* The following Article coincides with current CDC and CMS guidelines at time of publication *
The Covid-19 Pandemic has touched everyone’s lives, especially within the long term care industry. Since the outbreak began, facilities have had to adapt to comply with ever changing requirements and utilize best practices to reduce the spread of the virus. As time has continued, further guidelines were introduced, revised, and along came a vaccine. Vaccinations began to be administered, some case numbers declined, and in comes a variant that is still very much a risk to the elderly population that has seen active cases on the increase nationwide and globally.
All long term care facilities have a responsibility to protect their residents to the fullest extent and need to consider using technology to make this even more effective.
Long Term Care Covid-19 Control Protocols
Every facility needs to ensure their protocols in place for Covid-19 testing are current, adequate, and reviewed regularly by management for any needed modifications.
It all begins at the main entrance, the first barrier of defense. A secure system should already be in place to allow relevant staff and visitors secure access. Using only the main entrance allows the facility to monitor the number of visitors present at one time and reduces ‘traffic’ around the facility that in turn reduces the chances of a spread.
The facility should display required signage to inform the public of current visitation requirements. Consider sanitizing the main entrance area on a regular basis and document its completion as well as training staff to open doors for others in order to reduce visitors having to touch these areas.
Temperature Tracking in Long Term Care Facilities
The temperature tracking and screening process in long-term care facilities should be conducted correctly for covid-19 testing to prevent potential risks of introducing or spreading the virus into the facility. Long-term care facilities are required to document screenings to show compliance and identify any concerns with resolutions.
The right software or system can assist the screening process. It should be easily documented and completed every time a visitor wishes to enter. It can also prompt an alert if a concern arises from the information inputted into the software system This alert should be resolved in order to complete the screening process. It can ensure all visitors are treated in the same manner as well as hold staff accountable to complete all screenings properly.
Facilities can choose the method they wish to use to take temperatures and most adopt the forehead digital thermometer method. This thermometer can be pointed at the forehead without direct contact to obtain a result. The facility is responsible to check that the thermometers used are sanitized and checked for normal operations.
Staff Training In Long Term Care To Minimize Covid-19 Transfer
Every facility should train their staff to be comfortable in not only using the covid-19 testing and tracking system but to be able to ask visitors relevant questions during the screening process.
- Be trained to be observant of concerns such as a visitor persistently coughing or a temperature 100.4 degrees Fahrenheit or higher.
- Know they should contact management if they have a reason to deny a visitor entry and make the visitor wait until an outcome is decided. The staff has the right to suspend the screening if there is a concern and have a manager report to them immediately to discuss the matter.
- Understand they must treat visitors with respect but they have a duty to protect their residents first. For example, staff can tell the visitor “Please understand we have to screen everyone carefully at this time for covid-19 testing, please take a seat while we finish the process, it won’t take long.” Some visitors will need questions answered or additional time to understand the visitation routine.
- Remain calm and management needs to explain to the visitor why they have been denied access to the facility. In the extreme event, the visitor behaves in a threatening manner or refuses to comply with the facility protocols, security or the police may be called to remove the visitor and the facility needs to document the incident.
Most visitors are more than willing to comply with protocols in place in order to be able to visit with their loved ones. It is gracious to thank those visitors for helping to keep a safer environment.
Long-Term Care Entrance Screening Processes
The covid-19 testing and screening area itself should provide current facility visitation guidelines, education about the virus, sanitizer access, mask supplies, and the method of collecting screening procedures.
The screening process involves gathering information from each visitor:
- Purpose of visit
- Type of visit (family, facility maintenance, hospice, surveyors, etc)
- Temperature check
- Questions relating to the Coronavirus
The facility is not required to ask visitors if they have had the Covid-19 vaccine and cannot prevent someone from entering if they have not been vaccinated. However, some facilities choose to ask this question to create a log of vaccinated visitors who are usually regular visitors. Staff should inform visitors on site of their facility protocols such as wearing a mask as required by the facility and where the visitor is permitted to go. Many visitors who have been vaccinated often offer this information freely now before staff has a chance to ask!
Covid-19 testing and screening software can make the screening process brief and straightforward for both visitors and staff. It also stores all information required in one area, can track who is in the facility at any given time and assists with deciding if a particular visitor is safe to enter, and enables contact tracing when necessary.
Once a visitor has successfully been screened, a member of the staff may escort them to their destination. The facility needs to make sure the visitor exits when required if on a scheduled visit or did indeed complete their task within the facility. Facility areas should be sanitized after the visits have taken place and documented when completed.
Covid-19 Testing for Long Term Care Staff
The facility must conduct Covid-19 testing of all staff, document results, and report results as required. Any staff or resident who begins to show symptoms of the virus must be immediately tested. Symptoms may include a hoarse cough, a fever, a headache, and loss of taste and smell as well as body aches. Some people may wonder if those symptoms could be something other than Covid-19. This is a possibility until a confirmed diagnosis is established, but if symptoms are also accompanied by shortness of breath and chest congestion, the virus may be the culprit.
The Centers for Medicare and Medicare Services (better known as CMS) issued a fact sheet dated 3-10-2021 which can be reviewed at this link. It contains visitation guidance recommendations.
Many facilities have adopted weekly staff tests to monitor for Covid-19. The CMS memorandum also states the facility must have a system in place for any member of staff who refuses to be tested. This may mean the staff member is not permitted to be in the facility until certain work criteria are met by the staff member.
There are different methods of testing for Covid-19, one of the easiest methods is the rapid point of care test. These usually involve taking a swab inside of a nostril or a saliva swab. It should take approximately 15 to 30 minutes to provide a result. Point of care tests ranges from 70% to 85% accuracy on average.
If a facility does not conduct its own testing it must have laboratory services readily accessible to administer testing and receive the results back within 48 hours. If a test is deemed positive, then another test will be required at a hospital or medical clinic to confirm the result. A staff member who is positively identified by the rapid test must leave the facility immediately and only return to work once criteria have been met to do so.
The facility is responsible for ensuring it has enough supplies to conduct testing as required. One way is to arrange testing kits to be shipped directly to the facility on a regular basis. Deliveries of supplies can be documented as proof of receiving necessary supplies. Supplies, such as thermometers, should be checked on a regular basis to ensure they are working correctly.
The facility also needs to ensure it has supplies for personal protective equipment (also known as PPE) for all staff and for visitors as needed. Inventory needs to be monitored to prevent any supplies from running out. It needs to document attempts to replenish an item that is currently unavailable from most regular sources. Abbott is one company whose website contains covid-19 testing information.
Covid-19 Reimbursements in Long Term Care
Residents who are covered by Medicare and Medicaid can receive the vaccine at no cost to them. At the present time, there is no cost to anyone for the vaccine if the staff member has chosen to be vaccinated. Facility policies vary regarding the vaccine, some have made it mandatory whereas other facilities consider it optional. The facility may provide education as well as encourage and educate all staff about the vaccine. Management should inspire their staff by taking the vaccine themselves. They may also have to dispel misinformation about the vaccine. Some staff members may believe the rumors that the vaccine can give them the virus or that it contains a microchip.
Additional CMS policy and regulatory revisions in response to Covid-19 are constantly being promulgated. Facilities can document copies of any letters sent out to residents and/or families, memorandums shared from CMS and the facility’s updates. State surveyors for Covid-19 are ultimately reviewing what the facility is actively doing to protect residents and promote safety for all in the facility. They may visit or contact facilities if there is an outbreak, current active cases, an increase in cases, complaints specific to Covid-19, or deficient practices which were previously identified.
Surveyors will ask if the facility is providing visitations between residents and families and how this is conducted taking Covid-19 protocols into account. There was a time when virtually all visitations had to be halted, in that time facilities had to get creative with finding other ways to maintain contact. Face-time, phone calls, regular mail, and ‘looking through the door’ visits came into fruition and are still widely used. CMS is aware in its revision that residents need physical contact from their families and are now looking to see that some form of visitation is allowed.
Facilities should log all incidents that may occur and how it was resolved. For example, if a visitor was able to access the facility without being screened. A scenario may include the following:
- The visitor was stopped by a member of staff who questioned her presence on a weekend when scheduled visits to her family did not usually occur.
- The visitor was from out of town and did not know any of the requirements. He or she was able to enter as a new hire accidentally opened the main entrance door.
- The visitor was screened right where she stood with no concerns.
- The visitor was educated on the process of scheduled visits and scheduled one for the following week. She was escorted politely out of the facility. Staff informed the resident her friend would visit in the near future. The new hire had not been trained on visitor restrictions and was inserviced immediately after the visitor had left.
- The visitor was stopped in an area near three residents’ rooms, all three were rapidly tested with no concerns. The following week all new hires were inserviced.
Strong documentation shows what occurred and how the facility resolved the matter.
Surveyors may ask questions regarding how staff may handle an unexpected incident. By fully documenting the whole incident, the facility can provide solid answers that may avoid future issues and possible deficiencies. Surveyors may ask to see supplies, check that required signs are posted, observe the Covid-19 testing and screening process, and review staff to make certain they are complying with requirements, such as wearing masks.
Covid-19 and its variants are still very much a risk to long-term care facilities. All facilities and staff must remain vigilant during the pandemic. It is important that facilities stay updated with all changes and recommendations CMS and CDC provide to continue to protect their residents.
All staff members deserve a working system that is straightforward to follow. This allows them more time to complete their assigned tasks. All members of staff have earned sincere thanks for their dedication.