirators, facemasks, and eye protection, which refers to the practice of wearing the same respirator or facemask and eye protection for the care of more than one resident (for example, for an entire shift). Care must be taken to avoid touching the respirator, facemask, or eye protection. If this must occur (for example, to adjust or reposition PPE), staff should perform hand hygiene immediately after touching PPE to prevent contaminating themselves or others.
    • Prioritizing gowns for activities where splashes and sprays are anticipated (including aerosol-generating procedures) and high-contact resident care activities that provide opportunities for transfer of pathogens to hands and clothing of staff. If extended use of gowns is implemented as part of crisis strategies, the same gown should not be worn when caring for different residents unless it is for the care of residents with confirmed COVID-19 who are cohorted in the same area of the facility and these residents are not known to have any co-infections (for example, Clostridioides difficile).
    • Implement a process for decontamination and reuse of PPE such as face shields and goggles.
    • Facilities should continue to assess PPE supply and current situation to determine when a return to standard practices can be considered.
  • Implement a respiratory protection program that is compliant with the OSHA respiratory protection standard for employees if not already in place. The program should include medical evaluations, training, and fit testing.
  • Environmental cleaning and disinfection:
    • Develop a schedule for regular cleaning and disinfection of shared equipment, frequently touched surfaces in resident rooms and common areas.
    • Ensure EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment.
  • Use an EPA-registered disinfectant from List N on the EPA website to disinfect surfaces that might be contaminated with SARS-CoV-2. Ensure staff are appropriately trained on its use.
  • Nursing homes should ensure all staff are using appropriate PPE when interacting with residents, to the extent PPE is available and per CDC guidance on conservation of PPE.
    • Full PPE should be worn per CDC guidelines for the care of any resident with known or suspected COVID-19 and per CDC guidance on conservation of PPE.
    • If COVID-19 is identified in the facility, restrict all residents to their room and have staff wear all recommended PPE (gloves, facemask, face shield, and gown) for all resident care, regardless of the presence of symptoms. Resident care includes personal care, meals, and exercise, such as walking. 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 nursing home residents with COVID-19 do not demonstrate symptoms.
  • When possible, all nursing home residents, regardless of COVID-19 status, should cover their noses and mouths when staff are in their room. Tissues or cloth face coverings may be used for this purpose. Residents should not use medical facemasks unless they are COVID-19 positive or assumed to be so.

Evaluate and Manage Residents with Symptoms of COVID-19

  • Ask residents to report if they feel feverish or have symptoms consistent with COVID-19.
  • Actively monitor all residents upon admission and at least daily for fever (T≥100.0oF) and symptoms consistent with COVID-19. Ideally, include an assessment of oxygen saturation via pulse oximetry. If residents have fever or symptoms consistent with COVID-19, implement transmission-based precautions as described below.
    • Older adults with COVID-19 may not show common symptoms such as fever or respiratory symptoms. Less common symptoms can include new or worsening malaise, headache, or new dizziness, nausea, vomiting, diarrhea, loss of taste or smell. Additionally, more than two temperatures higher than 99.0°F might also be a sign of fever in this population. Identification of these symptoms should prompt isolation and further evaluation for COVID-19.
  • The health department should be notified about residents or staff with suspected or confirmed COVID-19, residents with severe respiratory infection resulting in hospitalization or death, or three or more residents or staff with new-onset respiratory symptoms within 72 hours of each other.
  • Information about the clinical presentation and course of patients with COVID-19 is described in the Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19). The CDC has also developed guidance on Evaluating and Reporting People Under Investigation (PUI).
  • If COVID-19 is suspected, based on evaluation of the resident or prevalence of COVID-19 in the community, follow the CDC's infection control guidance. This guidance should be implemented immediately once COVID-19 is suspected.
    • Residents with suspected COVID-19 should be prioritized for testing.
    • Residents with known or suspected COVID-19 do not need to be placed into an airborne infection isolation room (AIIR) but should ideally be placed in a private room with their own bathroom.
    • Residents with COVID-19 should, ideally, be cared for in a dedicated unit or section of the facility with dedicated staff.
    • As roommates of residents with COVID-19 might already be exposed, it is generally not recommended to place them with another roommate until 14 days after their exposure, assuming they have not developed symptoms or had a positive test.
  • Residents with known or suspected COVID-19 should be cared for using all recommended PPE, which includes use of an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (for example, goggles or a disposable face shield that covers the front and sides of the face), gloves, and gown. Cloth face coverings are not considered PPE and should not be worn when PPE is indicated.
  • Increase monitoring of ill residents, including assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exam, to at least three times daily to identify and quickly manage serious infection.
    • Consider increasing monitoring of asymptomatic residents from daily to every shift to more rapidly detect any with new symptoms.
  • If a resident requires a higher level of care or the facility cannot fully implement all recommended infection control precautions, the resident should be transferred to another facility that is capable of implementation. Transport personnel and the receiving facility should be notified about the suspected diagnosis prior to transfer.
    • While awaiting transfer, residents should be separated from others (for example, in a private room with the door closed) and should wear a cloth face covering or facemask (if tolerated) when others are in the room and during transport.
    • All recommended PPE should be used by health care personnel when coming in contact with the resident.
  • Because of the higher risk of unrecognized infection among residents, universal use of all recommended PPE for the care of all residents on the affected unit (or facility-wide depending on the situation) is recommended when even a single case among residents or staff is newly identified in the facility; this could also be considered when there is sustained transmission in the community. The health department can assist with decisions about testing of asymptomatic residents.
  • For decisions on removing residents who have had COVID-19 from Transmission-Based Precautions refer to the Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19.

For additional information see: Preparing for COVID-19 in Nursing Homes.

Infection Prevention and Control: Frequently Asked Questions

New Admissions, Transfers, and Discharges

Note: See additional guidance regarding admissions in the Resources to Support Skilled Nursing Facilities in Determining Admission Policies during a COVID-19 Outbreak section of this page.

Nursing homes should admit any individuals that they would normally admit to their facility. Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes Memo, QSO-20-14-NH (Revised) (PDF) provides the following guidance about the ability of nursing homes to accept a resident diagnosed with COVID-19 from a hospital:

Additionally CDC guidance recommends the following:

  • Facilities should create a plan for managing new admissions and readmissions whose COVID-19 status is unknown. Options include placement in a single room or in a separate observation area so the resident can be monitored for evidence of COVID-19.
  • All recommended COVID-19 PPE should be worn during care of residents under observation, which includes use of an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection (for example, goggles or a disposable face shield that covers the front and sides of the face), gloves, and gown.
  • DHS Updated Guidance on Infection Control during Specimen Collection for COVID-19 in Outpatient Settings Memo, BCD 2020-06 (PDF) states that N95 respirators do not need to be worn for specimen collection or resident care other than during aerosol generating procedures.
  • Testing residents upon admission could identify those who are infected but otherwise without symptoms and might help direct placement of asymptomatic SARS-CoV-2-infected residents into the COVID-19 care unit. However, a single negative test upon admission does not mean that the resident was not exposed or will not become infected in the future. Newly admitted or readmitted residents who are not fully vaccinated should still be monitored for evidence of COVID-19 for 14 days after admission and cared for using all recommended COVID-19 PPE. Quarantine is no longer recommended for residents who are being admitted to a post-acute care facility if they are fully vaccinated and have not had prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.


If a resident has been exposed and is being discharged, the resident requires quarantine at the receiving facility. Therefore, you must inform the facility that is accepting the resident. If the facility is unable to meet transmission-based precautions and quarantine for the appropriate length of time, then the resident cannot be transferred.

Guidance from the State Disaster Medical Advisory Committee

The following memos were prepared by the State Disaster Medical Advisory Committee (SDMAC) to provide recommendations to nursing homes and hospitals regarding the transfer, discharge and management of patients from hospitals to nursing homes. The purpose of the SDMAC is to advise the DHS Secretary regarding medical ethics during a declared disaster or public health emergency and to recommend policy relating to the equitable and fair delivery of medical services to those who need them under resource-constrained conditions.

Outdoor Visitation Guidance for Nursing Homes

DHS recognizes that the effects of isolation can have serious impact on the health and well-being of residents in nursing homes. Nursing Home Visitation - COVID-19, CMS Memo QSO-20-39 (PDF), has new guidance and expectations on how nursing homes can safely facilitate in-person visitation to address the psychosocial needs of residents. The memo covers information specific to outdoor visitation.

We strongly encourage facilities to implement the guidance below when providing outdoor visitation.

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 six 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 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 six 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.


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 800-815-0015.

Phased Relaxation of Restrictions/Reopening Nursing Homes


Early in the pandemic, the Centers for Medicare Medicaid Services (CMS) issued memo QSO-20-14-NH Revised (PDF) recommending limiting visitation in nursing homes to help control and prevent the spread of COVID-19. On September 28, 2020, CMS issued revised memo QSO-20-30-NH (PDF) that included a phased relaxation of restrictions/reopening nursing homes plan for states and important guidance regarding visitation from CMS memo QSO-20-39-NH Revised (PDF). Wisconsin has adopted the CMS-recommended phased reopening plan in CMS memo QSO-20-30-NH (PDF). Please note, CMS memo QSO-20-30-NH (PDF) does not link to CMS memo QSO-20-39-NH Revised (PDF). Please use the revised CMS memo QSO-20-39-NH Revised (PDF) when relaxing restrictions and reopening your nursing home.

Phased Approach

Effective immediately, nursing homes may enter and move through the reopening phases using the factors for informed decision-making and the home's ability to meet the criteria for implementation contained in CMS memo QSO-20-30-NH (PDF). The following information, including the factors to consider when making informed decisions about relaxing restrictions in your facility, includes valuable links to Wisconsin data sources and information about the plan that is unique to Wisconsin.

Factors that should inform decisions about relaxing restrictions in nursing homes include:

  • Case status in the county: The facility will monitor the disease spread in their county using the following data sources:
    • CMS COVID-19 nursing home data
    • Information from the DHS data dashboard
    • If available, information posted on the county website, dashboard, or communication from public health (that is, Division of Public Health [DPH], local/tribal public health department [LTHD])
  • Case status in the nursing home: Absence of any new nursing home-onset of COVID-19 cases (resident or staff).
  • Testing: Continue to conduct routine staff testing and outbreak testing consistent with CMS memo QSO-20-38-NH (PDF).
  • Adequate staffing: The facility maintains sufficient staffing levels so that it is not operating at crisis capacity as defined by the CDC. The facility has a contingency staffing plan that includes a risk assessment for staff holding multiple jobs.
  • Universal source control: Residents and visitors wear a well-fitting facemask. If a visitor is unable or unwilling to maintain these precautions (such as young children), consider restricting their ability to enter the facility. All visitors should maintain social distancing and perform hand hygiene upon entry to the facility.
  • Access to adequate personal protective equipment (PPE) for staff: Facilities regularly evaluate their supply levels and are able to designate each type of PPE as being in the CDC PPE categories. Contingency capacity strategy is allowable, such as CDC's guidance at Strategies to Optimize the Supply of PPE and Equipment (facilities' crisis capacity PPE strategy would not constitute adequate access to PPE). All staff wear all appropriate PPE when indicated. Staff wear cloth face covering if facemask is not indicated, such as administrative staff. Information regarding PPE can be obtained from the DHS webpage: COVID-19 Personal Protective Equipment (PPE).
  • Local hospital capacity: Ability for the local hospital to accept transfers from nursing homes. Information regarding hospital capacity can be obtained on the DHS data dashboard.

Recommended Nursing Home Phased Plan

Nursing homes should assess their current ability to meet the factors for an informed decision to begin relaxing restrictions in the home. If the nursing home meets the above factors, it may enter the Recommended Nursing Home Phased Reopening listed on Attachment 1 of CMS memo QSO-20-30-NH (PDF).

Nursing homes may move through the phases when the home meets the criteria for implementation at each phase. Each phase includes visitation and service considerations, such as visitors, communal dining, trips outside the facility, and nonessential personnel in the facility.

In addition to the service considerations identified by CMS, please note that outdoor visitation and salon services may occur in all phases following the Outdoor Visitation Guidance for Nursing Homes and Guidance for Providing On-Site Hair Salon and Barber Services established by DHS and available on this page.

Resources and Questions

If you have questions about this information, please contact your Division of Quality Assurance Bureau of Nursing Home Resident Care Regional Office.

Planning for Staff Shortages

Maintaining appropriate staffing is essential to providing a safe work environment for facility staff and safe resident care. As COVID-19 progresses, staffing shortages will likely occur due to health care staff exposures, illness, or need to care for family members at home. 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. Facilities can take steps to assess and improve their preparedness for responding to COVID-19.

Minimum Planning Should Include:

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

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

Strategies to Lessen Staffing Shortages

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

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 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 campuses or organizations with multiple facilities or 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 the areas that are new to them.

Wisconsin Emergency Assistance Volunteer Registry (WEAVR)

If the 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. Facilities can submit their request directly to We ask that you copy your local public health agency on the submission.

Information from facilities that would expedite this process includes:

  • Contact information at the facility.
  • A brief description of the situation at the facility.
  • The skill set(s) and/or 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.

EMResource Bed Tracking System

The Department of Health Services (DHS), Division of Quality Assurance (DQA) and Division of Public Health (DPH) asks all nursing homes, hospitals, EMS providers, and other eligible entities to use the EMResource Bed Tracking System during the COVID-19 pandemic and into the future.

The EMResource Bed Tracking System tracks bed availability, identifies the number of patients pending post-acute discharges, and provides a real-time picture of bed capacity in both hospitals and nursing homes across the state. The system, expanded in March 2021 to include a nursing home dashboard, has the ability to save hospitals and nursing homes many hours of searching for beds by phone and email. Forty percent of nursing homes are signed up and actively report in the system. DHS requests the remaining 60% to enroll in EMResource and consistently report into the bed tracker dashboard.

Please register with EMResource. If you have questions or would like more information about the program, contact DHS.


Additional Resources


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

Resources to Support Skilled Nursing Facilities in Determining Admission Policies During a COVID-19 Outbreak

This information serves as a decision support tool for skilled nursing facilities (SNF). It is a companion document to "Prevention and Control of Acute Respiratory Illness Outbreaks in Long-Term Care Facilities," BCD Memo 2021-13 (PDF).

Following CDC guidance, and "Prevention and Control of Acute Respiratory Illness Outbreaks in Long-Term Care Facilities," BCD 2021-13 (PDF), "When a suspected or confirmed case of COVID-19 is identified in a facility, the CDC recommends temporary restriction of admissions to the facility, at least until the extent of transmission can be clarified and interventions can be implemented."

While COVID-19 remains a threat in Wisconsin, a SNF's administrator, in consultation with their medical director and/or director of nursing, may determine that the facility can safely admit a resident if certain considerations are taken into account. Before proceeding with resuming admissions, facility leadership should carefully review the considerations below, in consultation with the local public health officer when possible, taking into account all necessary infection prevention and control protocols.

For purposes of determining whether it is appropriate to accept admissions prior to the completion of the recommended 14-day temporary halt on admissions to affected wings or units, facilities should assess the following information:

  1. After subsequent facility-wide testing and contact tracing, either no units are impacted, or the outbreak is limited to a single unit, floor, or wing. The facility may admit to an unaffected unit, may establish an alternate temporary quarantine area, or may consider admissions within a wing or floor where an outbreak was identified if the outbreak is contained, and interventions are in place for continued containment.
  2. The facility has determined it has adequate caregiver staffing levels to safely allow admissions while in its current outbreak status.
  3. The facility has determined it has an adequate supply of PPE, based on CDC guidance, to safely allow admissions while in its current outbreak status.
  4. The facility has addressed or mitigated other extenuating circumstances that would preclude it from admitting new residents in less than 14 days.
  5. The facility will inform new admissions of the outbreak and steps it has taken to ensure patient safety.

A facility admitting a resident following review and analysis of the above considerations must document and keep record of the findings of the assessment that are being used to support a decision to allow admissions during the outbreak status, including notification to their local public health department.

Sample Language for Notification of Local Health Departments

Facilities opening in consultation with local health departments do not need to submit a notification form.

I hereby notify [local health department] that [name of facility] has experienced an outbreak and, after completing a round of facility-wide testing, have determined the facility can be open for new admissions. [Name of facility] has taken the following steps to ensure patient safety:

  • The outbreak has either not affected any units or has been limited to a single unit, floor, or wing. The unaffected unit, floor, or wing will open for admission.
  • If the unit, floor, or wing affected by an outbreak will open for admissions, the facility has established that the outbreak is contained and interventions are in place for continued containment.
  • In the event the positive case occurred in a staff member working on the facility's quarantine unit, the facility has established an alternative temporary quarantine area where there has been no infection.
  • The facility has determined it has adequate caregiver staffing levels to safely allow admissions while in its current outbreak status.
  • The facility has determined it has an adequate supply of PPE, based on CDC guidance, to safely allow admissions while in its current outbreak status.
  • The facility has addressed or mitigated other extenuating circumstances that would preclude it from admitting new residents in less than 14 days.
  • The facility will inform new admissions of the outbreak and steps it has taken to ensure patient safety.

We plan to re-evaluate this on an ongoing basis.

[Signature of Administrator/Medical Director/Director of Nursing, Date]

See DPH Communicable Diseases Memos for additional memos.

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 health care worker crisis staffing plan for long-term care facilities (LTCFs), specifically around the recommendation to let asymptomatic, COVID positive health care 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.
    • Facilities should review the Planning for Staff Shortages section of this page for guidance regarding "Strategies to Lessen Staffing Shortages."
    • 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 (PDF) and CDC Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance) 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. Review COVID-19 Health Alert #18: Return to Work for Health Care Personnel. COVID-19 Health Alert #18 provides guidance for health care facilities during a crisis situation to determine whether and how health care staff exposed to SARS-CoV-2 may be asked to return to work before completion of a quarantine period.
  5. If a facility has exhausted the resources listed in their crisis staffing plan and still does not have adequate staff to provide care and services to their residents, the facility may consider using asymptomatic, COVID-19 positive staff before they have completed the CDC recommended isolation. Facilities are encourage to implement the following strategies to address staffing shortages before using asymptomatic, COVID positive staff to provide care.

    • Review the Planning for Staff Shortages section of this page and implement the "Strategies to Lessen Staffing Shortages."
    • Communicate with WEAVR to increase staffing at the facility.
    • Allow quarantined staff exposed to COVID-19 to come back to work as indicated in HAN 18 before completing a full quarantine period.
    • Assess their PPE supply and have an adequate supply to care for residents.
    • Educate asymptomatic, COVID positive staff to self-monitor for symptoms and to immediately report any symptoms of COVID-19 to their supervisor.
    • Educate asymptomatic, COVID positive staff to limit their presence in the facility to the COVID-19 unit.
    • Provide a separate staff entrance and break area for asymptomatic staff who have tested positive for COVID-19.

    When asymptomatic, COVID positive staff return to work, they should:

    • Report a temperature and absence of symptoms before each shift.
    • Wear a facemask at all times for source control while in the facility. A higher level of personal protective equipment will be used when indicated.
    • Adhere to the requirement of home isolation, limiting close contact with others to the greatest degree possible, except while scheduled to work.
    • Stop working, notify their supervisor, and return home if they develop even mild symptoms at any time.

    Facilities are asked to notify the Division of Quality Assurance, Bureau of Nursing Home Resident Care regional office and the local public health department (LHD) of their decision by using Nursing Home Notification of Intent to Use Asymptomatic, COVID Positive Staff, F-02734 (Word). Staffing shortages should be re-evaluated regularly to determine whether exceptions to isolation remain necessary for resident safety.

  6. If the facility's Medical Director submitted a notification form to use staff exposed to SARS-C0V-2 before completing a quarantine period to the LHD, attach a copy of the notification form to the Nursing Home Notification of Intent to Use Asymptomatic, COVID Positive Staff, F-02734 (Word) and submit to the Division of Quality Assurance, Bureau of Nursing Home Resident Care regional office.

    The facility should take the following precautions:

    • Asymptomatic COVID-19 positive staff should only be allowed to work on the COVID-19 unit. There needs to be a separate entrance and break area for these staff. To prevent transmission between staff, only asymptomatic COVID-19 positive staff should be working on this wing once it is allowed, and they should not leave the unit for any reason.
    • The facility should have enough of the proper personal protective equipment (PPE) to prevent transmission of the virus, including respirators or facemasks, gowns, gloves, and eye protection (face shields or goggles).
    • All recommended COVID-19 PPE, including the use of a fit-tested N95 or higher-level respirator without an exhalation valve (or facemask if a respirator is not available), eye protection (that is, goggles or a disposable face shield that covers the front and sides of the face), gloves, and gown, must be worn by asymptomatic COVID-19 positive staff at all times in the building.
    • Strict symptom monitoring (prior to and during their shift) of these staff needs to be implemented. If they develop even mild symptoms currently 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.
    • Staff returning to work should be educated that this exception applies to their role in the facility. They should continue to isolate outside of work as previously indicated upon diagnosis.
  7. Facility representatives should check in regularly with their LHD to assess current staffing levels to determine when allowing asymptomatic COVID positive staff to return to work prior to completion of isolation should be discontinued.


Staff Vaccination Rule

On November 4, the Centers for Medicare & Medicaid Services (CMS) announced new emergency rules that requires all healthcare providers and suppliers that participate in a federally certified Medicare and Medicaid program under Medicare Conditions of Participation (COP), Conditions of Coverage or Requirements for Participation to develop a plan/process to vaccinate all staff with a first dose or single dose vaccine by December 6. All eligible staff must be fully vaccinated by January 4, 2022.

The federal emergency rule does not apply to providers that are certified through the Wisconsin Medicaid program but are not federally certified under the Medicare and Medicaid program under Medicare Conditions of Participation (COP), Conditions of Coverage or Requirements for Participation.

The Division of Quality Assurance hosted a COVID-19 Health Care Staff Vaccination Rule webinar on November 23. During the webinar, DQA staff provided information about the federal COVID-19 health care staff vaccination rule and answered questions. Learn more by viewing the following webinar recordings:

CMS has provided additional information in a FAQ document: CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (PDF).

The federal emergency regulations apply to the following Medicare and Medicaid-certified providers/suppliers:

  • Ambulatory Surgery Centers
  • Clinics
  • Community Mental Health Centers
  • Comprehensive Outpatient Rehabilitation Facilities
  • Critical Access Hospitals
  • End-Stage Renal Dialysis Facilities
  • Home Health Agencies
  • Home Infusion Therapy Suppliers
  • Hospices
  • Hospitals
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities
  • Long Term Care Facilities
  • Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
  • Psychiatric Residential Treatment Facilities (PRTFs)
  • Programs for All-Inclusive Care for the Elderly Organizations (PACE)
  • Rural Health Clinics/Federally Qualified Health Centers

Staff covered under this requirement:

The vaccination requirement applies to eligible staff working at a facility that participates in the Medicare and Medicaid programs, regardless of clinical responsibility or patient contact. This includes:

  • Facility employees
  • Licensed practitioners
  • Students
  • Trainees
  • Volunteers
  • Individuals who provide care, treatment or other services for the facility and/or its patients under contract or other arrangements

The federal emergency regulations do not apply to:

  • Adult Day Services
  • Assisted Living Facilities
  • Community Support Programs
  • Comprehensive Community Services
  • Home and Community-Based Services
  • Outpatient mental health, behavioral health, and alcohol and other drug use disorder (AODA) clinics
  • Personal Care Agencies
  • Physician’s offices

DQA Review

CMS expects state survey agencies to conduct onsite compliance reviews of the requirements during recertification surveys and complaint surveys. Surveyors will check to determine if a facility has met the three basic requirements:

  1. Having a process or plan for vaccinating all eligible staff.
  2. Having a process or plan for providing exemptions and accommodations for those who are exempt.
  3. Having a process or plan for tracking and documenting staff vaccinations.

Surveyors will review the facility’s vaccine policies, the number of resident and staff COVID-19 cases over the last 4 weeks and list of staff and their vaccination status. This information will be used to determine the compliance of the provider or supplier with these requirements.

Learn more by viewing the CMS Omnibus COVID-19 Health Care Staff Vaccination Rule presentation in video or slide (PDF) format.

Staffing and Designating Separate Areas for COVID-19 Positive Residents

The following practices reduce transmission of COVID-19 within facilities or units.

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

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

Facility leadership should work with state and local authorities to identify and designate facilities or units within a facility dedicated to residents with known or suspected COVID-19, ensuring that they are separate from COVID-19 negative residents.

  • COVID-19 positive facilities and units and wings must be capable of maintaining strict infection control practices and testing protocols, according to current regulations and emergency guidance.
  • When possible, facilities should use consistent assignments or have separate staffing teams for COVID-19 positives and those who are negative.
  • Capacity in dedicated facilities and units and wings may also include the ability to manage higher intensity residents, including ventilator management.
  • State health departments, hospitals, health systems, and advocates should work together to ensure coordination among facilities to identify and support designation of facilities or parts of facilities and ensure PPE and other supplies.
  • Facilities should, to the fullest extent possible, inform residents and their families of limited access to and ability to leave and re-enter the facility. Information should also be shared about requirements and procedures for placement in alternative facilities for COVID-19 positive or unknown status.

Testing Criteria


Testing Staff and Residents

The Overview of Wisconsin's COVID-19 Testing Plan for Nursing Homes and ICF/IIDs, P-02675 (PDF) and Preventing and Managing COVID-19 Outbreaks in Assisted Living Facilities and Skilled Nursing Facilities, P-02897 (PDF) publications describe Wisconsin's plan for testing, tracing, isolation, and quarantine.

Individuals who live and work in high-risk congregate living facilities are most at risk for spreading infection and developing complications from COVID-19. During May and June 2020 Wisconsin provided the opportunity to conduct baseline testing to every nursing home and intermediate care facility for individuals with intellectual disability (ICFs/IID) resident and staff member at no cost.

Initial Baseline Testing

Many nursing homes and ICFs/IIDs completed a point prevalence survey (PPS) (baseline testing) of all residents and staff for SARS-CoV-2 using molecular assay testing. Baseline testing establishes the prevalence of infection in a population and is used to appropriately isolate/cohort positive residents, restrict positive staff from work, and inform contact investigations so people who have been in close contact with infected cases receive quarantine instructions. Initial baseline testing should include testing of all residents and all staff, including both direct care staff and support staff.

Who Should NOT be Tested for SARS Cov-2

  • Newly admitted patients/residents known to have COVID-19 and placed into transmission-based precautions (TBP).
  • Newly admitted patients/residents placed in quarantine, unless using a test-based strategy to shorten quarantine, or they develop symptoms.
  • Asymptomatic residents and staff who have recovered from SARS-CoV-2 infection in the past three months.

CMS Testing Requirements

See Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID-19 Focused Survey Tool, QSO-20-38-NH (PDF) or testing regulations, guidance, and information regarding reporting, documentation of testing and surveying for compliance. Facilities can meet the CMS testing requirements in 42 CFR § 483.80 (h) (F886) by using rapid point-of-care (POC) antigen diagnostic testing devices provided by the Department of Health and Human Services (HHS) or through an arrangement with an offsite laboratory. Facilities without the ability to conduct COVID-19 POC testing should have arrangements with a laboratory to conduct tests to meet these requirements.

Considerations for Use of COVID-19 Antigen Testing in Nursing Homes

  • Antigen tests are available with rapid turn-around-time critical to the identification of COVID-19 infection and rapid implementation of infection prevention and control strategies.
  • These tests can augment other testing efforts, especially in settings where reverse transcription polymerase chain reaction (RT-PCR) testing capacity is limited or testing results are delayed (for example, more than 48 hours).
  • In general, these POC antigen tests have a lower sensitivity, but similar specificity, for detecting COVID-19 compared to RT-PCR tests.

Interpreting Antigen Testing

The CDC developed a process to help interpret antigen test results in nursing homes. Follow-up testing is recommended to confirm diagnosis depending on symptoms and exposure.

  • Symptomatic or close contact (including outbreaks) individuals have a higher likelihood for disease. So when the result is negative, perform confirmatory RT-PCR testing to rule out absence of infection.
  • Asymptomatic or low exposure individuals have a lower likelihood for disease. So when the result is positive, perform confirmatory RT-PCR testing to confirm presence of infection.

Implement a Plan for Follow-up Testing

Testing only provides information for a given point in time. Residents and staff with negative test results can become infected in the future. Following initial baseline testing, nursing homes and ICFs/IID should implement a plan for follow-up testing as a way to continue to identify infections early and stop transmission. A facility's plan for follow-up testing should be based on the results of initial baseline testing, the level of COVID-19 transmission in the community and the following guidance. The plan should include a procedure for addressing residents or staff who decline or are unable to be tested.

Testing Priorities – Symptomatic Testing, Outbreak Testing and Routine Testing

Regardless of the frequency of testing being performed, or the facility's COVID-19 status, the facility should continue to screen all staff (each shift), each resident (daily), and actively screen ALL persons entering the facility to include but not limited to employees, vendors, volunteers, and visitors, for signs and symptoms of COVID-19.

Symptomatic Testing

  • 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.
  • Exclude positive staff from work and use symptom-based, time-based, or test-based return to work strategies.
  • Immediately implement transmission-based precautions (TBP) in accordance with CDC guidance for any resident who develops signs, symptoms, or tests positive for SARS-CoV-2. This includes the use of the CDC COVID-19 PPE for Healthcare Personnel (PDF):
    • Gown
    • Gloves
    • Mask (respirator if involved in aerosol generating procedure)
    • Eye protection (face shield/goggles)
  • Contact and collaborate with the local public health department to identify all people who were in close contact with confirmed cases within the facility and in the community.

Outbreak Testing

  • To enhance surveillance and quickly identify residents who may be infected with COVID-19, long-term care facilities who meet the definition of an outbreak as defined in Prevention and Control of Acute Respiratory Illness Outbreaks in Long-Term Care Facilities, BCD 2020-27 (PDF), should immediately notify their local public health department to confirm the outbreak. (A resident admitted to the facility with COVID-19 does not constitute an outbreak.)
  • If the outbreak is confirmed, then the facility may order outbreak testing via the state testing portal. Facilities should follow the guidance of their state partnered lab for the collection and submission of samples.
  • Test all residents and staff upon identification of a single new case of COVID-19 in any resident or staff.
  • Retest all residents and staff that tested negative every 3–7 days until testing identifies no new cases of COVID-19 among residents or staff for a period of 14 days since the most recent positive result.
  • Repeat testing for residents or staff who previously tested positive for COVID-19 is not recommended.

Routine Testing

Process to Obtain Testing Supplies and Lab Support

Wisconsin has contracted with several labs to support both routine staff testing and outbreak testing. Submit all orders for both routine and outbreak testing via the state testing portal.

If you have questions regarding your lab testing partnership please notify testing team at:

If you have testing questions, please email

Updates are shared weekly on the nursing home provider webinars. The recordings and presentations for those meetings can be accessed in the Resources section of this page.

Staff/Resident Testing Consent Forms


Visitors to Facilities

On November 12th, the Centers for Medicare & Medicaid Services (CMS) revised CMS Memo QSO-20-39-NH REVISED (PDF) to state that visitation is now allowed for all residents at all times. CMS, in conjunction with the Centers for Disease Control and Prevention (CDC), has updated the visitation guidance but continues to emphasize the importance of adhering to the Core Principles of COVID-19 Infection Prevention. Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine should not enter the facility. Facilities should screen all who enter for these visitation exclusions.

Facilities must allow indoor visitation at all times and for all residents as permitted under the regulations. While previously acceptable during the public health emergency, facilities can no longer limit the frequency and length of visits for residents, the number of visitors, or require advance scheduling of visits. Although there is no limit on the number of visitors that a resident can have at one time, visits should be conducted in a manner that adheres to the Core Principles of COVID-19 Infection Prevention and does not increase risk to other residents. Facilities should ensure that physical distancing can still be maintained during peak times of visitation, such as lunch time or after business hours. Facilities should also avoid large gatherings (for example: parties, events) where large numbers of visitors are in the same space at the same time and physical distancing cannot be maintained.

CMS Memo QSO-20-39-NH REVISED (PDF) provides additional information regarding:

  • Use of face coverings or masks
  • Residents who are on transmission-based precautions (TBP) or on quarantine
  • Unvaccinated residents
  • Outbreak investigation
  • Visitor testing and vaccination
  • Compassionate care visits
  • Access to the Long-Term Care Ombudsman
  • Communal activities, dining and resident outings
  • Survey considerations and more


DHS Resources
CDC Resources
CMS Resources
  • Memo, QSO-20-25-NH (PDF): Supplemental information for transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status
  • Memo, QSO-20-23-ICF/IID & PRTF (PDF): Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs)
  • Memo, QSO-20-14-NH (PDF): Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (Revised)
  • Memo, QSO-20-17 (PDF): ALL Guidance for use of Certain Industrial Respirators by Health Care Personnel
  • Open Door Forums provide an opportunity for live dialogue between CMS and the stakeholder community at large.
Wisconsin Board on Aging and Long Term Care Resources
The Society for Post-Acute and Long-Term Care Medicine

Caring for PALTC Residents with Dementia During the COVID-19 Outbreak (PDF)

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
    • Smart home visual devices (Amazon Echo/Alexa, Facebook Portal, Nest Hub)
    • Smart home 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 site-wide 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 COVID-19 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 for Residents

Last Revised: April 29, 2022

211 Wisconsin

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Resilient Wisconsin

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