HAE
3/13/2020: Governor issued an official order restricting visitors

Governor issued an official order restricting visitors at all skilled nursing facilities, assisted living residences and intermediate care facilities. Read more here.

Retirement Communities and Independent Living Facilities

CDC guidance for Retirement Communities and Independent Living facilities is available here.

Long-Term Care and Nursing Facilities

On March 13, 2020, Colorado Governor Jared Polis issued an official order restricting visitors at all skilled nursing facilities, assisted living residences and intermediate care facilities. These facilities will now restrict the visitation of non-essential individuals, screen 100 percent of essential individuals prior to entry, and follow protocol if there are any suspected cases. Read more here.

This guidance is based on the currently available information about COVID-19. It will be refined and updated as more information becomes available and as response needs change in Larimer County.

For more information from CDC, please visit their website.

Current CDC guidance for long-term care and nursing facilities is included below.

On March 13, 2020, Colorado Governor Jared Polis issued an official order restricting visitors at all skilled nursing facilities, assisted living residences and intermediate care facilities. These facilities will now restrict the visitation of non-essential individuals, screen 100 percent of essential individuals prior to entry, and follow protocol if there are any suspected cases. Read more here.

FAILURE TO COMPLY WITH THIS ORDER IS SUBJECT TO THE PENALTIES CONTAINED IN SECTION 25-1-114, C.R.S., INCLUDING A FINE OF UP TO $1,000S AND IMPRISONMENT IN THE COUNTY JAIL FOR UP TO ONE YEAR.

Facilities must follow CMS guidelines related to screening, limiting and restricting visitors (CMS Ref. QSO-20-14-NH (March 9, 2020)
https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf and must:

1. Restrict visitation of non-essential individuals.

  • Facilities shall post signage clearly summarizing the essential individual visitor policy, such as vendors providing necessary supplies or services for the facility or residents, and individuals necessary for the physical and/or mental well-being of the resident.

2. For essential individuals entering the building, including personnel, contracted individuals or essential visitors, screen 100% prior to entry into the building,
consistent with screening criteria. Essential individuals should be limited.

  • All screenings must be documented via a form and logged.
  • Screening documentation must be maintained until further notice and made available upon request to CDPHE. After screening, if an essential visitor is allowed into the facility, they must:
    • Limit their movement within the facility to the resident’s room
    • Limit surfaces touched
    • Use appropriate personal protective equipment (PPE) – gown, gloves and mask
    • Limit physical contact with the resident
    • There can only be two essential visitors per resident at a given time.

3. If a facility has a suspected, presumptive, or confirmed COVID-19 patient, the facility must:

  • Consult with the county’s local public health agency.
  • Notify CDPHE as the licensing authority.
  • Further restrict visitation after consultation with the health department
  • Maintain a log of visitors and staff interacting with a patient who is isolated for presumptive or confirmed COVID-19.
  • Be able to identify the staff who interacted with the resident and resident’s environment.
  • Restrict all internal group activities to prevent infection exposure to other residents.

Alternative Communications. Facilities that restrict or limit visitor access for any of the foregoing reasons must:

  1. Offer alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.);
  2. Assign staff as primary contact to families for inbound calls, and conduct regular outbound calls to keep families up to date; or
  3. Offer a phone line with a voice recording updated at set times (e.g., daily) with the facility’s general operating status, such as when it is safe to resume visits.

Restrictions regarding Third Parties. Facilities shall review how they interact with volunteers, vendors and receiving supplies, agency staff, EMS personnel and equipment, transportation providers (e.g., when taking residents to offsite appointments, etc.), and other practitioners (e.g., hospice workers, specialists, physical therapy, etc.), and revise
policies, practices and procedures to implement necessary actions and best practices to prevent potential disease transmission.

CDPHE is tasked with protecting the health and welfare of the citizens of Colorado by investigating and controlling the causes of epidemic and communicable disease. This Public Health Order is necessary to control any potential transmission of disease to others. Section 25-1.5-102(1), C.R.S.Immediate issuance of this Order is necessary for the preservation of public health, safety, or welfare, and the requirements of the Administrative Procedure Act, article 4, title 24, C.R.S. do not apply to this Order.

  • Implement sick leave policies that are non-punitive, flexible, and consistent with public health policies that allow ill HCP to stay home.
  • As part of routine practice, ask HCP (including consultant personnel) to regularly monitor themselves for fever and symptoms of respiratory infection.
    • Remind HCP to stay home when they are ill.
    • If HCP develop fever or symptoms of respiratory infection while at work, they should immediately put on a facemask, inform their supervisor, and leave the workplace.
    • Consult occupational health on decisions about further evaluation and return to work.
  • Screen all HCP at the beginning of their shift for fever and respiratory symptoms.
    • Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and leave the workplace.
    • HCP who work in multiple locations may pose higher risk and should be asked about exposure to facilities with recognized COVID-19 cases.
  • Restrict nonessential healthcare personnel (including consultant personnel) and volunteers for entering the building.
  • When transmission in the community is identified, nursing homes and assisted living facilities may face staffing shortages. Facilities should develop (or review existing) plans to mitigate staffing shortages.
  • Ask residents to report if they feel feverish or have symptoms of respiratory infection.
  • Actively monitor all residents upon admission and at least daily for fever and respiratory symptoms (shortness of breath, new or change in cough, and sore throat).
    • If positive for fever or symptoms, implement recommended IPC practices.
  • In general, when caring for residents with undiagnosed respiratory infection use Standard, Contact, and Droplet Precautions with eye protection unless the suspected diagnosis requires Airborne Precautions (e.g., tuberculosis).  This includes restricting residents with respiratory infection to their rooms. If they leave the room, residents should wear a facemask (if tolerated) or use tissues to cover their mouth and nose.
    • Continue to assess the need for Transmission-Based Precautions as more information about the resident’s suspected diagnosis becomes available.
  •  
  • If COVID-19 is suspected, based on evaluation of the resident or prevalence of COVID-19 in the community,
    • Residents with known or suspected COVID-19 do not need to be placed into an airborne infection isolation room (AIIR) but should ideally be placed in a private room with their own bathroom.
    • Room sharing might be necessary if there are multiple residents with known or suspected COVID-19 in the facility. As roommates of symptomatic residents might already be exposed, it is generally not recommended to separate them in this scenario. Public health authorities can assist with decisions about resident placement.
    • Facilities should notify the health department immediately and follow the Interim Infection Prevention and Control Recommendations for Patients with COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings, which includes detailed information regarding recommended PPE.
  •  
  • If a resident requires a higher level of care or the facility cannot fully implement all recommended precautions, the resident should be transferred to another facility that is capable of implementation. Transport personnel and the receiving facility should be notified about the suspected diagnosis prior to transfer.
    • While awaiting transfer, symptomatic residents should wear a facemask (if tolerated) and be separated from others (e.g., kept in their room with the door closed). Appropriate PPE should be used by healthcare personnel when coming in contact with the resident.
  •  

Educate both facility-based and consultant personnel (e.g., wound care, podiatry, barber) and volunteers. Including consultants is important because they often provide care in multiple facilities and can be exposed to or serve as a source of pathogen transmission.

Reinforce sick leave policies that are non-punitive, flexible, and consistent with public health policies that allow ill HCP to stay home when they are not feeling well. Remind HCP not to report to work when ill. As part of routine practice, ask HCP (including consultant personnel) to regularly monitor themselves for fever and symptoms of respiratory infection.

  • If HCP develop fever or symptoms of respiratory infection while at work, they should immediately put on a facemask, inform their supervisor, and leave the workplace.
  • Consult occupational health on decisions about further evaluation and return to work.

Reinforce adherence to infection prevention and control measures, including hand hygiene and selection and use of personal protective equipment (PPE). Have HCP demonstrate competency with putting on and removing PPE.

Provide information about

  • COVID-19
  • Actions the facility is taking to protect them and their loved ones, including visitor restrictions
  • Actions residents and families can take to protect themselves in the facility

Put alcohol-based hand sanitizer with 60–95 percent alcohol in every resident room (ideally both inside and outside of the room) and other resident care and common areas (e.g., outside dining hall, in therapy gym).

Make sure that sinks are well-stocked with soap and paper towels for handwashing.

Make tissues and facemasks available for people with respiratory symptoms such as coughing and sneezing.

Consider designating staff to steward those supplies and encourage appropriate use by residents, visitors, and staff.

Put a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room, or before providing care for another resident in the same room. Facilities should have supplies of:

  • Facemasks
  • Respirators (if available and the facility has a respiratory protection program with trained, medically cleared, and fit-tested HCP)
  • Gowns
  • Gloves
  • Eye protection (i.e., face shield or goggles).

If your facility is running low on resources and not able to re-order through typical channels/vendors, please complete this form to request resources.

Make sure that EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment.

Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against COVID-19.