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Anyone, 6 months of age and older, is eligible to receive the COVID-19 vaccine. Find your nearest vaccination location at vaccines.gov.

Long-Term Care Facilities Guidance

This interim guidance provides guidelines to mitigate the spread of COVID-19 in nursing homes and other long-term care (LTC) facilities that provide skilled personal care services. The guidance in this document is specifically intended for facilities as defined in the Nursing Home Care Act (210 ILCS 45), Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), State-Operated Developmental Centers (SODC), Medically Complex/Developmentally Disabled Facilities (MC/DD), and Illinois Department of Veterans Affairs facilities.

In accordance with updated Centers for Disease Control and Prevention (CDC) Guidance facility types such as Supportive Living Facilities, Assisted Living Facilities, Shared Housing Establishments, Sheltered Care Facilities, and Specialized Mental Health Rehabilitation Facilities (SMHRFs), whose staff provide non-skilled personal care, similar to that provided by family members in the home (e.g., many assisted living group homes), should follow community prevention strategies based on COVID-19 Community Levels, similar to independent living, retirement communities or other non-health care higher risk congregate settings.  The CDC definition of non-skilled personal care is provided below. 

Any health care personnel (HCP) providing significant health care to one or more residents in non-skilled long-term care facilities (e.g., hospice care, memory support, physical therapy, wound care, intravenous injections, or catheter care) should follow the health care infection prevention and control (IPC) recommendations in this guidance, and all facility policies related to SARS-CoV-2.

Employers should be aware that other local, state, and federal requirements may apply, including those promulgated by the Occupational Safety and Health Administration (OSHA).

Reason for Update

The Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS) have made significant revisions to guidance for the community and health care settings. This health care guidance change reflects CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, released on September 23, 2022, which is based on “the high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention, which have substantially reduced the risk for medically significant COVID-19 illness (severe acute illness and post-COVID-19 conditions) and associated hospitalization and death.” These revisions focus on minimizing the impact of COVID-19 on individual persons, communities, and health care systems.

Continued Focus on County Level COVID-19 Transmission: Defining Community Transmission of SARS-CoV-2

Community Transmission is the metric currently recommended to guide select practices in health care settings which allows for earlier intervention before there is a strain on the health care system and to better protect the individuals seeking care in these settings.

The CDC COVID-19 Data Tracker shows the difference between Community Transmission and the COVID-19 Community Level used for non-health care higher risk congregate settings. Community Transmission refers to measures of the presence and spread of SARS-CoV-2. COVID-19 Community Levels place an emphasis on measures of the impact of COVID-19 in terms of hospitalizations and health care system strain, while accounting for transmission in the community.

Facilities should monitor Community Transmission and implement select infection prevention and control measures (e.g., use of source control, screening testing for nursing home admissions) based upon levels of SARS-CoV-2 transmission in the community.

Updated CDC recommendations released September 23, 2022, refer to Community Transmission in two distinct categories: HIGH and NOT HIGH.

  • HIGH (red)
  • NOT HIGH includes SUBSTANTIAL (orange), MODERATE (yellow), and LOW (blue) levels of Community Transmission

Key Points

Facilities must use the CDC COVID-19 Data Tracker to monitor Community Transmission.

  • Facilities must monitor their Community Transmission once a week on Monday given that CDC currently updates this metric late on Thursday or Friday every week
    • If the Community Transmission changes to High, the facility should consider implementing more stringent infection prevention measures by HCP during resident care encounters (e.g., source control, eye protection, etc.)
    • If the Community Transmission is not high, the facility should consider following the higher level of Community Transmission for at least two weeks before relaxing infection prevention measures

The Core Principles of COVID-19 Infection Prevention

Use of Engineering Controls and Indoor Air Quality

When indoors, improving ventilation and increasing the number of times fresh or filtered air enters a room can help reduce viral particle concentration and have been proven to decrease COVID-19 transmission. “The lower the concentration, the less likely viral particles can be inhaled into the lungs (potentially lowering the inhaled dose); contact eyes, nose, and mouth; or fall out of the air to accumulate on surfaces,” according to the CDC.

Improving ventilation practices and interventions can reduce the airborne concentrations and reduce the risk that residents, visitors, and HCP come in contact with viral particles.

Approaches Include:

  • Increasing the introduction of outdoor air.
  • Ensuring ventilation systems are operating properly as defined by ASHRAE Standard 62.1.
  • Optimizing the use of engineering controls to reduce or to eliminate exposures. 
  • Exploring options to improve ventilation delivery and indoor air quality in all shared spaces. The higher number of air exchanges per hour will result in better results with respect to purging airborne contaminants. Refer to the CDC suggested options for Air Changes per Hour (ACH).
  • Using portable room air cleaners with a high efficiency particulate air (HEPA) filter to enhance air cleaning. Air cleaners need to have the appropriate CADR (Clean Air Delivery Rate) rating for the room size [e.g., a 300-foot2 room with an 11-foot ceiling will require a portable air cleaner labeled for a room size of at least 415 foot2 (300 × [11/8] = 415)].
  • Optimize the use of engineering controls to reduce or eliminate exposures by shielding HCP and other residents from infected individuals (e.g., physical barriers at reception / triage locations and dedicated pathways to guide symptomatic residents through waiting rooms and triage areas). Ensure that barriers are in compliance with the National Fire Protection Agency (NFPA) 101, Life Safety Code (LSC).
  • Take measures to limit crowding in communal spaces.
  • Encourage social distancing at large gatherings, such as parties or events.
  • Explore options, in consultation with facility engineers, to improve ventilation delivery and indoor air quality in resident rooms and all shared spaces.
  • The following resources provide evidence-based guidance:

Vaccinations

Vaccination remains critically important in reducing hospitalization and death for COVID-19. Facilities should encourage residents, staff, and families to remain up to date with COVID-19 vaccination, including all eligible booster doses.

Reporting of Staff and Resident COVID-19 Vaccinations and Testing

Report SARS-CoV-2 infection data to the National Healthcare Safety Network (NHSN) Long-term Care Facility (LTCF) COVID-19 Module.

Facilities that are not required to report COVID-19 aggregate vaccination and testing data into the National Healthcare Safety Network (NHSN) shall report this data to IDPH weekly utilizing the online form at LTC Weekly Reporting COVID-19 Vaccinations and Testing.  The required information matches that submitted by CMS-certified facilities to NHSN.

Oral Antivirals, Other Therapeutics for Outpatient Management of COVID-19

Treatment has been shown to reduce the risk of severe COVID-19 disease and hospitalization, especially in the elderly.  As soon as a resident is diagnosed with COVID-19, contact the resident’s medical provider to assess whether treatment is warranted.

Information is available at:

  • National Institutes of Health (NIH) treatment guidelines
  • A clinical decision tree is also available to help clinicians determine if a resident/patient is eligible for treatment and the right choice of treatment
  • Pre-exposure prophylaxis is available for those residents who are not expected to mount a response to vaccination due to their immunosuppressed state or have a contraindication to receiving the vaccine
  • Treatment: Persons who are older or who have chronic respiratory, cardiac, or renal disease; obesity; immunosuppressive disease; diabetes; and other medical conditions or factors, including race and ethnicity associated with increased risk of severe COVID-19 disease, may benefit from monoclonal antibody (mAb) treatment, regardless of vaccination status
  • Providers/facilities looking to directly administer or provide medications should use the IDPH Therapeutics Request Form

Screening

Active screening (e.g., completing screening tool {electronic or paper}, taking temperatures, or directly asking screening questions) before someone enters a facility is no longer required.  Instead, facilities must establish a process to inform HCP, residents, and visitors of recommended actions to prevent the transmission of COVID-19 by posting visual alerts (e.g., signs, posters) at entrances and other strategic places. These alerts should include instructions about current IPC recommendations (e.g., when to use source control and perform hand hygiene). 

Visitors

Facilities need to ensure visitors are aware that if they have any of the following three criteria, they should limit or defer non-urgent in-person visitation while they are infectious or potentially infectious or until they have met the health care criteria to end isolation to preserve the safety of residents.

  • A positive viral test for SARS-CoV-2
  • Symptoms of COVID-19
  • If visitors who have had close contact with someone with SARS-CoV-2 infection or were in another situation that put them at higher risk for transmission, it is safest to defer non-urgent in-person visitation until 10 days after their close contact if they meet any of the criteria described in Section 2 (e.g., cannot wear source control)

Residents

The evaluation of residents may vary or be adjusted based on the individual resident, Community Transmission level, and/or whether the facility is in outbreak.

  • When Community Transmission is HIGH or if the facility is in outbreak, all residents, including new admissions, should be evaluated at least daily for signs and symptoms of COVID-19. To clarify, the evaluation includes:
    • Screening for signs and symptoms of COVID-19 (can be done during daily assessment)
    • Actively monitoring temperature
    • Assessing respiratory status with pulse oximetry
  • If residents have a fever or symptoms consistent with COVID-19, increase the monitoring to every four hours. Include an assessment of symptoms, vital signs (temperature, pulse, respirations), oxygen saturation via pulse oximetry, and assess respiratory status to identify and to quickly manage serious infection. Blood pressure per health care provider orders.
  • When Community Transmission is NOT HIGH and the facility is not experiencing an outbreak, vital signs should be checked at least weekly including temperature, pulse, and respirations (TPR), blood pressure (BP), and pulse oximetry.
  • In addition, more frequent vital signs may be recommended for individual residents when the resident exhibits signs or symptoms of an acute illness (e.g., respiratory illness {other than COVID-19}) or per physician orders.

HCP

LTC facilities no longer need to screen HCP upon entry to work. Instruct HCP to report a positive viral test, symptoms of COVID-19, or close contact with someone with SARS-CoV-2 infection or a higher-risk health care exposure to SARS-CoV-2 to occupational health or another point of contact designated by the facility so these HCP can be properly managed.

Implement Source Control Measures

Source control refers to use of respirators or well-fitting face masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing.

When SARS-CoV-2 Community Transmission is HIGH, source control is recommended for everyone in a health care setting when they are in areas of the health care facility where they could encounter residents.

Visitors

Facilities may choose to offer well-fitting masks as a source control option for visitors but should allow the use of a mask or respirator with higher-level protection that is not visibly soiled by people who chose that option based on their individual preference.

Residents

For the safety of residents, source control is recommended for everyone including residents when the Community Transmission is HIGH. Residents should wear source control when in the common areas of the facility especially if attending a large gathering and to and from the dining room or activities. A well-fitted mask is preferred. Residents do not have to wear source control in their rooms.

HCP

Source control options for HCP include:

  • A NIOSH-approved particulate respirator with N95 filters or higher
  • A well-fitted mask

When used solely for source control, any of the options listed above for HCP could be used for an entire shift unless they become soiled, damaged, or hard to breathe through. If used during the care of a resident for which a NIOSH-approved respirator or face mask is indicated for personal protective equipment (PPE) (e.g., NIOSH-approved particulate respirators with N95 filters or higher during the care of a resident with SARS-CoV-2 infection, face mask during care of a resident on Droplet Precautions), they should be removed and discarded after the resident care encounter and a new one should be donned.

HCP could choose not to wear source control when they are in well-defined areas that are restricted from resident access (e.g., staff lounge or meeting rooms). Facility policies should define what areas are considered to be well-defined.

When Community Transmission is NOT HIGH, health care facilities could choose not to require universal source control.

However, even if source control is not universally required, it remains recommended for individuals in health care settings who:

  • Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze)
  • Had close contact (residents and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure
  • Reside or work on a unit or area of the facility experiencing a SARS-CoV-2 outbreak
  • Have otherwise had source control recommended by public health authorities

Universal use of source control could be discontinued as a mitigation measure once no new cases have been identified for 14 days.  Individuals might also choose to continue using source control based on personal preference.

Universal PPE for HCP

  • If a resident is suspected or confirmed to have COVID-19, HCP must wear an N95 respirator, eye protection, gown, and gloves.
  • For those residents not suspected to have COVID-19, HCP should use Community Transmission levels to determine the appropriate PPE to wear and follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis).

When Community Transmission is HIGH

  • At a minimum, HCP must wear a well-fitted mask at all times while in areas of the facility where they may encounter residents
  • Eye protection (i.e., goggles or a face shield that covers the front and sides of the face) should be worn during all resident care
  • If residents are unable to wear source control, HCP should wear eye protection in areas of the facility where they may encounter residents to avoid exposures

For COVID-19 specimen collection

  • PPE requirements vary based on the staff’s role in specimen collection and whether they will be at least 6 feet away from the person being tested
  • Gloves and mask are needed for staff who will not be directly involved in specimen collection or who will be greater than 6 feet away from person being tested
  • Gown, NIOSH-approved N95 equivalent or higher-level respirator, gloves, and eye protection are needed for staff collecting specimens or working within 6 feet of the person being tested
  • Consider whether you can minimize the number of staff needed and amount of PPE used by having individuals collect their own specimens while being supervised by health care providers who are at least 6 feet away

Guidance for CPAP/BIPAP for asymptomatic residents, who are not suspected to have COVID-19 (regardless of vaccination status)

  • In areas where Community Transmission is HIGH, HCP must wear an N95 respirator and eye protection when entering the room of a resident with CPAP/BIPAP. N95 and eye protection should be worn for 60 minutes post-use of CPAP/BIPAP to allow air contaminants to be removed.
  • In areas where Community Transmission Is NOT HIGH, HCP must wear a well-fitted face mask provided there is no concern for other respiratory infections that would warrant droplet or airborne precautions.

As Community Transmission increases, the potential for encountering asymptomatic or pre-symptomatic residents and visitors with SARS-CoV-2 infection also likely increases.  In these circumstances, to simplify implementation health care, facilities should consider implementing broader use of N95 respirators and eye protection by HCP during resident care encounters. For example, facilities located in counties where the Community Transmission is HIGH should consider having HCP wear N95 respirators and eye protection for the following:

  • HCP working in situations where additional risk factors for transmission are present, such as the resident is unable to use source control and the area is poorly ventilated (e.g., memory care units)
  • If health care-associated SARS-CoV-2 transmission is identified and universal respirator use by HCP working in affected areas is not already in place

Testing Plan and Response

The facility must have a written COVID-19 testing plan and response strategy in place based on contingencies informed by the CDC and, as applicable, CMS requirements.

Facilities may be eligible for no cost direct shipments of BinaxNOW COVID-19 rapid antigen tests from the federal government. To enroll, email the U.S. Department of Health and Human Services (HHS) Binax Team at Binax.Team@hhs.gov and indicate you are a long-term care facility interested in signing-up for the free shipments of BinaxNOW COVID-19 antigen tests. The HHS Binax Team will assist with eligibility and enrollment.

COVID-19 testing is required for any of the following:

  • Symptomatic residents or HCP, even those with mild symptoms of COVID-19, regardless of vaccination status, should receive a viral test for SARS-CoV-2 as soon as possible. Implement recommended infection prevention and control (IPC) practices when caring for a resident with suspected or confirmed SARS-CoV-2 infection (see below).
  • Asymptomatic residents and HCP with a close contact or higher-risk exposure with someone with SARS-CoV-2 infection should have a series of three viral tests for SARS-CoV-2 infection unless they have recovered from COVID-19 in the prior 30 days. Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of a nucleic acid amplification test (NAAT) (e.g., PCR) is recommended.  This is because some people may remain NAAT positive but not be infectious during this period. Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.
  • Routine serial testing of HCP who are unvaccinated or not up to date is no longer recommended but may be performed at the discretion of the facility. The yield of screening testing for identifying asymptomatic infection is likely lower when performed on those in counties with lower levels of SARS-CoV-2 Community Transmission.
    • If implementing a screening testing program, testing decisions should not be based on the vaccination status of the individual being screened.
    • To provide the greatest assurance that someone does not have SARS-CoV-2 infection, if using an antigen test instead of a NAAT, facilities should use three tests, spaced 48 hours apart, in line with Food and Drug Administration (FDA) recommendations.
Admissions and residents who leave the facility
  • In general, admissions in counties where Community Transmission Is HIGH should be tested upon admission.
    • Testing is recommended at admission and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This will typically be at day 0, day 3, and day 5.
    • Residents should also be advised to wear source control for the 10 days following their admission (day 0 is the date of admission). 
  • Residents who leave the facility for 24 hours or longer, regardless of vaccination status, should generally be managed as an admission and managed as above.
  • Testing is not required for residents who leave the facility for fewer than 24 hours. Admission testing in counties where Community Transmission is NOT HIGH is at the discretion of the facility. When implemented, follow the guidance above for HIGH Community Transmission levels. 
Outbreak testing
  • Facilities can choose to investigate an outbreak using contact tracing or a broad-based approach.
  • A broad-based approach includes the unit, floor, or other specific area of the facility where the positive COVID-19 case was identified (this could be where the resident resides or where the HCP worked). If a facility is unable to conduct contact tracing or contacts cannot be identified, the facility should follow a broad-based approach.
    • When using the broad-based approach, a facility should continue to test every 3-7 days until there are no more positive cases identified for 14 days.
    • If additional cases are identified after testing a unit, floor, or specific area of the facility, the facility may expand testing to facility-wide testing if testing and implementation of infection control measures have failed to halt transmission.
  • If contact tracing was completed, test all residents and HCP identified as close contacts or who had a higher-risk exposure regardless of vaccination status unless they have recovered from COVID-19 in the prior 30 days. Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of a NAAT (e.g., PCR) is recommended.  This is because some people may remain NAAT positive but not be infectious during this period. Test at day 1, day 3, and day 5 (as above).
    • If no additional cases are identified during contact tracing (testing only those residents or staff with a close contact or higher risk exposure) no further testing is indicated.
    • If additional cases are identified from testing close contacts or higher-risk exposures, facilities should expand testing as determined by the distribution and number of cases throughout the facility and ability to identify close contacts. This is considered a broad-based approach. When using the broad-based approach, a facility should continue to test every 3-7 days until there are no more positive cases identified for 14 days.
    • If a facility is unable to perform contact tracing, they should test all residents and HCP on the affected unit(s) using the broad-based approach. Test every 3-7 days until there are no more positive cases identified for 14 days
    • If additional cases are identified after testing a unit, floor, or specific area of the facility, the facility may expand testing to facility-wide testing if testing and implementation of infection control measures have failed to halt transmission.

Hand Hygiene

Hand hygiene is a core infection prevention measure and should be performed frequently to reduce the spread of organisms and the virus that causes COVID-19. The facility must train and validate competencies of all staff on hand hygiene. Facilities should encourage persons entering the facility to perform hand hygiene and ensure hand hygiene products are available at the point of care.

Environmental Infection Control

  • Dedicated medical equipment should be used when caring for a resident with suspected or confirmed SARS-CoV-2 infection. Reusable equipment must be cleaned and disinfected between residents.
  • Refer to List N on the U.S. Environmental Protection Agency (EPA) website, for EPA-registered disinfectants that kill SARS-CoV-2; the disinfectant selected should also be appropriate for other pathogens of concern at the facility (e.g., a difficile sporicidal agent is recommended to disinfect the rooms of residents with C. difficile infection).
  • Management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures.
  • Once the resident has been discharged or transferred, HCP, including environmental services personnel, should refrain from entering the vacated room without all recommended PPE until sufficient time (approximately 60 minutes) has elapsed for enough air changes to remove potentially infectious particles this is.  After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection utilizing routine PPE before it is returned to routine use.

Personal Protective Equipment Supply

Surge capacity refers to the ability to manage a sudden increase in patient volume that would severely challenge or exceed the present capacity of a facility. To help health care facilities plan and optimize the use of PPE in response to COVID-19, CDC has developed a Personal Protective Equipment (PPE) Burn Rate Calculator. Three general strata have been used to describe surge capacity and can be used to prioritize measures to conserve PPE supplies along the continuum of care: conventional (normal operations without shortages), contingency capacity (measures used temporarily during periods of anticipated PPE shortages), and crisis capacity (strategies implemented during periods of shortages even though they do not meet U.S. standards of care).

The supply and availability of NIOSH-approved respirators and other PPE has increased significantly. Health care facilities should not be using crisis capacity strategies for PPE at this time.

Facilities that extend the use of N95 respirators, face masks, and eye protection are operating at a contingency level of PPE utilization. If respirators, face masks, or gowns are reused, the facility is operating at a crisis level

Recommended infection prevention and control (IPC) practices when caring for a resident with suspected or confirmed SARS-CoV-2 infection or a close contact of someone with confirmed COVID-19 infection

Duration of Empiric Transmission-Based Precautions for Symptomatic Residents being Evaluated for SARS-CoV-2 infection

  • The decision to discontinue empiric Transmission-Based Precautions by excluding the diagnosis of current SARS-CoV-2 infection for a resident with symptoms of COVID-19 can be made based upon having negative results from at least one NAAT (e.g., PCR) viral test
  • If a higher level of clinical suspicion for SARS-CoV-2 infection exists, consider maintaining Transmission-Based Precautions and confirming with a second negative NAAT or second negative antigen test taken 48 hours after the first negative test
  • If a resident is suspected of having SARS-CoV-2 infection is never tested, the decision to discontinue Transmission-Based Precautions can be made based on time from symptom onset as described in the Isolation section below
  • Ultimately, clinical judgement and suspicion of SARS-CoV-2 infection determine whether to continue or discontinue empiric Transmission-Based Precautions
  • Facilities should consult with residents’ health care provider to rule out other respiratory infections before discontinuing Empiric Transmission-Based Precautions

Duration of Empiric Transmission-Based Precautions for Asymptomatic Residents following Close Contact with Someone with SARS-CoV-2 Infection

Asymptomatic Residents do not require Empiric Transmission-Based Precautions while being evaluated for COVID-19 following a close contact with someone with COVID-19 infection.

  • Testing is not recommended for those recovered from COVID-19 in the prior 30 days
  • Testing should be considered for those who have recovered in the prior 31-90 days
  • These residents should wear source control when out of their rooms

Empiric Transmission-Based Precautions following close contact may be considered when:

  • Resident is unable to be tested or wear source control as recommended for the 10 days following their exposure
  • Resident is moderately to severely immunocompromised
  • Resident is residing on a unit with others who are moderately to severely immunocompromised
  • Resident is residing on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions

If residents are placed in Transmission-Based Precautions for any reason listed above

  • Residents can be removed from Transmission-Based Precautions after day 7 following the exposure (count the day of exposure as day 0) if they do not develop symptoms and all viral testing as described for asymptomatic individuals following close contact is negative
  • Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test
    • This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5

If viral testing is not performed, residents can be removed from Transmission-Based Precautions after day 10 following the exposure (count the day of exposure as day 0) if they do not develop symptoms.

Management of Residents

COVID-19 Unit

  • Facilities are not required to have a dedicated COVID-19 unit unless the number of positive residents would warrant such a unit. If residents can be safely managed in the general population, a facility can place a COVID-19 positive resident in a single room with appropriate isolation signage, and staff wearing N95 respirator, eye protection, gown, and gloves upon entry to the room.
  • Facilities could consider designating entire units within the facility, with dedicated HCP, to care for residents with SARS-CoV-2 infection when the number of residents with SARS-CoV-2 infection is high.
    • When feasible, dedicate HCP to the COVID-19 area or unit (including environmental services or housekeeping staff). Dedicated means that HCP are assigned to care only for these residents during their shifts. Dedicated units and/or HCP might not be feasible due to staffing crises or a small number of residents with SARS-CoV-2 infection.
    • Consideration should be given to assigning staff who are up to date with COVID-19 vaccination or have recently recovered from COVID-19 infection to care for residents in the dedicated area or unit.

Resident Placement if not using a COVID-19 Unit

  • Place a resident with suspected or confirmed SARS-CoV-2 infection in a single-person room using Transmission-Based Precautions (isolate). The door should be kept closed (if safe to do so). Ideally, the resident should have a dedicated bathroom.
  • If limited single rooms are available, or if numerous residents are simultaneously identified to have known SARS-CoV-2 exposures or symptoms concerning for COVID-19, residents should remain in their current location, draw a privacy curtain between beds, and wait for test results.
  • If cohorting, only residents with the same respiratory pathogen should be housed in the same room. MDRO colonization status and/or presence of other communicable disease should also be taken into consideration during the cohorting process.
  • Limit transport and movement of the resident outside of the room to medically essential purposes.
  • Communicate information about residents with suspected or confirmed SARS-CoV-2 infection to appropriate personnel before transferring them to other departments in the facility and to other health care facilities.

Residents with Confirmed COVID-19

  • Resident placement: single room with door closed if safe to do so. Dedicated bathroom if possible.
  • If limited single rooms are available or if numerous residents are simultaneously identified to have COVID-19, residents can remain in their current location with appropriate signage and PPE use. Cohorting may occur with other positive COVID-19 residents.
  • Isolate using Transmission-Based Precautions (see duration of TBP below).
  • Discuss treatment options with resident or their decision maker, to prevent hospital admissions.
  • Monitor the resident every four hours for clinical worsening.  Include an assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exam to identify and to quickly manage serious infections.
  • Residents should report any symptoms to HCP. If symptoms recur (e.g., rebound), these residents should be placed back into isolation until they again meet the health care criteria below to discontinue Transmission-Based Precautions for SARS-CoV-2 infection unless an alternative diagnosis is identified.
  • In general, residents who are hospitalized for SARS-CoV-2 infection should be maintained in Transmission-Based Precautions for the time period described for residents with severe to critical illness.
  • In general, residents should continue to wear source control until symptoms resolve or, for those who never developed symptoms, until they meet the criteria to end isolation below. Then they should revert to usual facility source control policies for residents.
  • Use dedicated medical equipment.
  • Staff must wear full PPE (N95 respirator, gown, gloves, eye protection) when providing care.
  • Residents with confirmed COVID-19 should have in-room meals and activities until recovered.
  • Follow the Environmental Infection Control section listed above in this guidance.
  • Visitation may occur following guidance in the visitation section.
Duration of Transmission-Based Precautions for residents confirmed to have COVID-19

Mild-to-moderate illness

  • A minimum of 10 days since symptoms first appeared or first diagnostic test
  • Fever free for 24 hours without fever-reducing medications
  • Symptoms improving (e.g., shortness of breath, cough)

Severe-to-critical illness or moderate-to-severely immunocompromised

  • A minimum of 10 days (or up to 20 days) since symptoms first appeared
  • Fever free for 24 hours without fever-reducing medications
  • Symptoms improving (e.g., shortness of breath, cough)
  • Consider consultation with infectious disease expert

Residents who were asymptomatic throughout their infection and are not moderately to severely immunocompromised should be maintained on Transmission-Based Precautions until:

  • At least 10 days have passed since the date of their first positive viral test

Note: The test-based strategy while not recommended could be used to inform the duration of isolation for those residents who are moderately to severely immunocompromised. Refer to CDC recommendation.

Residents Suspected to have COVID-19

  • Test symptomatic residents regardless of vaccination status.
  • In general, asymptomatic residents do not require empiric use of Transmission-Based Precautions while being evaluated (tested) for COVID-19 following close contact with someone with SARS-CoV-2 infection.
  • Resident placement: single room with door closed if safe to do so. Dedicated bathroom when possible.
  • If limited single rooms are available or if numerous residents are simultaneously identified to have COVID-19 exposures or symptoms concerning for COVID-19, residents should remain in their current location, draw a privacy curtain between beds, and wait for test results.  However, these residents should NOT be cohorted with residents with confirmed SARS-CoV-2 infection unless they are confirmed to have SARS-CoV-2 infection through testing.
  • Isolate empirically using Transmission-Based Precautions until results of tests are known.
  • Monitor residents at least daily.
    • Screening for signs and symptoms of COVID-19
    • Actively monitoring temperature
    • Assessing respiratory status with pulse oximetry
    • If residents have a fever or symptoms consistent with COVID-19, increase the monitoring to every four hours. Include an assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exam to identify and to quickly manage serious infection.
  • Use dedicated medical equipment.
  • Staff must wear full PPE (N95 respirator, gown, gloves, eye protection) when providing care.
  • Follow the Environmental Infection Control section listed above in this guidance.
  • Residents with suspected COVID-19 should have in-room meals and activities until recovered.
  • Visitation may occur following guidance in the visitation section.

New Admissions or Readmissions

  • In general, new admissions or readmissions in counties where Community Transmission Is HIGH should be tested upon admission (Follow Testing and Response section).
  • Admission testing in counties where Community Transmission is NOT HIGH is at the discretion of the facility.
  • Testing is recommended at admission and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This will typically be at day 0, day 3, and day 5.
  • Residents should also be advised to wear source control for the 10 days following their admission (day 0 is the date of admission).
  • Empiric use of Transmission-Based Precautions is generally not necessary for admissions unless they meet criteria described below.
    • Examples of when empiric Transmission-Based Precautions may be considered include:
      • Resident is unable wear source control as recommended for the 10 days
      • Resident is moderately to severely immunocompromised
      • Resident is placed on a unit with others who are moderately to severely immunocompromised
      • Resident is placed on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions
  • Residents who leave the facility for 24 hours or longer, regardless of vaccination status, should generally be managed as an admission.
  • Testing and quarantine are not required for residents who leave the facility for fewer than 24 hours.

New Admission/Readmissions and Residents who Leave the Facility

Resident vaccination status is no longer used to inform recommendations
Is Quarantine of Resident Necessary? Is Testing of the Resident Necessary?
High Community Transmission
Not high (Substantial, moderate, or low) Community Transmission
Residents out for less than 24 hours
No No No
Residents out for 24 hours or more
No

Yes

Testing is recommended at admission and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test (Due to challenges in interpreting the result, an antigen test is recommended instead of a nucleic acid amplification test (NAAT). This is because some people may remain NAAT positive but not be infectious during this period.).

This will typically be at day 0, day 3, and day 5 unless the new admission has recovered from COVID-19 in prior 30 days. Testing is required if resident has recovered prior 31-90 days.

No

Resident Activities

Communal Dining and Activities

  • Residents should wear a mask to and from dining hall or activity room when Community Transmission is HIGH. Residents may wear a face mask or a cloth mask.
  • When SARS-CoV-2 Community Transmission is NOT HIGH, health care facilities may choose to have policies and procedures that do not require universal source control.

Beauty Salons and Barber Shops

To operate facility-based beauty salons and barber shops:

  • Allow services in beauty salons and barber shops only for residents who are not in isolation or quarantine due to known or suspected COVID-19 infection or exposure
  • All residents should wear source control to, from, and in the beauty salon when Community Transmission is HIGH
  • Source control is not required when Community Transmission is not HIGH unless required by the facility
  • The beautician or barber should wear source control at all times while in the beauty salon when residents are present when Community Transmission Is HIGH
  • Hand-held blow dryers may be used in salons

Live Music, Vocal Performances, Sing-alongs, or Worship Services

  • Residents are allowed to participate in indoor performances or religious services unless suspected or confirmed positive for COVID-19. Residents on Transmission-Based Precautions should not participate in these gatherings.
  • No restrictions on outdoor events regardless of vaccination status.
  • Residents should wear source control to, from, and during the performance or service when Community Transmission is HIGH while indoors regardless of vaccination status. Physical distancing is not required.
  • Source control is not required when Community Transmission is NOT HIGH unless required by the facility.
  • Performers should wear source control while performing indoors when Community Transmission is HIGH. No source control is required when outside or if Community Transmission is NOT HIGH unless required by the facility. Physical distancing is no longer required.
  • There is no longer a limit on the number of individuals who can perform. Musical instruments no longer need to be fitted with bell covers. Performers who play wind instruments can use bell/end coverings or face coverings with a slit when Community Transmission is HIGH. No face covering or bell/end covering is required when Community Transmission is NOT HIGH.
  • Individual serving packets of wafer and juice/wine are still preferred for Communion. Do not share or pass Holy Communion among residents.
  • If required, individuals providing pastoral care visits must wear source control and other PPE (e.g., eye protection, gown, and gloves) when indicated.
  • Group outings beyond the facility grounds may be considered, provided precautions, such as source control, are worn when Community Transmission is HIGH.
  • Residents should consider source control and physical distancing if attending a large gathering (e.g., festivals, fairs, and parades), especially if immunocompromised and Community Transmission is HIGH.

Visitation

Residents have the right to receive visitors of their choosing at the time of their choosing and in a manner that does not impose on the rights of another resident, such as a clinical necessity or safety restriction (see 42 CFR § 483.10(f)(4)(v)).

For the safety of the visitor, in general, residents should be encouraged to limit in-person visitation while they are infectious. However, facilities should adhere to local, state, and federal regulations related to visitation. Additional information about visitation from the CMS is available at Policy & Memos to States and Regions | CMS.

  • Counsel residents and their visitor(s) about the risks of in-person visits
  • Encourage use of alternative mechanisms for resident and visitor interactions, such as video-call applications on cell phones or tablets, when appropriate
  • Facilities should provide instruction, before visitors enter the resident’s room, on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy
  • Visits may occur in common areas and in the resident rooms
  • When the visit occurs in common areas, source control should be worn by the resident and their visitors especially when Community Transmission Is HIGH
  • When SARS-CoV-2 Community Transmission Is NOT HIGH, health care facilities could choose not to require universal source control
  • If the visit occurs in the resident’s room, the resident and their visitors may choose not to wear source control
  • When the resident is in Transmission-Based Precautions for suspected or confirmed COVID-19, visits should occur in the resident’s room
  • While allowed, visitors should minimize the time spent in other locations in the facility besides the resident’s room

Compassionate Care Visits

While end-of-life situations have been used as examples of compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life circumstances. Compassionate care visits and visits required under federal disability rights law should be allowed at all times regardless of a resident’s vaccination status, the community transmission level, or an outbreak.

Managing Health Care Personnel with COVID-19 Infection or Exposure

HCP with higher risk exposure

In general, asymptomatic HCP who have had a higher-risk exposure do not require work restriction, regardless of vaccination status, if they do not develop symptoms or test positive for SARS-CoV-2.

Following a higher-risk exposure, HCP should be managed as follows:

  • Have a series of three viral tests for SARS-CoV-2 infection.
  • Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test.
    • This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.
  • Due to challenges in interpreting the result, testing is generally not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days.
  • Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of NAAT is recommended.  This is because some people may remain NAAT positive but not be infectious during this period.
  • Follow all recommended infection prevention and control practices, including wearing well-fitting source control, monitoring themselves for fever or symptoms consistent with COVID-19, and not reporting to work when ill or if testing positive for SARS-CoV-2 infection.
  • Any HCP who develops fever or symptoms consistent with COVID-19 should immediately self-isolate and contact their established point of contact (e.g., occupational health program) to arrange for medical evaluation and testing.
  • While work restriction is not necessary for most asymptomatic HCP following a higher-risk exposure, regardless of vaccination status, examples of when work restriction may be considered include:
    • HCP is unable to be tested or wear source control as recommended for the 10 days following their exposure.
    • HCP is moderately to severely immunocompromised.
    • HCP cares for or works on a unit with residents who are moderately to severely immunocompromised.
    • HCP works on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions.

The specific factors associated with these exposures should be evaluated on a case-by-case basis to determine if a higher-risk exposure occurred. CDC guidance is found at evaluating an exposure. Exposures that might require testing and/or restriction from work can occur both while at work and in the community.  Higher-risk exposures generally involve exposure of HCP’s eyes, nose, or mouth to material potentially containing SARS-CoV-2, particularly if these HCP were present in the room for an aerosol-generating procedure.

HCP with SARS-CoV-2 Infection--Return to Work Criteria

  • HCP with confirmed COVID-19 should be excluded from work.
    • After returning to work, HCP should self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen.
    • If symptoms recur (e.g., rebound) these HCP should be restricted from work and follow recommended practices to prevent transmission to others (e.g., use of well-fitting source control) until they again meet the health care criteria below to return to work unless an alternative diagnosis is identified.
  • The following are criteria to determine when HCP with SARS-CoV-2 infection could return to work and are influenced by severity of symptoms and presence of immunocompromising conditions.

HCP with mild-to-moderate illness

HCP with mild-to-moderate illness who are not moderately-to-severely immunocompromised could return to work after all of the following criteria have been met:

  • At least seven (7) days have passed since symptoms first appeared if a negative viral test is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7)
    • Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT. Antigen testing is preferred if testing asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days.
  • At least 24 hours have passed since last fever without the use of fever-reducing medications
  • Symptoms (e.g., cough, shortness of breath) have improved

HCP who was asymptomatic throughout their infection

HCP who was asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

  • At least seven (7) days have passed since the date of their first positive viral test if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7)
    • Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT. Antigen testing is preferred if testing asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days.
  • Either a NAAT (molecular) or antigen test may be used.
    • If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP with severe to critical illness

HCP with severe to critical illness who are not moderately to severely immunocompromised could return to work after all of the following criteria have been met:

  • At least 10 days and up to 20 days have passed since symptoms first appeared
  • At least 24 hours have passed since last fever without the use of fever-reducing medications
  • Symptoms (e.g., cough, shortness of breath) have improved

HCP who are moderately-to-severely immunocompromised

HCP who are moderately-to-severely immunocompromised may produce replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test. The test-based strategy as described below for contingency staffing can be used for moderately-to-severely immunocompromised HCP and inform the duration of work restriction.

When Contingency staffing strategies are used, HCP with SARS-CoV-2 infection must be well enough and willing to return to work. When following Contingency staffing strategies:

  • HCPs with mild-to-moderate illness who are not moderately-to-severely immunocompromised:
    • At least five (5) days have passed since symptoms first appeared (day 0)
    • At least 24 hours have passed since last fever without the use of fever-reducing medications
    • Symptoms (e.g., cough, shortness of breath) have improved
    • Health care facilities may choose to confirm resolution of infection with a negative nucleic acid amplification test (NAAT) or a series of two (2) negative antigen tests taken 48 hours apart
      • Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT. Antigen testing is preferred if testing asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days.
  • An HCP who was asymptomatic throughout their infection and are not moderately-to-severely immunocompromised:
    • At least five (5) days have passed since the date of their first positive viral test (day 0)
    • Health care facilities may choose to confirm resolution of infection with a negative NAAT (molecular) or a series of two (2) negative antigen tests taken 48 hours apart
      • Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT. Antigen testing is preferred if testing asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days.

Staffing and Other Personnel

Staffing

If conventional strategies cannot be sustained during a surge in cases, facilities may consider implementing contingency strategies, then crisis strategies, in an incremental manner. Facilities are best positioned to evaluate their own needs as to whether conventional, contingency, or crisis strategies are most appropriate at a given time. IDPH generally does not support HCP working while ill, as sickness presenteeism, or working while ill, increases risk of errors and COVID-19 transmission. If a facility is allowing HCP who are positive to work, they must be willing and well enough to work.  For additional strategies refer to CDC website Mitigation Strategies for Staffing Shortages.

Essential Caregivers

Facilities should encourage visits by essential caregivers (ECs) in nursing homes and other long-term care facilities (LTCF). Essential caregivers are not general visitors.  These individuals participate in resident care by meeting an essential need of the resident, by assisting with activities of daily living, or positively influencing the behavior of the resident. Utilize the EC to provide care and emotional support in the same manner as prior to the pandemic, or in whatever manner would best support current needs, as resident health care or psychological conditions may have changed.

It is important to ensure residents can receive individualized person-centered care while preventing the transmission of pathogens that cause disease. For this reason, ECs should follow all regulatory and facility requirements related to infection prevention and control that apply to LTCFs.  The basic elements of an infection prevention and control program are designed to prevent the spread of infection in health care settings. When these elements are present and practiced consistently, the risk of infection among patients and health care personnel is reduced.

Essential Caregivers Guidance

  • Facilities should encourage participation by ECs and communicate the role of the EC with ECs, residents, and families.
  • Facilities should establish policies and procedures for designating and utilizing ECs that include a process and parameters for training of ECs on infection prevention and control measures.
  • ECs must be screened, tested, offered vaccination, and provided PPE in accordance with the health care personnel guidance in the facility’s COVID-19 plan. ECs will be subject to the same standards for testing, quarantine, and isolation based on their vaccination status as for health care personnel at the facility.
  • The facility must document that it has trained the EC on proper infection control, including hand hygiene and appropriate use of PPE, and include the ECs in hand hygiene and PPE use audits. This training should occur at least annually.
  • The administrator, infection preventionist, or director of nursing should determine if EC participation is appropriate or can be considered under compassionate care if a resident has tested positive or is symptomatic for COVID-19, other respiratory infections, or multidrug-resistant organisms (MDROs).
  • The facility should permit flexibility in scheduling EC participation, such as allowing evening and weekend visits, to accommodate the needs of the resident and the EC. This is consistent with Centers for Medicare and Medicaid Services (CMS) and Illinois Department of Public Health (IDPH) guidance related to residents’ rights and visitation.
  • Residents may designate more than one EC based on needs (e.g., more than one family member may split time to provide care for the resident).

State-Authorized Personnel

IDPH grants authorization for entry to state-authorized personnel. They should not be classified as visitors. State-authorized personnel will follow the COVID-19 rules and policies set forth by their respective state agencies. (For additional guidance, see this IDPH guidance document:  Access to Hospital Patients and Residents of Long-Term Care Facilities by Essential State-Authorized Personnel, April 17, 2020). Failure to allow entry of state-authorized personnel may lead to penalties and sanctions pursuant to applicable state and federal law.

Long-Term Care Ombudsman

As stated in previous CMS guidance QSO-20-28-NH, regulations at 42 CFR § 483.10(f)(4)(i)(C) require that Medicare- and Medicaid-certified nursing homes provide representatives of the Office of the State Long-Term Care Ombudsman with immediate access to any resident. Representatives of the Office of the State Long-Term Care Ombudsman should adhere to the core principles of COVID-19 infection prevention as described above. 

Surveyors

Federal and state surveyors must be permitted entry into facilities unless they exhibit signs or symptoms of COVID-19.  Consistent with QSO-20-39-NH, LTC facilities are not permitted to restrict access to surveyors based on vaccination status, nor ask a surveyor for proof of his or her vaccination status as a condition of entry.  Surveyors must adhere to the core principles of COVID-19 infection prevention.

Health Care Workers and Other Service Providers

Health care workers who are not employees of the facility but provide direct care to the facility’s residents, such as hospice workers, emergency medical services (EMS) personnel, dialysis technicians, laboratory technicians, radiology technicians, social workers, clergy, etc., must be permitted to come into the facility as long as they are not subject to a work exclusion due to an exposure to COVID-19 or showing signs or symptoms of COVID-19. These personnel should adhere to the core principles of COVID-19 infection prevention.

Definitions

Close Contact

  • Being within 6 feet of a person with confirmed SARS-CoV-2 infection.
  • Having unprotected direct contact with infectious secretions or excretions of the person with confirmed SARS-CoV-2 infection. Distances of more than 6 feet might also be of concern, particularly when exposures occur over long periods of time in indoor areas with poor ventilation.

Contingency staffing

Staffing shortages are imminent and, if action is not taken, will interrupt care functions. Contingency strategies are used to mitigate staffing shortages.

Crisis staffing

Staffing shortages already exist, and crisis strategies are used in order to continue to provide resident care.

Essential Caregiver (EC)

Essential Caregivers are not general visitors. These individuals meet an essential need of the resident by assisting with activities of daily living or positively influencing the behavior of the resident. The goal of such a designation is to help ensure high-risk residents continue to receive individualized, person-centered care. The plan of care should include services provided by the EC.

Facility-onset case

Following the definition from CMS (QSO-20-30-NH): “A COVID-19 case that originated in the facility; not a case where the facility admitted an individual from a hospital or other congregate care setting with known COVID-19 positive status, or an individual with unknown COVID-19 status that became COVID-19 positive within 14 days after admission.”

Facility-associated case of COVID-19 infection in a staff member

A staff member who worked at the facility for any length of time two calendar days before the onset of symptoms (for a symptomatic person) or two calendar days before the positive sample was obtained (for an asymptomatic person) until the day that the positive staff member was excluded from work. (CDC Contact Tracing for COVID-19).

Higher-risk exposure

HCP who had prolonged close contact with a resident, visitor, or HCP with confirmed COVID-19, and

  • HCP was not wearing a respirator (or if wearing a face mask, the person with SARS-CoV-2 infection was not wearing a cloth mask or face mask)
  • HCP was wearing a surgical or procedure mask, and the individual later identified to have COVID-19 was not wearing a face covering or mask
  • HCP was not wearing eye protection if the individual with COVID-19 was not wearing a face covering or mask
  • HCP was not wearing all recommended PPE (i.e., gown, gloves, eye protection, respirator) while performing an aerosol-generating procedure

Prolonged close contact is within 6 feet for 15 minutes or longer during a 24-hour period, or for any duration during an aerosol generating procedure.

Non-skilled personal care

CDC defines non-skilled personal care as consisting of any non-medical care that can reasonably and safely be provided by non-licensed caregivers, such as help with daily activities like bathing and dressing; it may also include reminders for the kind of health-related care that most people do themselves, like taking oral medications. In some cases where care is received at home or a residential setting, care can also include help with household duties such as cooking and laundry.

Source Control

Source control refers to the use of a well-fitting face covering, face masks, or respirators to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. Source control offers varying levels of protection for the wearer against exposure to infectious droplets and particles produced by infected people.

  • Resident source control = cloth face covering, surgical mask, or procedure mask
  • HCP source control = surgical mask, procedure mask, or respirator, as applicable

Staff (also known as health care personnel (HCP) or health care worker (HCW))

Staff include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the health care facility, and persons not directly involved in resident care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).

State-Authorized Personnel

State-authorized personnel include, but are not limited to, representatives of the Office of the State Long-Term Care Ombudsman Program, the Office of State Guardian, IDPH Office of Health Care Regulation, and the Legal Advocacy Service; and community-service providers, social-service organizations, prime agencies, or third parties serving as agents of the state for purposes of providing telemedicine, transitional services to community-based living, and any other supports related to existing consent decrees and court mandated actions, including, but not limited to, the prime agencies and sub-contractors of the Comprehensive Program serving the Williams and Colbert Consent Decree Class Members.

Resources

Forms