• Outdoor visitation continues to be preferred even when the resident and visitor are fully vaccinated against COVID-19, as this space allows increased space and airflow.
• Facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident or visitor, unless certain scenarios exist, including:
• Unvaccinated residents if the COVID-19 county positivity rate is >10% AND <70% of residents in the facility are fully vaccinated;
• Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the criteria to discontinue transmission-based precautions; or
• Residents in quarantine, whether vaccinated or unvaccinated, until they have met the criteria for release from quarantine.
• DHHS continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection prevention, including maintaining physical distancing and conducting visits outdoors whenever possible. However, residents who are fully vaccinated may choose to have close, physical contact with visitors if both parties wear well-fitted masks and perform hand hygiene before and after contact.
• If a new case of COVID-19 is identified among residents or staff, visitation should be suspended and the facility should immediately conduct outbreak testing. If the first round of facility-wide outbreak testing reveals no additional COVID-19 cases in other areas/units of the facility, then visitation can resume in the unaffected areas/units.
• However, if outbreak testing detects one or more COVID-19 cases in other units of the facility, the facility must stop visitation for both vaccinated and unvaccinated residents until it can meet the criteria to end outbreak testing.
• Compassionate care visits, and visits required under federal disability rights law, should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak.
• While end-of-life situations have been used as examples of compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life situations. Examples of other types of compassionate care situations are outlined in CMS guidance.

• Residents leaving the facility for less than 24 hours: quarantine is not recommended for vaccinated or unvaccinated residents (unless there is prolonged close contact with someone with SARS-CoV-2 infection). Residents are encouraged to adhere to the 3 W's.
• For unvaccinated residents that leave the facility for ≥24 hours: quarantine is recommended when they return.
• For vaccinated residents that leave the facility for ≥ 24 hours: quarantine is not recommended unless they have had prolonged close contact with someone with SARS-CoV-2 infection while they were outside the facility. An exception to this would be if residents have “traveled”. CDC travel guidance states that individuals who have traveled should quarantine for 14 days after travel (regardless of vaccination status) if they will be having contact with individuals at increased risk for severe illness.
• Fully vaccinated residents being admitted to a LTCF no longer require quarantine as long as they have not been in prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.
• Fully vaccinated residents in LTCFs should continue to quarantine following prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.
• Although not preferred, facilities could consider waiving quarantine for fully vaccinated residents following prolonged close contact with someone with SARS-CoV-2 infection as a strategy to address critical issues (e.g., lack of space, staff, or PPE to safely care for exposed patients or residents) when other options are unsuccessful or unavailable. These decisions could be made in consultation with public health officials and infection control experts.
• Fully vaccinated staff with higher-risk exposures who are asymptomatic do not need to be restricted from work for 14 days following their exposure. Work restrictions for the following fully vaccinated staff with higher-risk exposures should still be considered for staff who have underlying immunocompromising conditions (e.g., organ transplantation, cancer treatment), which might impact the level of protection provided by the COVID-19 vaccine.

• Symptomatic or close contact testing of residents or staff.
• Serial screening testing of staff and/ or residents as recommended by the CDC.
• Screening of visitors upon arrival to the facility.

• CLIA Certificate—Obtain a CLIA certificate or partner with an entity with a CLIA certificate.
• Physician Order—Secure a signed physician order or elect to use the Statewide Order.
• PPE–Maintain an adequate supply of PPE to perform tests.
• Medical Waste—Adhere to standards to properly handle and dispose of medical waste.
• Training—Ensure all testing personnel have completed BinaxNOW or BD Veritor training.
• Reporting—Verify ability to complete DHHS reporting requirements. Options for electronic reporting can be found at Getting Started with Automated Reporting: NC DHHS COVID-19. Choices best suited for long-term care facilities are the COVID-19 Laboratory Data Automation (“CLDA”) process or an online tool, eCATR Patient Test Results (PTR ).
• Quarantine & Isolation Support—Sites should have a plan in place to safely quarantine and isolate all residents with suspected or confirmed cases of COVID-19 or who are close contacts of a COVID-19 case and support staff who may be disparately impacted by quarantine and isolation requirements.

• For more information on antigen testing, please email NCDHHS_Antigen@dhhs.nc.gov.
• For general COVID-19 response guidance, please see the NC DHHS Toolkit of Long Term Care Facilities.