Defining Crisis Staffing Shortage in Congregate Care Facilities: COVID-19

Maintaining adequate staffing in congregate care facilities is essential to provide a safe environment for residents and staff. Throughout the COVID-19 pandemic, staffing shortages rose exponentially among congregate care settings. Facilities should be prepared for varying levels of staffing shortages, have contingency staffing plans in place, and ensure resident safety.

Health care facilities may need to implement crisis-level staffing strategies. These strategies could include allowing asymptomatic staff with confirmed COVID-19 to return to work in roles that provide direct care for residents with confirmed COVID-19. Staff with signs or symptoms of illness should not work, whether or not they are known to be COVID-19-positive. The criteria below must be met before allowing asymptomatic (not ill) staff with confirmed COVID-19 to work.

Criteria to establish staffing crisis

Below are criteria that must be met before asymptomatic staff known to have COVID-19 can be asked to return to work prior to meeting CDC’s return to work conditions for health care personnel with COVID-19.

• The facility has activated its contingency staffing plan and has exhausted all options to address staffing needs, triggering a crisis level of staffing.
• The facility has exhausted all options to cohort COVID-19-positive residents internally or transfer positive residents to COVID-19 care sites.
• The only remaining approach to ensure adequate resident care and safety is to evacuate the facility.

Asymptomatic staff with confirmed COVID-19

If possible, staff should take on a non-direct resident care role (e.g., telemedicine, phone triage). If it remains necessary for staff with confirmed COVID-19 to continue providing direct resident care during the staffing crisis, they should:

• Provide direct care only for residents with confirmed COVID-19, preferably in a cohort/COVID-19 unit setting.
• Practice diligent hand hygiene and wear a face shield and surgical facemask for source control at all times, including in non-resident care areas, such as breakrooms.
• Separate themselves from others if they need to remove their facemask.
  

Facilities with asymptomatic COVID-19-positive staff working on-site

• Document the shifts worked by COVID-19-positive staff and residents that received direct care from these staff members.
• Ensure COVID-19-positive staff wear a face shield and surgical facemask at all times and receive training in proper use.
• COVID-19-positive staff should continue to be actively screened for symptoms and excluded from work if symptoms develop.
• Restrict interaction between COVID-19-positive staff and other staff to prevent transmission. Designate a separate break area, entrance, bathrooms, and other communal areas for COVID-19- positive staff.
• Continue to explore all avenues to obtain emergency staffing.
• Do not allow staff with confirmed COVID-19 to work after the facility is no longer in a staffing crisis.

For more information, refer to Clarification of Staffing Options for Congregate Care Facilities Experiencing Staff Shortages.

References

• Long-term Care (LTC) Emergency Preparedness
  Tools developed to assist LTC facilities with emergency preparedness planning, including a COVID-19 Contingency Staffing Plan template and training webinar.
• COVID-19 Toolkit: Information for Long-term Care Facilities (PDF)
• CDC: Strategies to Mitigate Healthcare Personnel Staffing Shortages
• CDC: Return to Work Criteria for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance)