Frequently Asked Questions: COVID-19 and Long-Term Care and Residential Care Facilities

The Long-Term Care and Residential Care Sector team will continue to update this information as often as possible. If your question is not addressed below, please contact us at COVID-LTC@sdcounty.ca.gov.  

 

What are the general recommendations for nursing homes and other long-term care institutions before and during an outbreak of COVID-19?

  • Ongoing use of general infection control measures (see CDC’s preparedness checklist here).
  • Symptom watch processes for COVID-19.
  • Timely notification to public health about outbreaks of cases.
  • Education and guidance of infection control and prevention measures.
  • Screening and testing of symptomatic patients, as needed (or appropriate).
  • Implementation of limits on visitor and new admissions.
  • Ensuring adequate supply of Personal Protective Equipment (PPE) and supplies.
  • Ensuring a healthy and symptom free staff.
  • Good communication and coordination with local and state response partners.
  • Timely transport of severely infected individuals to the hospital.
  • Monitoring of the situation.

 

What are the definitions for an outbreak and an outbreak for this setting?

  • Community outbreak criteria for COVID-19 is two or more cases of acute respiratory infection (ARI) with symptom onset within 14-days of each other, at least one of whom is laboratory-confirmed for COVID-19, and who are in proximity to the same infectious source – this assessed on a case by case basis – Note: in the absence of CDPH definition.
  • Institution/Congregate setting (acute health care, long term care, dormitory, etc) outbreak criteria for COVID-19 is two or more cases of ARI with symptom onset within 14-days of each other, at least one of whom is laboratory-confirmed for COVID-19.

 

What is the investigative process?

  • Public Health Services becomes aware either through a call from the facility, a medical record report noting a nursing home or through matching a patient’s positive lab result against a list of known addresses of nursing home or long-term care facilities (LTCF).
  • Initial assessment steps include:
    • Connect with the facility point of contact (POC) and evaluate for an outbreak using the outbreak definitions and intake form.
    • Review CDC COVID-19 recommendations:
    • Instruct the facility to evaluate their stock of PPE using the COVID-19 LTCF PPE Assessment document. If additional PPE and/or environmental cleaning/disinfection supplies are needed they should contact: MOC.LOGS.HHSA@sdcounty.ca.gov.
    • If the facility has symptomatic residents and testing would aid classifying the outbreak, then offer testing via Public Health Lab (PHL).
      • At minimum, request 4 nasopharyngeal (NP) swabs be submitted from ill residents/staff.
      • Complete PHL requisition form and order testing for ‘2019-nCoV’ and Influenza PCR.
      • Ensure that the requisition form accompanies the specimen to PHL.
      • Inform PHL of incoming outbreak specimens

 

What actions are taken during an outbreak investigation?

  • Conduct a facility assessment which includes establishing POC.
  • Review and provide guidance on infection control and prevention measures.
  • Provide a surveillance log for facilities to record detections, characterize and investigate their outbreak.
  • The facility should immediately report to the investigator if a second laboratory-confirmed COVID-19 case is identified, or if a resident/staff member develops ARI. If afterhours, contact the Epidemiology Program Duty Officer.
  • Request updates from the POC. Immediately notify if surge in cases, increase in severity of illness, hospitalizations, or a death occurs.

 

How is the outbreak controlled?

  • If the facility cannot fully implement all recommended precautions, then the Epidemiology Unit and medical directors should be consulted on alternative options (e.g., transfer of cases to a fully equipped facility).

 

How is the outbreak monitored?

  • Ongoing work with the facility with frequent check in.

 

What determines the end of an outbreak?

  • Keep the outbreak open for the 14-day monitoring period. After 14-days, confirm with the POC that no new cases have been identified. 

Is it possible to get testing for potential residents or participants in programs before we admit them?

  • Testing for COVID-19 is recommended for people at higher risk of developing severe complications from the disease, especially those in congregate settings and experiencing symptoms. Per the State licensing entities, all new residents should be tested prior to being admitted to a facility.
  • For a resident or program participant to be tested, first make arrangements with their medical provider or healthcare plan. A doctor will determine if he or she should be tested. If they do not have a medical provider, they can call 2-1-1. In addition to seeking testing from medical providers, there are various testing sites set up around the county. For more information, visit coronavirus-sd.com and click on Testing
  • For additional testing options through commercial laboratories, please see below:

 

Commercial Laboratory

Website

Phone

BioCept

https://biocept.com/covid-19/

888-332-7729

Bioreference Laboratories

https://www.bioreference.com

833-684-0508

Helix

https://www.helix.com/pages/covid19-efforts

415-805-3360

LabCorp

https://www.labcorp.com/coronavirus-disease-covid-19/provider-information

858-210-0926

Mayo

https://news.mayocliniclabs.com/covid19/

800-533-1710

Mira Dx

info@miradx.com  

424-387-8100

Quest Diagnostics

https://www.questdiagnostics.com/home/Covid-19/

866-697-8378

COVID-19 Testing Taskforce Lab List

https://testing.covid19.ca.gov/wp-content/uploads/sites/332/2020/07/COVID-19-Testing-Task-Force-Lab-List-updated-07_2_20.pdf

N/A (see full list on CDPH website for San Diego County labs)

 

 

Will all nursing home workers and patients be required to get regular testing?

  • California Department of Public Health recommends that Skilled Nursing Facilities (SNFs) conduct baseline, surveillance and response-driven testing of SNF residents and healthcare personnel to prevent spread of infection in the facility. For detailed guidance, please see information here.

 

Where can I express a concern or complaint about a long-term care facility?

  • Concerns or complaints can be reported to the appropriate state licensing entities:
    • California Department of Public Health (CDPH) – for Skilled Nursing Facilities
      • State office: (916) 552-8632 or go on-line here
      • Local office: (619) 278-3700
    • California Department of Social Services, Community Care Licensing Division (CCL) – for Residential Care Facilities for the Elderly, Adult Residential Facilities (assisted living facilities, board and care facilities)
  • Concerns or complaints can also be reported to the County of San Diego Long-Term Care Ombudsman program: (858) 560-2507

 

Is the Ombudsman Program operating during this time?

  • Yes, the County of San Diego Long-Term Care Ombudsman program is operating.  This free program advocates for residents in Long-Term Care facilities, such as nursing homes and other licensed facilities. An Ombudsman listens to concerns, provides information and assistance when requested and will investigate and resolve complaints related to care or personal rights. They can be reached by calling (858) 560-2507 or sending an email.

 

How can I find out what long-term care facilities have positive COVID cases?

  • COVID+ Cases at Skilled Nursing Facilities (SNFs):
    • SNFs are required to report COVID-19 facility data to the California Department of Public Health and notify residents, residents' representatives, and families of residents when there are COVID-19 positive residents or healthcare workers in the facility. The report must include suspected and confirmed COVID-19 infections and deaths among residents and staff.  The data can be found here.
  • COVID+ Cases at Residential Care Facilities for the Elderly (RCFEs, also known as Assisted Living Facilities, Board and Care Facilities):
    • RCFEs are required to report COVID-19 facility data to the California Department of Social Services, Community Care Licensing Division.  The data can be found here; click on Additional Resources, then click on COVID-19 Positive Cases in Adult and Senior Care Facilities.



What special measures should be taken to help residents with dementia, intellectual disabilities, and/or mental health challenges during COVID-19?

 

 

How can I obtain PPE (personal protective equipment) for staff?

  • Equipment such as masks, gowns, and face shields can be obtained by contacting the County of San Diego’s Medical Operations Center at moc.logs.hhsa@sdcounty.ca.gov.

 

Collaborative efforts by Public Health Services and Epidemiology

  • Public Health Services and Epidemiology coordinate closely with the state for any outbreak response
  • CDPH healthcare associated infection program
  • CA State Licensing Branch

Additional Resources

 

More questions are added regularly, please check back soon. For additional information, please contact us at COVID-LTC@sdcounty.ca.gov