HHSC Update: To Do's for Nursing Facilities
Updated: Jun 4, 2020
This is a subset of the information included in the LTC Regulatory NF COVID-19 Response Plan (v3.1 6/2/20). Revisions from the prior version are indicated in red text.
To Do's for Nursing Facilities:
Review the CDC’s Key Strategies to Prepare for COVID-19 in Longterm Care Facilities.
Review the CDC’s Preparing for COVID-19: Long-term Care Facilities, Nursing Homes.
Review the CDC’s Responding to Coronavirus (COVID-19) in Nursing Homes.
Review the CDC’s Testing for Coronavirus (COVID-19) in Nursing Homes.
Review the CDC’s Strategies to Mitigate Healthcare Personnel Staffing Shortages.
Review the CDC’s Considerations for Memory Care Units in Long-term Care Facilities
Review CMS blanket (1135) waivers which include: Resident Care & Program Requirements, Physical Environment & LSC
Review resident isolation and quarantine plans with staff.
Review handwashing, surface-cleaning, and other environmental hygiene precautions with staff.
Develop a staffing contingency plan in case a large number of staff must self-quarantine or isolate because of potential exposure, being suspected of, or positive for COVID-19.
Report a confirmed COVID-19 case to the local health department or DSHS and to HHSC.
Report all confirmed COVID-19 cases and persons under investigation for COVID-19 among residents and staff to the CDC via NHSN weekly. See CMS QSO 20-29.
Keep all residents’ and their representatives up to date on the conditions inside the facility, such as when new cases of COVID-19 occur. See CMS QSO 20-29.
Obtain and properly use PPE.
Comply with all CMS and CDC guidance related to infection control. (NFs need to frequently monitor CDC and CMS guidance, as it is being updated often.)
For the duration of the state of emergency, all NF personnel should wear a facemask while in the facility. Staff who are have been appropriately trained and fit-tested can use N95 respirators. Staff who are caring for residents with COVID-19, or caring for residents working in a building with widespread COVID-19 infection, should wear an N95 respirator and all suggested PPE. See guidance in the section related to PPE use when caring for residents with COVID-19.
If N95 or other respirators are used, review OSHA’s Respiratory Protection Training Videos
Actively screen, monitor, and surveil everyone who comes into the facility.
To avoid transmission within facilities, NFs should use separate staffing teams for COVID-19-positive residents to the best of their ability, designate separate facilities or units within a facility to separate residents who are COVID-19-negative from residents who are COVID19-positive and people with unknown COVID-19 status.
Quarantine residents with exposure or symptoms.
Isolate residents with positive cases.
Upon the first positive test result of a NF staff member or resident, the facility shall work with local health authorities, DSHS, and HHSC to coordinate testing of all NF staff and residents.
Follow direction from DSHS, HHSC, and TDEM as they develop and implement a plan to test all residents and NF staff.
Clean and sanitize the facility when a positive case occurs.
Coordinate resident diagnoses and symptoms with transferring and receiving hospitals and other NFs.
Communicate with residents, staff, and family when exposure, suspected, or confirmed cases occur in the facility.
Keep an up-to-date list of all staff who work in other facilities.
Require staff self-monitoring on days they work and on days they don’t work.
Require staff to report via phone prior to reporting for work if they have known exposure or symptoms.
Follow the guidance beginning on page 40 of the linked document to determine when staff can return to work after recovering from an illness.
Follow physician’s plan for immediate care of any resident with a positive case. Orders can include increased assessment frequency, increased monitoring of fluid intake and output, supportive care, a treatment plan, and what to do in case of a change in the resident’s status.
Inform the resident of treatment or supportive care plans; residents have the right to participate in care planning.
Utilize the ASPR TRACIE workforce virtual toolkit.
Review the ASPR TRACIE resources document: Nursing Home Concepts of Operations for Infection Prevention and Control
If needed, request deployment of the Rapid Assessment Quick Response Force.
Read the full Response Plan Here:
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