Long-term Care Guidance for Non-medically Necessary Outings - Minnesota Dept. of Health

Long-term Care Guidance for Non-medically Necessary Outings

Download for print:
Long-term Care Guidance for Non-medically Necessary Outings (PDF)
1/25/21

Background

COVID-19 has had a greater impact on the lives of people living in long-term care settings than on others. The pandemic impacts the health of those who have COVID-19 and affects all other residents through visitation restrictions that decrease valuable time spent with family and friends.

The Centers for Disease Control and Prevention (CDC) recently reported that an important driver of the recent increases in the number of people with COVID-19 is small family gatherings. The CDC and the Minnesota Department of Health (MDH) recommend that people at increased risk of severe illness from COVID-19 avoid in-person gatherings with anyone who does not live with them.

Before taking a loved one out of a facility, you should contact the facility administration to review quarantine plans and, if applicable, to make sure that an observation room will be available on their return. If such a room is not available, you may be required to care for your loved one at home until a room is available.

Instead of gathering in family homes, MDH recommends visiting with loved ones outdoors at their long-term care communities, or indoors if the organization meets criteria for safe indoor visitation. For residents who want to exercise their right to leave their long-term care facilities for outings that are not necessary for medical reasons, we recommend taking the following steps to lower the risk of spreading COVID-19. This guidance will be updated as more information becomes available.

Most people living in long-term care settings are considered at increased risk for COVID-19. At this time, MDH strongly recommends against families taking people who live in long-term care settings to their homes or to gatherings.

  • Residents who are currently in isolation for COVID-19 should not leave the long-term care setting to gather with others.

Consider testing residents around five to seven days after they return from an outing if they have not tested positive for COVID-19 in the last 90 days and if they had close prolonged contact with anyone who does not live or work in the long-term care setting.

  • Residents who leave the building to gather with others may be required to quarantine when they return. The need to quarantine may vary, depending on whether or not the resident or the persons they are visiting have recovered from COVID-19 within the past 90 days. At this time, quarantine recommendations are the same no matter if residents or family members are vaccinated for COVID-19.
  • Residents who meet any of the following criteria should be placed in quarantine for 14 days upon return to the facility:
    • Have not tested positive for COVID-19 in the past.
    • Tested positive for COVID-19 more than 90 days prior to leaving the facility.
    • Tested positive by antigen test (without confirmatory RT-PCR test) and had no symptoms during the initial infection.
  • Residents who meet any of the following criteria do not need to be quarantined upon return to the facility:
    • Tested positive by RT-PCR testing within the 90 days prior to returning to the facility.
    • Tested positive by antigen test, with symptoms present during the infection.
  • Residents who return without quarantine must have previously met criteria for release from isolation. Isolation is a method to keep someone who is infected with the virus away from others who might be at risk of infection.
    • The approach based on time and symptoms to release a resident from isolation is preferred by MDH and used by most facilities:
      • At least 10 days (or 20 days for those with severe to critical illness or severe immune compromise) have passed since symptoms first appeared, AND
      • At least 24 hours have passed since last fever without the use of fever-reducing medications, AND
      • Symptoms (e.g., cough, shortness of breath) have improved.
    • Test-based approach for resident release from isolation:
      • Negative molecular test (e.g., RT-PCR) results from at least two consecutive respiratory specimens collected more than 24 hours apart (total of two negative test results), AND
      • If resident had symptoms, resolution of fever without the use of fever-reducing medications AND symptoms (e.g., cough, shortness of breath) have improved.
  • Residents who have tested positive for COVID-19 within the 90 days prior to returning to the facility should quarantine upon return to the facility if:
    • The resident is severely immune compromised.
    • A member of the group (e.g., family) with which the resident visited develops COVID-19 in the 48 hours after the visit. Testing of residents may be recommended in this situation, within five to seven days of return. However, the difference between a new infection and a resident who has tested positive in the past can be challenging. People can continue to test positive for some time after having COVID-19, without having an active infection. This is called persistent positivity.
    • All residents who leave the building to gather with others should be monitored for symptoms for 14 days upon their return.

Information for families

Plan ahead

Take steps to lower the risk that anyone in your house, or visiting your house, is has contact with COVID-19.

  • Limit chances for contact: For two weeks before your gatherings, avoid indoor settings with people who do not live with you and where you cannot stay at least 6 feet away from others or consistently wear a mask (e.g., indoor social events, bars, restaurants, carpooling).
  • Wear a mask: Wear a cloth mask at all times when you are inside at locations outside of your house or at outdoor events where you cannot stay at least 6 feet away from others.
  • Wash your hands regularly and thoroughly: As recommended by the CDC, regularly wash your hands or use hand sanitizer and ask those coming in your house to do the same.
  • Physically distance: Follow CDC guidelines and keep a distance of at least 6 feet from others who live outside your household, whenever you can.

Create a safe setting

Create a safe setting for those visiting.

  • Screen: Ask anyone entering or staying in your house if they have had symptoms (e.g., fever, body aches, fatigue, runny nose, cough) of COVID-19 or if they have recently been near someone with COVID-19.
    • People with symptoms should stay home and away from all others and be tested for COVID-19 as soon as possible.
    • People who have spent time near a person with COVID-19 should stay home and away from others and should be tested five to seven days after the contact.
  • Testing: If possible, get yourself and your household members tested for COVID-19 in time to get the results before bringing a long-term care resident into your home.
  • Mask: When at-risk people are visiting, wear a mask while visiting with them inside your house. In addition, you should wear a cloth face covering while in the car with them and avoid riding in cars with people outside your household whenever possible. If people staying with you can also wear a mask, ask them to do so as well.
  • Socially distance: Set up your house so people can keep a physical distance between themselves and others. See Indoor Air Considerations: COVID-19.

Contact the facility

Long-term care facilities follow strict regulations and guidelines to prevent the entry and spread of COVID-19 in their buildings. Before taking someone out of a long-term care setting, make sure you contact the facility administrator and understand the following:

  • Visitation: MDH guidance is available for window visits, outdoor visitation, and for beginning indoor visitation again, based on Centers for Medicare and Medicaid Support (CMS) recommendations.
  • Many facilities are allowing both indoor and outdoor visits and are planning for families to safely visit. Please be aware that visits may be restricted due to physical limitations of a given facility, weather conditions, and whether a facility or its neighboring county has had an outbreak.
  • In addition, the number of visitors allowed in the facility at one time may be limited to manage possible contact with COVID-19. Compassionate care visits are a form of visitation that facilities will allow even if county infection rates are high. Contact the facility administrator to schedule your family visit.
  • Outbreaks: If a facility is currently having an outbreak of COVID-19 or currently testing individuals on suspicion of an outbreak, understand and consider the risks of exposing yourself and your family to COVID-19.

Vaccination for COVID-19 has begun. We anxiously look forward to the day when these restrictions can be removed. At this time, visitation guidance will not be modified based on people getting vaccinated. While the vaccine can protect people from the virus, it is unknown whether a person who has been vaccinated can still be a carrier of the virus.

Resources

Updated Monday, 25-Jan-2021 16:12:00 CST