Residents (includes cohorting, testing & reporting, transporting & returning to the facility; new admissions)

If you have new COVID-19 cases in your facility see: Recommendations for Responding to Long Term Care Facility Cases of Coronavirus Disease 2019 (COVID-19)

Below is historical information. Information on this page may be useful but some NH DHHS guidance is no longer in force. For current guidance, please see Reopening, and visit the NH DHHS COVID-19 web page for Long Term Care Facilities.

Cohorting, Quarantine, and Isolation

Q: Should residents be separated by COVID-19 status?

Cohorting & isolating:

A: See the NH DHHS Bureau of Infectious Disease Control Recommendations for Responding to Long Term Care Facility Outbreaks of Coronavirus Disease 2019 (COVID-19) — “A resident with new-onset suspected or confirmed COVID-19 should be isolated and cared for using all recommended COVID-19 PPE. Place the resident in a single room with a private bathroom if possible pending results of COVID-19 test.”

In December 2020 this guidance was updated to note that they do not advise cohorting residents with suspected cases, but isolating:
“Cohorting residents on the same unit based on symptoms alone could result in inadvertent mixing of infected and non-infected residents (e.g., residents who have fever, for example, due to a non-COVID-19 illness could be put at risk if moved to a COVID-19 unit).”

After test results are confirmed, “If the resident is confirmed to have COVID-19, regardless of symptoms, they should be transferred to the designated COVID-19 care unit.”

Quarantining:

HAN #33 and the NH DHHS Bureau of Infectious Disease Control Quarantine Guide updated quarantine guidelines for asymptomatic people who have recovered from COVID within the last 90 days or are 2 weeks beyond their 2nd dose of vaccine. They make the distinction thatRegardless of prior infection or vaccination status, any person with new or unexplained symptoms of COVID-19 still needs to isolate (Isolation Guide), and be evaluated for COVID-19 testing.”

NH Bureau of Infectious Control’s updated reopening guidance (note this is a historical document, this guidance no longer in effect as of 5/6/21) includes further Quarantine Guidance which “applies to ALFs, SNFs, and similar facilities, including those who are regulated by CMS” and affirms the information in HAN #33. They further clarify:

“This applies in all of the following quarantine scenarios:
• Upon admission to a LTCF
• After an unprotected exposure to a person with COVID-19
• After domestic travel outside of New England
• After an overnight stay at a hospital”

If someone does not meet any of these criteria, see NH DHHS’s Coronavirus Disease 2019 (COVID-19) Guidance for Long-term Care Facilities (LTCF)

Further reading on cohorting:

CDC has guidelines for Responding to Coronavirus (COVID-19) in Nursing Homes. This includes recommendations for cohorting residents. CDC also includes information about patient placement as part of infection prevention and control.

CMS and CDC also released the COVID-19 Long-Term Care
Facility Guidance
covering actions facilities should take to prevent transmission of COVID-19. These actions include separating residents based on COVID-19 status (i.e., positive,negative, unknown/under observation).

CMS provided an update to these recommendations with further guidance on “transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status.”

Screening

Q: What are the guidelines for screening residents?

A: In addition to the references above, especially Coronavirus Disease 2019 (COVID-19) Guidance for Long-term Care Facilities (LTCF), NH’s Department of Public Health Services reopening guidance (note this is a historical document, this guidance no longer in effect as of 5/6/21) including screening recommendations and surveillance testing, has been developed to operate in phases, in accordance with CMS guidelines.

In April 2021 on a DHHS call with LTCFs, DHHS staff affirmed that screening of residents, including pule oximetry, should continue daily as stated in their guidance.

Note that these documents refer to screening for infection prevention and control. Consult with the facility’s medical director or resident’s primary care physician for screening residents who have COVID-19.

Testing and reporting

Please note, on Friday, June 18, 2021, Kelly Keefe from DHHS Health Facilities Administration announced the following update regarding COVID-19 testing at senior residential facilities:

“The department has filed an emergency rulemaking to exempt nursing homes and residential care facilities from requiring a lab and/or collection station license to perform COVID-19 collections/testing on residents/staff/visitors.  Effective immediately, nursing homes and residential care facilities may resume COVID-19 collections/testing on residents/staff/visitors.

Q: Can a resident refuse testing, and what do we do if that happens?

A: Residents have the right to refuse testing. See CDC’s Clinical Questions about COVID-19: Questions and Answers: Testing in Nursing Homes for decision-making guidance.

Q: Does insurance cover testing?

A: Surveillance testing is covered by the state. For other testing, see the NH Insurance Department Guidance on COVID-19 coverage. It states: “Health insurance companies must provide coverage–prior to application of any deductible and without cost-sharing–of the initial health care provider visit and FDA-authorized COVID-19 testing for those who meet the Centers for Disease Control and Prevention (CDC) criteria for testing.”

For residents on Medicare, testing is covered.

Q: In what circumstances should a resident be tested for a variant of COVID-19, and how do we arrange for that?

A: Residents being evaluated for COVID-19 testing who meet these criteria, outlined in NH DHHS HAN #35, should be tested for variants:

  • Travel outside of New England (ME, VT, MA, RI, CT) in the prior 14 days
  • Previous SARS-CoV-2 infection in prior 90 days
  • Completion of an approved COVID-19 vaccination series

Read the HAN, as well as these specimen collection and transport directions from the NH Public Health Lab, and fill out this form.

Q: Should residents who have been COVID positive be retested? What about those who are fully vaccinated?

A: For those who have had COVID: If they recovered within the last 90 days and are asymptomatic, they may be exempted from testing. See NH DHHS Bureau of Infectious Disease Control Reopening Guidance for Long-term Care Facilities (LCTFs)( (note this is a historical document, this guidance no longer in effect as of 5/6/21) testing guidance.

See p. 13 of this CMS guidance. For information about why this is the case, see this CDC article.

For those who are at least 14 days beyond their second dose of a COVID-19 vaccine: they may be exempted from testing, see NH DHHS Bureau of Infectious Disease Control Reopening Guidance for Long-term Care Facilities (LCTFs) (note this is a historical document, this guidance no longer in effect as of 5/6/21) testing guidance.

AND

Q: Do people who were COVID positive more than 90 days ago need to be retested?

A: Yes. For information about why this is the case, see this CDC article.

Q: What are the CDC recommendations about testing residents? (note, see also NH DHHS Bureau of Infectious Disease Control Reopening Guidance for Long-term Care Facilities (LCTFs) (note this is a historical document, this guidance no longer in effect as of 5/6/21) testing guidance.

A: See Testing Guidelines for Nursing Homes and Testing in Nursing Homes FAQ (scroll down to this section) on the CDC website.

Q: What are the different kinds of COVID-19 tests?

A: See the Texas Department of State Health Services handout, COVID-19 Testing: PCR, Antigen, and Antibody Tests Explained. NH DHHS HAN#23 also discusses the different kinds of tests.

Q: What is the process for obtaining testing for residents with symptoms?

If a resident shows symptoms and/or needs testing outside the surveillance testing program, or if the surveillance program does not apply to your facility, facilities may schedule tests using this form. NH DHHS Health Alert Network (HAN) Messages provide the latest guidance on testing

DHHS notes that residents have the right to refuse testing. (See above, Q: Can a resident refuse testing, and what do we do if that happens?)

Q: What is the process for reporting if a resident develops symptoms?

A: Immediately report any suspected cases to the DPHS Public Health Professional on call at 603-271-4496. After hours call 603-271-5300 to report (ask for the Public Health Professional on call OR the EOC duty officer).

Q: What is the protocol for obtaining an NP swab?

and Q: Where can I get specimen collection kits?

A: For testing supplies, see NH DHHS HAN #15 “Facilities should continue to order specimen collection supplies (e.g. swabs, transport media) through your own purchasing mechanisms. If supplies are unavailable or difficult to obtain, please contact the NH Public Health Laboratories (PHL) to request specimen collection supplies at 603-271-4605, or email phlclinicalkitorders@dhhs.nh.gov

Email ltcftesting@dhhs.nh.gov to ask for a training powerpoint for staff that shows how to collect different kinds of specimens for testing.

Rhode Island Department of Health has created a step-by-step guide you can download; as did Yukon Communicable Disease Control and Sigma, and there is an illustration with steps outlined in this NH DHHS health alert.

New England Journal of Medicine produced a video tutorial, as did Puritan Health.

Transporting and return to facility and new admissions

Q: Can we admit new residents?

A: See NH Bureau of Infectious Control’s updated reopening guidance (note this is a historical document, this guidance no longer in effect as of 5/6/21) for LTCFs; yes except in Phase 0.

Q: What PPE should people transporting a COVID-19 patient wear? What about the patient?

A: The CDC recommends the patient should wear a facemask; the level of PPE needed for transport personnel depends on how close the contact will be. See this page for explanations from the CDC.

Q: What should we do after a resident has an appointment or tests (non COVID related) and returns to the facility (do they need to quarantine)?

and what about people being newly admitted or returning from acute care facilities (do they need to quarantine)?

A: For appointments that did not include an overnight stay, no, see: NH DHHS’s Coronavirus Disease 2019 (COVID-19) Guidance for Long-term Care Facilities (LTCF), p. 6.

For overnight stays and new admissions, see updated NH DHHS Bureau of Infectious Disease Control Reopening Guidance for Long-term Care Facilities (LCTFs) (note this is a historical document, this guidance no longer in effect as of 5/6/21)  Quarantine guidance, pp. 8-9, unless the person does not fit that criteria. If not see Cohorting, Quarantine, & Isolation at the top of this page.

Further reading: CDC’s Standard Precautions for infection prevention, as noted above and Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. This DHHS Health Alert also summarizes CMS guidance, including recommended quarantine for residents newly admitted from acute care settings.

CDC also issued Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination, and also updated Interim Infection Prevention and Control guidelines as well as Preparing for COVID-19 in Nursing Homes, and both address isolating patients.

Q: What are the recommendations for quarantine or isolation for people who have recently (within 90 days) had COVID or been vaccinated:

A: See Cohorting, Quarantine, & Isolation at the top of this page..

This page updated 6/24/21

See also: After work precautions, Gloves, Masks, Surveillance testing, and Transport

Information is changing rapidly as the COVID-19 outbreak evolves. Please take the links on these pages, especially the NH DHHS, which coordinates the COVID-19 response in our state, and other public health resources such as your local public health department, the CDC and WHO to find the latest guidance and recommendations.

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