Unfortunately, we are well-aware of COVID-19, commonly referred to as coronavirus, whether it is because we can no longer watch our favorite athletes play due the postponement or cancellation of nearly all sporting events, cannot take that trip to Disney World that was planned a year in advance, or simply cannot go about life as normal because of shortages at the grocery stores and the interruption to our social life.
Coronavirus symptoms include fever, coughing, and shortness of breath and the majority of people that acquire the illness report mild symptoms and recover fully with little to no treatment.
However, this seemingly mild illness can present serious health complications and even prove fatal to the most vulnerable in our society namely those individuals who reside in nursing homes and long-term care facilities.
Since nursing home populations are at the highest risk of being affected by coronavirus, it is imperative that the facilities in which they live take the necessary precautions to prevent and contain the virus.
If you have a loved one in a nursing home, long term care, or assisted living facility the following precautions should be taken by the facility according to the Centers for Disease Control and Prevention:
1. Educate Residents, Healthcare Personnel, and Visitors
Education is critical because often individuals working at these facilities include facility-based and consultant personnel including doctors, barbers, podiatrists, etc. that provide care to multiple facilities and can be exposed or serve as a source of transmission. Education can take many forms and includes the following:
- Educate healthcare providers on the latest information about coronavirus and reinforce sick leave policies. It is imperative that individuals not report to work if they are ill.
- Demand strict adherence to infection and control measures, including hand hygiene and use of personal protective equipment.
- Educate residents and families about coronavirus and the actions the residents and families can take to protect themselves in the facility such as frequent handwashing.
2. Provide Supplies for Recommended Infection Prevention and Control Practices
- Hand hygiene supplies are critical and in addition to being well-stocked with hand soap and paper towels, the facilities should have alcohol-based hand sanitizer with 60-95% alcohol in every resident room and preferably inside and outside the room as well as in resident care and common areas.
- Respiratory hygiene supplies such as tissues and facemasks should be readily available for individuals with a cough.
- Make Personal Protective Equipment (PPE) available in areas where resident care is provided. Put 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. Facilities should have supplies of facemasks, respirators, gowns, gloves, and eye protection.
- Make sure that EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment.
3. Assessing Risk and Possible Restrictions for HCP
- Implement sick leave policies that are non-punitive, flexible, and consistent with public health policies that allow sick health care professionals to stay home.
- Ask health care professionals to regularly monitor themselves for fever and symptoms of respiratory infection.
- If healthcare professionals develop fever or symptoms of respiratory infection while at work, they should immediately put on a facemask, inform their supervisor, and leave the workplace.
- When transmission in the community is identified, nursing homes and assisted living facilities may face staffing shortages. Facilities should develop (or review existing) plans to mitigate staffing shortages.
4. Consider New Policies and Procedures for Visitors
- Facilities should discourage or prevent visitation. Signs should be posted at the entrances to the facility instructing visitors to not enter if they have fever or symptoms of a respiratory infection. Consider having visitors sign visitor logs in case contact tracing becomes necessary.
- When allowed, visitors should be encouraged to frequently perform hand hygiene and limit their movement and interactions with others in the facility, for example, confine themselves to the resident’s room).
- When visitor restrictions are implemented, the facility should facilitate remote communication between the resident and visitors and have policies addressing when and how visitors might still be allowed to enter the facility in case of end of life situations.
5. Evaluate and Manage Residents with Symptoms of Respiratory Infection
- Ask residents to report if they feel feverish or have symptoms of respiratory infection.
- Immediately assess residents for fever and symptoms and signs of respiratory infection upon admission and throughout their stay in the facility.
- Implement appropriate infection prevention practices for symptomatic residents:
- If a resident has severe respiratory infection, or a cluster of residents has symptoms of respiratory infection, or there is an increase in cases reported in the community, begin active monitoring of all residents and health care personnel in the facility for signs and symptoms.
- Notify the health department about residents with severe respiratory infection and clusters of respiratory infection.
6. Additional Measures
- Minimize group activities inside the facility or field trips outside of the facility.
- Develop criteria for halting group activities and communal dining, closing units or the entire facility to new admissions, and restricting visitation.
- Create a plan for coordinating residents with symptoms of respiratory infection, including dedicating HCP to work only on affected units.
IF CORONAVIRUS IS SUSPECTED, BASED ON EVALUATION OF THE RESIDENT OR PREVALENCE OF CORONAVIRUS IN THE COMMUNITY
- 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.
- Room sharing might be necessary if there are multiple residents with known or suspected COVID-19 in the facility. As roommates of symptomatic residents might already be exposed, it is generally not recommended to separate them in this scenario. Public health authorities can assist with decisions about resident placement.
- Facilities should notify the health department immediately.
- If a resident requires a higher level of care or the facility cannot fully implement all recommended 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.
In addition, the following stricter guidelines should be followed:
Policies and Procedures for Visitors:
- Restrict all visitors to the facility. Exceptions might be considered in limited circumstances as in end of life situations. In those circumstances the visitor should wear a facemask and restrict their visit to the resident’s room.
Healthcare Personnel Monitoring and Restrictions:
- Implement universal use of facemask for healthcare professionals while in the facility.
- Consider having healthcare professionals wear all recommended personal protective equipment for the care of all residents, regardless of presence of symptoms. Implement protocols for extended use of eye protection and facemasks.
Resident Monitoring and Restrictions:
- Encourage residents to remain in their room. If there are cases in the facility, restrict residents to their rooms except for medically necessary purposes.
- If they leave their room, residents should wear a facemask, perform hand hygiene, limit their movement in the facility, and perform social distancing (stay at least 6 feet away from others).
- In addition to cancelling group field trips and activities, cancel communal dining.
- Implement protocols for cohorting ill residents with dedicated HCP.
For most of us, the coronavirus is just an inconvenience, however for the most vulnerable in our society it can have tragic results. All facilities should have a plan in place to combat the spread of the illness and to properly care for all patients in the event that the virus is presented there. If you feel your loved ones’ facility is not taking the proper steps to fight the coronavirus, you can also seek the guidance of an experienced attorney. The attorneys at Creighton Macaluso Law Firm, LLC have years of experience assisting and helping residents and their families in protecting their rights. Contact them today to schedule a completely free consultation if you or someone you know is concerned with the response a nursing home, assisted living, or residential facility is taking to the coronavirus.