First . . . A Little Holiday Humor
Why was the Thanksgiving Soup so Expensive?
It had 24 carrots.
Knock Knock. Who's there? Norma Lee.
Norma Lee who? Norma Lee I don't eat this much!
Staff told me to stop telling Thanksgiving jokes.
... but I told them I couldn't quit "cold turkey!”
COVID-19 Fatigue: Now's Not the Time to Let Your Guard Down During the Thanksgiving Holiday
See Clarification Below for CMS, CDC and AHCA Guidance
to Share with Families and Staff
FSLA has received several questions from members who are concerned about residents and staff who are leaving the community spending time with family or friends during the Thanksgiving holidays.
This past Friday, AHCA issued a friendly holiday guidance reminder for residents and staff. The notice points to CMS guidance (although addressed to nursing homes, the guidance is appropriate for ALFs and other long ter care communities) and CDC recommendations for holiday celebrations and small gatherings in general.
After FSLA’s review and discussion of the guidance with fellow members, a few practical recommendations could include:
- Discuss the increased risks and recent rise in the number of cases statewide with residents, families and staff and ask them to adhere to CDC guidelines for wearing masks, social distancing, washing hands and using hand sanitizer, etc.
- Ask the resident, perhaps with a family member’s assistance, to complete and sign a form stating that the resident understands the risks before leaving and re-entering the community, and that the resident may need to self-isolate for 14 days upon return to protect the other residents.
- Provide or request that residents and staff receive at least two negative COVID tests at least 14 days apart upon return to the community to ensure that they are not asymptomatic or positive.
- The Surgeon General recently stated that the optimal time to test is 7 days after return.
- Double-check with your local Department of Health to see if they have additional requirements to CDC guidance, such as quarantining residents upon return to the building due to the number of cases in your county - and make that information available to residents and families before leaving community.
Otherwise, CMS reminds us that:
- During the holidays, facilities, residents, and visitors should continue to follow the guidelines for visitation and adhere to the core principles of infection prevention, such as remaining six feet or more apart, wearing a face covering, and limiting the number of visitors in the nursing home at any one time.
- While CMS supports family engagement and a resident’s right to leave the community, everyone needs to work together to take extra precautions to help reduce the spread of COVID19, which can pose an elevated danger to the health of residents. Therefore, CMS recommends against residents leaving the community during this public health emergency.
- Communities should educate residents and families of the risks of leaving the facility, the steps they should take to reduce the risk of contracting COVID-19, and encourage residents to stay connected with loved ones through alternative means of communication, such as phone and video communication.
For staff, CMS recommends:
Staff should also use extra caution, especially during the holidays. Staff should follow the same recommendations for residents and families regarding gathering with their families and friends outside of work to protect the vulnerable residents they care for.
For residents that choose to leave the community for the Thanksgiving holiday, the Center for Medicare and Medicaid Services (CMS) recommends:
- Limit close contact (maintain physical distancing of six feet or more), keep gatherings as small as possible, and use technology to engage with others remotely.
- Wear facemasks or cloth face covering at all times (including in cars, homes, restaurants, etc.)
- Limit contact with commonly touched surfaces or shared items
- Keep safe around food and drinks. Avoid communal serving utensils, passing of food, potluck or buffet style food service, and instead opt for individually prepared plates by a single server
- Perform hand hygiene often (e.g., wash hands with soap and water or alcohol-based hand sanitizer)
- Avoid large gatherings, crowded areas, and high-risk activities such as singing
- For those attending a gathering, avoid contact with individuals outside of their household for 14 days prior to the gathering
- Ask anyone who has signs or symptoms of COVID-19, or has been exposed to someone diagnosed with COVID-19, to not attend the gathering
- If possible, conduct gatherings outdoors. Indoor gatherings should have good ventilation, open windows and doors if possible
- Verbally greet others instead of shaking hands or giving hugs. Think ahead about how you will manage to prevent physical interactions with loved ones of different ages such as young children; and
- Check local conditions and state requirements for precautions and restrictions, including positivity rates and quarantine requirements, before crossing state lines.
Upon resident’s return, CMS recommends:
- Screen and increase monitoring for signs and symptoms.
Test a resident for COVID-19 if signs or symptoms are present or if a resident or their family reports possible exposure to COVID-19 while outside the building. Also, opt to test residents without signs or symptoms if they leave the building frequently or for a prolonged length of time, such as over 24 hours. For more information on testing guidelines (see CMS Memorandum QSO-20-38-NH).
- Place the resident on transmission-based precautions (TBP) if the resident or family member reports possible exposure to COVID-19 or if the resident has signs or symptoms of COVID-19 upon return.
- Please note that residents and loved ones should report if they have had any exposure to COVID-19 while outside of the building.
- Consider placing residents on TBP if they were away for more than 24 hours.
23. Holiday Leave: Can a resident leave the facility for a holiday visit with family and are there restrictions on the length of absence?
Answer: Residents must be permitted to leave the facility if they wish, including holiday visits. There is no restriction on the length of absence, and it may include an overnight absence. Residents leaving the facility temporarily must wear a face mask, if tolerated by the resident’s condition. Eye protection should also be encouraged. All residents must be screened upon return to the facility. Families must be informed of necessary precautions to take during the absence, and of the requirement to screen the resident upon return to the facility. Any time a resident is out in the community, the resident and the resident’s family should encourage adherence to infection prevention and control requirements, including social distancing and especially hand hygiene.
In addition to routine screening criteria for temperature and symptoms, screening for returning residents should assess potential exposure such as contact with anyone who was symptomatic, attendance at large gatherings and adherence to social distancing. If upon return, the resident does not pass screening criteria, they should be quarantined or isolated based on their circumstances consistent with CDC guidance. If the resident passes screening criteria, then they do not have to be quarantined or isolated. Please continue to monitor any updates from the CDC or Department of Health.
Many individuals who contract COVID-19 may not display symptoms or test positive for several days after exposure, so it is still critical to diligently follow infection control precautions for residents returning from an absence including wearing a mask, hand washing, and social distancing. Facilities may consider re-testing residents periodically after an extended absence.
Long-term care facilities are strongly encouraged to utilize testing resources to perform COVID-19 testing for residents returning from absences. Many facilities have received Point of Care tests that may be used for this purpose; however, this should not be the only tool to monitor residents. Symptomatic individuals who test negative with a Point of Care test should still be quarantined, and retesting using a PCR test should be considered. If the facility conducts testing, it must be based on current CDC and FDA guidance and results reported to the Department of Health as required.
EXTRA -- EXTRA!!!! Based on the information above and input from members, below is a few extra thoughts to help you develop a questionnaire for leaving the community during the holidays. Also, download a copy of the guidance to give to your residents and staff.
If a resident leaves the building for Thanksgiving, ask for the following information:
- Identify the resident’s name, date/time, and destination;
- Identify all persons by name that the resident believes they will have contact with;
- Check a box confirming that the resident:
- Understands that by leaving the community they are putting themself, other residents, and staff at higher risk of exposure to COVID-19 which is a highly contagious, severe respiratory virus. COVID-19 can include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
- Understands the importance of infection control such as PPE, social distancing and washing hands - for themselves, but also for their fellow residents and staff.
- Upon return to the community, the resident will immediately put on a mask and practice infection control strategies. Depending on the community’s evaluation of the risk of exposure, residents may need to have increased monitoring or stay in room for up to 14 days; however, when leaving room, wear a mask and practice infection control strategies.
- Require Resident’s signature.
Upon the resident’s return, ask for the following information:
- Identify the resident’s name, date/time;
- Identify the resident’s temperature and screen upon return;
- Update all persons the resident had contact with during the outing; and
- Check a box confirming that the resident:
- Understands they will be required to put on a mask immediately, and will be required to wear a mask when leaving their apartment.
- Require Resident’s signature.
AHCA Requests ALF Providers to Answer Testing and CLIA ID Questions in Daily ESS Database
AHCA has now added several new questions to ESS about conducting routine staff testing. They also need to know the CLIA ID for the facility – some are leaving this field blank.
Please make sure to answer the new testing questions and if your community is not testing, answer N/A.
If You Missed Signing Up for the Vaccine
Please contact your county Department of Health location and request instructions on how to sign up your community.