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COVID-19 guidance, recommendations, and resources
Facilities should admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was or is present. Facilities should follow the CDC guidance for infection control when COVID-19 is identified or suspected in a resident. Facilities may not require a negative COVID-19 test as a condition of admission.
Newly admitted or readmitted residents who are not up to date with all recommended COVID-19 vaccinations should be educated and offered a COVID-19 vaccine per CDC recommendations and CMS requirements (PDF).
Admissions During a COVID-19 Outbreak
When a suspected or confirmed case of COVID-19 is identified in a facility, the facility may temporarily halt admissions to the facility, at least until the extent of transmission can be clarified and interventions can be implemented. See Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities for more information.
While COVID-19 remains a threat to long-term care residents, a facility may determine that they can safely admit a resident if certain considerations are taken into account. Facility leadership should carefully review CDC's Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic for Nursing Homes and consult with the local public health officer when possible.
Discharges and Transfers
If a resident has been exposed and is being discharged, the discharging facility must inform the facility that is accepting the resident. This will allow the facility that is accepting the resident to ensure the resident uses source control and that any recommended testing is completed.
- CDC COVID-19 Data Tracker: United States COVID-19 Hospitalizations, Deaths, Emergency Visits, and Test Positivity by Geographic Area
- CDC COVID-19: Wastewater Surveillance
- CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2
- CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
- CDC Similarities and Differences between Flu and COVID-19
- CDC Stay Up to Date with COVID-19 Vaccines
- CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages
- CDC Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating
- CDC Ventilation in Buildings
- CDC's Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings
The CMS Quality, Standards, and Oversight Board memos are posted on the Survey and Certification memos website. Filter on nursing home.
- CMS QSO-20-29 (PDF) - Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes (COVID-19 Tags F884 and F885)
- CMS QSO-20-39 (PDF) - Nursing Home Visitation - COVID-19 (Revised)
- CMS QSO-21-19 (PDF) - Interim Final Rule - COVID-19 Vaccine Immunization Requirements for Residents and Staff (COVID-19 Tag F887)
- CMS 23-10 (PDF) - Strengthened Enhanced Enforcement for Infection Control Deficiencies and Quality Improvement Activities in Nursing Homes
- CMS QSO-23-13 (PDF) - Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)
- Updated Guidance for Nursing Home Resident Health and Safety
- COVID-19: Health Care Providers
- DPH Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities
- Preventing and Managing COVID-19 Outbreaks in Assisted Living and Skilled Nursing Facilities, P-02897 (PDF)
- Infection Preventionist Starter Kit, P-02992 (PDF)
- Additional COVID-19 infection prevention and personal protective equipment fact sheets can be found on the COVID-19: Communication Resources webpage.
- DHS COVID-19: Wisconsin Coronavirus Wastewater Monitoring Network
CMS COVID-19 Reporting Requirements
On May 6, 2020, CMS issued Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes Memo, QSO-20-29-NH (PDF) requiring nursing homes to report COVID-19 facility data to the CDC and also to residents, their representatives, and families. On May 1, 2023, CMS issued Guidance for the Expiration of the COVID-19 Public Health Emergency, QS0-23-13 (PDF) that removed the facility requirement to report COVID-19 information to residents, their representatives, and families. Reporting of COVID-19 facility data to the CDC's NHSN remains in effect. Failure to report COVID-19 facility data may result in an enforcement remedy.
DHS Reporting Requirements
Wisconsin has communicable diseases reporting requirements. Specific reporting requirements are described in Wis. Admin. Code ch. DHS 145 Control of Communicable Diseases. A list of reportable communicable diseases and other conditions is provided in Wis. Admin. Code ch. DHS 145 - Appendix A.
On September 29, 2023, DHS issued Changes to COVID-19 Reporting Requirements in Wisconsin, BCD 2023-05 (PDF) wherein the State Epidemiologist declared effective November 1, 2023, reporting of COVID-19 cases to public health is no longer required unless a confirmed or probable case is associated with a hospitalization or pediatric death.
Outbreak Reporting Requirements
In Wisconsin, confirmed or suspected outbreaks of any disease in health care facilities, including long-term care facilities, are a Category I Disease, meaning they shall be reported immediately by telephone to the patient's local health officer, or to the local health officer's designee, upon identification.
Suspected respiratory disease outbreak, including COVID-19
According to DHS guidance for Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities, a suspected respiratory disease outbreak in a long-term care facility is defined as three or more residents and/or staff from the same unit with illness onsets within 72 hours of each other and who have pneumonia, acute respiratory illness, or laboratory-confirmed viral or bacterial infection (including influenza and COVID-19).
CDC recommendations and CMS guidance (PDF) recommends nursing homes establish a process to provide guidance about screening everyone (all staff, visitors, hospice, clergy, external health care personnel, surveyors and all vendors) entering the facility and what actions they should take for anyone who meets any of the following criteria:
- Tested positive for SARS-CoV-2 with a viral test
- Has symptoms of COVID-19, or
- Had a known exposure to someone with COVID-19 (or a higher-risk exposure for health care personnel).
Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they have met CDC criteria for healthcare settings to end isolation. Visitors who have had close contact with someone with COVID-19 infection should defer non-urgent in-person visitation until 10 days after their close contact if they meet criteria described in the CDC healthcare guidance (e.g., cannot wear source control).
Staff who have a fever or any COVID-19 symptoms prior to or during their shift should be excluded from work. Decisions about when staff can return to work should be made using Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection.
Source control is recommended for individuals in healthcare settings who:
- Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
- Had close contact (residents and visitors) or a higher-risk exposure (health care personnel) with someone with SARS-CoV-2 infection, for 10 days after their exposure
Source control is recommended more broadly as described in the CDC's Core Infection Prevention and Control Practice in the following circumstances:
- By those residing or working on a unit or area of the facility experiencing a SARS-CoV-2 or other outbreak of respiratory infection; universal use of source control could be discontinued as a mitigation measure once the outbreak is over (e.g., no new cases of SARS-CoV-2 infection have been identified for 14 days); or
- Facility-wide or, based on a facility risk assessment, targeted toward higher risk resident populations (e.g., when caring for residents with moderate to severe immunocompromise) during periods of higher levels of community SARS-CoV-2 or other respiratory virus transmission
- Facility-wide when COVID-19 hospital admission levels are high
Anyone with even mild symptoms of COVID-19 should receive a viral test for SARS-CoV-2 as soon as possible.
Asymptomatic residents with close contact and HCP following a high-risk exposure with someone with SARS-CoV-2 infection should have a series of three viral tests for SARS-CoV-2 infection. Testing is recommended immediately, but not earlier than 24 hours after the exposure. If the test is negative, the resident should be tested again in 48 hours. If the second test is negative, the resident should be tested again in 48 hours. If exposure is day 0, testing will typically be on day 1, day 3, and day 5. Source control is recommended for 10 days after their exposure.
According to the CDC, there is strong scientific evidence that antiviral treatment of outpatients at risk for severe COVID-19 reduces their risk of hospitalization and death. COVID-19 treatment should be considered in residents with mild to moderate COVID-19 who have one or more risk factors for severe COVID-19. Treatment must be started as soon as possible within 5 days of symptom onset to be effective.
On May 6, 2022, the Division of Public Health published BCD Memo 2022-07 (PDF) titled COVID-19 Oral Antivirals Medication for Long-Term Care Residents. The purpose of this memo is to provide an overview of Paxlovid and Lagevrio, outline requirements for maintaining a contingency supply in SNFs, and to describe the medication ordering process for long-term care (LTC) pharmacies. Clinical guidance about the use of COVID-19 therapeutics changes frequently. Links to federal guidance are provided throughout this memo, and clinicians are encouraged to consult these resources for the most up-to-date information.
On November 22, 2022, CMS published CMS QSO Memo 23-03-All (PDF) titled The Importance of Timely Use of COVID-19 Therapeutics that states every patient who tests positive for COVID-19 should be evaluated to determine whether the use of an available therapeutic is appropriate. Nursing homes should ensure residents receive (in consultation with their physician and family) appropriate treatment when tested positive for COVID-19.
Nursing homes, in particular, are encouraged to review the latest updated information from the National Institutes of Health for use of clinically appropriate therapeutics.
DHS offers a Free Virtual COVID-19 Treatment Telehealth Consultation Service for Wisconsinites over the age of 18 and clinicians wanting guidance on prescribing the antiviral treatments.
- To improve ventilation in your building, keep your system operating as designed. Aim for at least 5 air changes each hour and upgrade to MERV-13 filters if able to do so.
- Good ventilation is essential to maintaining a healthy indoor environment and protecting building occupants from respiratory infections.
- Improving ventilation in buildings can help reduce the number of viral particles in the air and lower occupants' risk of exposure to respiratory viruses.
- Implementing multiple infection prevention and control strategies at the same time can increase the overall effectiveness of ventilation interventions.
Nursing home resources
- Avoiding Physical Restraints, P-63113 (PDF) - Find information on avoiding restraints in nursing homes.
- Consumer Guide: Consumer Information Reports for Nursing Homes and Facilities for People with Developmental Disabilities - Access consumer reports, resources, directories, survey results, and more.
- Consumer Guide: Finding and Choosing a Nursing Home - Find directories and survey results.
- Healthcare-Associated Infections in Long-Term Care Coalition - Find information on efforts to eliminate these infections from long-term care facilities.
- Independent Informal Dispute Resolution for Federally Certified Nursing Homes, P-01855 (PDF) - Learn about dispute resolution for federally certified nursing homes.
- Informal Dispute Resolution for Nursing Homes and Facilities Serving People With Developmental Disabilities (FDD), P-01856 (PDF) - Find guidance for dispute resolution to resolve citations from the Wisconsin Division of Quality Assurance (DQA).
- Informed Consent for Psychotropic Medications for Nursing Home Residents - Learn more about requirements for written consent for medication for nursing home residents.
- Medication Aides: Nursing Home/Hospice - Learn about specific rules for giving medications to nursing home residents and hospice patients in Wisconsin.
- Music & Memory Program - Learn about a Wisconsin initiative to support nursing home residents.
- Nursing Homes: Pressure Injury (Pressure Ulcer) Information - Find information for providers on avoiding pressure injuries in nursing homes.
- Preadmission Screening and Annual Resident Review - Learn about the federal requirement to identify patients with mental illness and/or intellectual developmental disabilities.
- Prevention and Control of Viral Gastroenteritis Outbreaks, P-06653 (PDF) - Learn how to avoid breakouts of viral illnesses at nursing homes and other facilities.
- Resident Relocation Manual - Learn about the process for bed or facility closures and resident relocation.
- Survey Guide for Long Term Care Facilities, P-62014 (PDF) - Find information on the survey process in the state of Wisconsin.
- Aging: Programs and Services for Older Adults - Find a variety of topics to learn more.
- Caregiver Programs - Learn more about caregiver programs, including background checks, feeding assistance, medication aides, and more.
- Client Rights Office - Find guidance for patients receiving services for developmental disabilities, mental health, or substance use.
- Clinical Laboratories - Find information on alcohol and drug testing laboratories.
- Construction/Remodeling Plan Review for Health Care Facilities - Find information on submitting a plan for construction or remodeling of a health care facility.
- Consumer Guide: Traumatic Brain Injury Care Units - Learn more about finding and choosing providers to support care.
- Consumer Guide: Ventilated Care Units - Learn how to find and choose providers to support ventilated care.
- DHS Partners and Providers - Find useful information for all agencies, organizations, and providers that partner with the Wisconsin Department of Health Services (DHS).
- Dementia Care in Wisconsin - Access the State Dementia Plan and build a dementia-friendly community of support for those with dementia and their families.
- Diabetes Prevention & Control Program - Learn more about diabetes and prevention programs.
- Do-Not-Resuscitate Information - Learn more about do-not-resuscitate orders and what they mean for health care professionals.
- e-SOD/e-POC Process - Learn more about the electronic process for statements of deficiencies and plans of correction.
- Feeding Assistant Program - Learn more about the feeding assistant program.
- Medicaid Nursing Home Reimbursement - Find reimbursement information for Medicaid.
- Misconduct Resources - Find information on background checks and the misconduct investigation program.
- Pharmacy Newscapsule - Newsletter published regularly by DQA.
- Resilient Wisconsin - Learn about efforts to improve health equity.
- WisCaregiver Careers Program - Find more information on this workforce development program.
- Wisconsin Alzheimer's Institute - Read about research initiatives, memory clinics, education and public health programs, and more.
- Wisconsin Board on Aging and Long Term Care - Find resources to understand options for aging, long term care, Medicare, and prescription drug coverage.
- Wisconsin Medicaid Information - The ForwardHealth portal will direct you to provider-specific Medicaid information. Learn more about Medicaid in Wisconsin.
- Wisconsin Tuberculosis Program - Learn more about tuberculosis in Wisconsin and how the state program identifies, treats, and stops the spread.
- Federal Resources - Find information about CMS (Centers for Medicare & Medicaid Services), civil rights, the U.S. Department of Labor, and more.
- Nursing Home Comparison Tool - Find and compare nursing homes and other providers in your area using this online CMS tool.
- Wage and Hour Division Topical Fact Sheet Index - Find Fair Labor Standards Act information by topic from the U.S. Department of Labor. Topics include health care, nursing care facilities, nurses, home health care, overtime, and more.
State reporting requirements
- Report Abuse, Neglect, or Misappropriation - Learn about reporting and timing requirements for any claims of abuse or neglect, or misappropriation of client property. This includes DQA-regulated providers and non-regulated providers.
- Reporting a Client, Patient, or Resident Death - Learn about reporting requirements for programs or facilities when there is a death.
- Cold Weather Safety - Learn more from the National Weather Service about staying safe in extreme, cold temperatures.
- Influenza Immunization Resources for Health Care Providers - Find information including patient education, how to prepare your office for flu season, and other resources to improve flu vaccination rates.
- Preventing Heat-Related Illness and Severe Weather Awareness - Use and share information about preventing heat-related illness and planning for power outages and severe weather.
- Winter Safety Measures for Health Care Providers - Learn more about different topics, such as hypothermia, and indoor and outdoor safety.
Safety and emergency preparedness
- Emergency Preparedness and Response - Find preparedness resources for health care facilities from the CDC (Centers for Disease Control and Prevention).
- Emergency Preparedness for Long Term Care and Assisted Living Facilities - Find preparedness resources for health care facilities from DQA.
- Safety in Health Care - Resources from DQA to help providers create a culture of safety. Find ways to guide staff on critical safety practices in health care facilities.
- Nursing Home Educational Series - Part Four: May 30, 2023
- Nursing Home Educational Series - Part Three: April 18, 2023
- Agenda (PDF)
- IPC Superior Health (PDF)
- Enhanced Barrier Precautions Guidance Review (PDF)
- QSO-23-10-NH (PDF)
- Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs)
- Contact Precautions - CMS SOM Appendix PP – Guidance to Surveyors (PDF)
- CDC Nursing Home Infection Preventionist Training Course
- Training the Next Generation of WI Nursing Home Infection Preventionists
- Nursing Home Educational Series - Part Two: March 28, 2023
- Nursing Home Educational Series - Part One: February 28, 2023
- View the DQA Long-Term Care Provider Webinar showcase for past webinars.
- American Health Care Association & National Center for Assisted Living - Find information from national organizations supporting hospices and other entities.
- LeadingAge - Learn more from a national group supporting aging services providers.