Long-term Care Guidance for Outings
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Long-term Care Guidance for Outings (PDF)
On March 10, 2021, the Centers for Medicare & Medicaid Services (CMS) revised CMS guidance QSO-20-39-NH (PDF) to incorporate positive changes resulting from COVID-19 vaccinations. Additionally on March 10, the Centers for Disease Control and Prevention (CDC) released new guidance for health care settings on infection control after vaccination. See Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.
On March 29, 2021, the CDC published revised guidance for preventing the spread of COVID-19 in nursing homes with updated recommendations for public outings: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes.
CDC continues to evaluate the impact of vaccination and the emergence of COVID-19 variants on recommendations to prevent or control the spread of COVID-19 in health care settings. The Minnesota Department of Health (MDH) will update this guidance as new information becomes available.
Information for providers
Effective immediately, MDH will expect long-term care providers, including nursing homes and assisted living-type facilities, to comply with the new CMS and CDC directives and guidance. This new MDH guidance replaces previous guidance for non-medically necessary outings.
This new guidance from CMS and CDC applies to all long-term care providers, regardless of vaccination status and level of vaccination coverage in the nursing home or assisted living-type facility, unless otherwise noted in the Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.
Key elements of the CMS and CDC guidance documents
- Residents are considered fully vaccinated for COVID-19 two weeks after their second dose of a vaccine that requires two doses (like Pfizer or Moderna), or two weeks after they get a single dose of a vaccine that requires one dose (like Johnson & Johnson).
- Residents who are living in the nursing home or assisted living-type facility and who are currently in isolation or quarantine for COVID-19 should not leave their long-term care settings to gather with others. This applies to all residents who are living in the nursing home or assisted living-type facility, regardless of whether they are fully vaccinated.
- If residents who are living in the nursing home or assisted living-type facility choose to leave the building to gather with others, they should watch for symptoms of COVID-19 for 14 days after they return to the nursing home or assisted living-type facility. This applies to all residents who are living in the nursing home or assisted living-type facility, regardless of whether they are fully vaccinated.
Create a plan for leaving the nursing home or assisted living facility
Residents who choose to leave the nursing home or assisted living-type facility should follow the recommendations for preventing or controlling the spread of COVID-19:
- Wearing a well-fitting mask.
- Staying 6 feet apart from other people.
- Washing or sanitizing hands often (alcohol-based hand rub is preferred).
People accompanying residents (e.g., transport personnel, family members) should also be educated about these infection prevention practices, should adhere to them, and should assist the resident with adherence.
For residents going to medical appointments, regular communication between the long-term care facility and the medical facility is essential to help identify residents with potential exposures or symptoms of COVID-19 before they enter the facilities so that proper precautions can be implemented.
In most circumstances, quarantine is not recommended for residents who leave the nursing home or assisted living-type facility for less than 24 hours (e.g., for medical appointments, community outings with family or friends) and do not have close contact with someone with COVID-19 infection. Close contact is defined as spending 15 minutes or more in a 24-hour period within 6 feet of someone who has COVID-19.
Facilities might consider quarantining residents who leave the nursing home or assisted living-type facility if, based on an assessment of risk, uncertainty exists about their adherence or the adherence of those around them to recommended infection prevention and control measures.
Residents who leave the nursing home or assisted living-type facility for 24 hours or longer should generally be managed as described in the CDC’s guidance for New Admission and Readmission section detailed below.
Residents who want to exercise their right to leave their long-term care facility should take the following steps to lower the spread of COVID-19
Residents who leave the nursing home or assisted living-type facility may gather indoors or outdoors with other people. All persons in the group should follow the recommendations for preventing the spread of COVID-19 found at CDC: Interim Public Health Recommendations for Fully Vaccinated People.
If residents are fully vaccinated, they can choose to have close contact (including touch) with the persons they are visiting.
If a resident chooses to attend a place of worship or other group event, or to shop or eat in public establishments, the resident should follow the core principles of COVID-19 infection prevention. Places of worship and restaurants follow the guidance found on Stay Safe Industry Guidance.
MDH strongly encourages attending places of worship or other group events only when the 14-day county percent positivity rate is below 5%. The positivity rate is the percentage of people who test positive for COVID-19 among all the people in the county who are tested.
Fully vaccinated residents should continue to do the following:
- If residents living in the nursing home or assisted living-type facility are fully vaccinated, they should follow the recommendations for visiting friends or family in a private setting outside the nursing home, as described in the CDC: Interim Public Health Recommendations for Fully Vaccinated People.
- Comply with any current state mandates or restrictions on group size at the time of the outing.
- Get tested if they have CDC: Symptoms of Coronavirus.
- Follow CDC and health department travel requirements and recommendations.
- Continue to be follow current guidance, including staying 6 feet apart from others, inside a nursing home. CMS and the CDC have not updated guidance for dining or activity inside nursing homes.
Create a plan for managing new admissions and readmissions
- Residents with confirmed COVID-19 infection who have not met criteria for discontinuation of Transmission-Based Precautions should be placed in the designated COVID-19 care unit.
- In general, all other new admissions and readmissions should be placed in a 14-day quarantine, even if they have a negative test upon admission.
- Exceptions include residents within 3 months of a COVID-19 infection and fully vaccinated residents as described in CDC’s Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.
- Facilities located in areas with minimal to no community transmission might elect to use a risk-based approach for determining which residents require quarantine upon admission. Decisions should be based on whether the resident had close contact with someone with COVID-19 infection while outside the nursing home or assisted living-type facility and if there was consistent adherence to infection prevention practices in health care settings, during transportation, or in the community prior to admission.
Information for families
Take steps to lower the risk COVID-19
- If you are unvaccinated, limit chances for contact with someone with COVID-19. Two weeks prior to your gathering, avoid people who do not live with you and settings where you cannot stay at least 6 feet away from others. Avoid bars, restaurants, or carpools where people do not consistently wear a mask.
- Wear a well-fitting mask when you are inside places other than your home.
- Wear a well-fitting mask at outdoor events where you cannot stay at least 6 feet away from others. See CDC: Improve How Your Mask Protects You.
- Wash your hands regularly and thoroughly and ask people coming into your home to do the same.
- Stay at least 6 feet from others who live outside your household, whenever you can.
Create a safe setting
Create a safe setting for visitors
- Before anyone enters your home, ask if they have had a fever, cough, body aches, fatigue, runny nose, or other symptoms of COVID-19. People with symptoms should stay home and away from all others. They should be tested for COVID-19 as soon as possible.
- Before anyone enters your home, ask if they have recently been near someone with COVID-19. People who have spent time near a person with COVID-19 should stay home and away from others. They should be tested five to seven days after the contact.
- Before bringing someone who needs long-term care into your home, get yourself and your household members tested for COVID-19.
- Before anyone enters your home, especially someone at-risk for more severe illness, wear a mask that covers your mouth and nose completely.
- Before anyone enters your car, wear a mask that covers your mouth and nose completely. If people staying with you can also wear a mask, ask them to do so as well.
- Before anyone enters your home, set up your house so people can stay 6 feet apart from others. See Indoor Air Considerations: COVID-19.
- For current recommendations about creating a safe space for visitors, see Protect Yourself & Others: COVID-19.
Contact the nursing home or assisted living-type facility
Nursing homes and assisted living-type facilities follow strict regulations and guidelines to prevent the spread of COVID-19 in their buildings. Before taking someone out of nursing homes or assisted living-type facilities, make sure you understand the current guidelines.
- MDH has guidance for window visits, outdoor visitation, and for indoor visits. This guidance is based on CMS recommendations.
Vaccination for COVID-19 is ongoing. We look forward to the day when more restrictions can be removed. We continue to learn more about whether people who are fully vaccinated can transmit the virus. See CDC: Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.
- Residents and their loved ones may contact the nursing home or assisted living-type facility where they live with questions about visitation.
- The Office of Ombudsman for Long-term Care is available if advocacy services are needed. Contact them at 651-431-2555 or 800-657-3591.
- Long-term Care: Visitors and outside services
Additional visitation guidance for long-term care and assisted living-type facilities, including flowcharts for outbreak status and exceptions.
- Interim Guidance for Discharge to Home or New/Re-Admission to Congregate Living Settings and Discontinuing Transmission-Based Precautions (PDF)
- CDC: Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings
- CDC: Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination
- CDC: Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes