Employees — when staff should cohort, isolate, quarantine, return to work, etc. (including after travel)

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 Information on this page may be useful but some NH DHHS guidance is no longer in force.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.

Q: Should staff “shelter in place” at the facility to limit exposure for residents?

A: The CDC recommends sick leave policies be enforced, infection prevention and control measures be followed (see also this updated guidance for post vaccination) and employees as well as residents be screened. There are no recommendations on staying at the facility.

Q: Should staff working with residents who are presumed or confirmed to have COVID-19 work with other residents as well? (Should staff cohort?)

A: The Centers for Medicare & Medicaid Services (CMS) recommends “To avoid transmission within long-term care facilities, facilities should use separate staffing teams for COVID-19-positive residents to the best of their ability.” Details are on p. 2 of this guidance.

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

A: 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 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)

Q: What are the recommendations for when employees should not work? And related questions such as:

Q: If an employee believes that they have been exposed, what steps should be taken to protect residents?

or: Q: If an employee tests positive but is asymptomatic, can they still work?

or, Q: If an employee travels out of state, what steps should be taken?

or, Q: If an employee works at another place in addition to this facility (and might have secondary or unknown exposure to COVID-19), or visits with or lives with someone else who works at a facility that has suspected or confirmed COVID-19 cases, what steps should be taken?

A: Screening is the best way to determine who should work and what precautions should be taken. The answers depend on many factors.

AHCA has a checklist for screening staff as well as many other resources.

AMDA (The Society for Post-Acute and Long-Term Care Medicine) has a bulletin. COVID-19 Update for the Nursing Home Worker that answers these and several other questions.

NH’s Bureau of Infectious Disease Control also addresses staff exposure, travel, and other questions about when and how staff should work in their guidance for LTCFs; they also issued an updated Criteria for Return to Work and Crisis Staffing in Long Term Care Facilities. The Bureau also issued additional guidance on employee travel for workplaces including healthcare settings. HAN #27 also affirmed its previous advice for “maintaining a 14 day quarantine for residents and staff” of LCTFs who have traveled or been exposed to COVID.

See above for updated guidance in HAN #33 for 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.

For all NH Bureau of Infectious Disease Control resources for LTCFs, visit this page.

CDC also has guidance related to staff COVID-19 exposure and return to work after having COVID-19, and staff are also addressed in Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. CDC previously issued updated guidance on infection prevention and control and updated Strategies to Mitigate Healthcare Personnel Staffing Shortages, which includes guidance on staff who may have been exposed to COVID-19 or who test positive but are asymptomatic. See also CDC’s Responding to Coronavirus (COVID-19) in Nursing Homes, which addresses infection prevention and control as well as testing.

New Hampshire Health Care Association’s Important COVID-19 Information for NH Long-Term Care Providers is another good resource.

Q: What are the guidelines for screening staff?

A: In addition to the references above, 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 three phases, in accordance with CMS guidelines.

This page updated 6/10/21

See also: COVID-19 in residents, Emergency licensing and temporary health partners program, Employees (staff) testing, Recruiting and hiring new staff, Self care

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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