COVID-19: LTC Facilities at Risk

March 2, 2020

By: Raul A. Tabora, Jr.

Recent deaths of nursing home resident and associate highlight focus of Coronavirus prevention efforts for special populations.

In the midst of a national panic involving the potential spread of coronavirus infections, it seems that the specific populations at risk have not been highlighted by the media. The Public Health Law is designed to pragmatically focus on such populations. This comes as the second death from COVID 19 is reported as being a nursing home resident who was allegedly infected during a hospital stay. Last week, this nursing home, in the state of Washington issued a statement noting: 

“Recently, one of our associates and one of our residents were diagnosed with coronavirus (COVID-19) while receiving care in local hospitals. Current residents and associates are being monitored closely, and any with symptoms or who were potentially exposed are quarantined. As a precaution, all visits to the facility from families, volunteers or vendors are not allowed.”

As a result, over the past weekend, the Centers for Disease Control (CDC) appears to have issued guidelines for prevention of coronavirus infections in long term care (LTC) facilities. 

The CDC issuance starts with some commonsense guidelines: 

  • Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.
  • Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
  • Assess residents’ symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.

The posting then sets forth some practical guidance for internal preparedness and instructs LTC facilities to: 

  • Identify dedicated employees to care for COVID-19 patients and provide infection control training.
    • Guidance on implementing recommended infection prevention practices is available in the CDC’s free online course — The Nursing Home Infection Preventionist Training — which includes resource checklists for facilities and employees to use.
  • Provide the right supplies to ensure easy and correct use of personal protective equipment (PPE).
    • Post signs on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE.
    • Make PPE, including facemasks, eye protection, gowns, and gloves available immediately outside of the resident room.
    • Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE. 

Finally, the issuance advises hospitals and referral sources to take precautions in terms of identifying patients with COVID-19 symptoms and advising the admitting facility appropriately noting that all facilities must “Prevent the spread of respiratory germs BETWEEN facilities.” 

  • Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
  • Report any possible COVID-19 illness in residents and employees to the local health department, including your state HAI/AR coordinator.

Importantly, New York State law and regulations expressly prohibit the admission of an individual to a nursing home where they are suffering from a communicable disease. Under  10 NYCRR 415.26(i)(1)(viii)(d), “a resident suffering from a communicable disease shall not be admitted or retained unless a physician certifies in writing that transmissibility is negligible, and poses no danger to other residents, or the facility is staffed and equipped to manage such cases without endangering the health of other residents.” 

In New York, “communicable diseases” are defined at regulations set forth in Part 2 of 10 NYCRR and include more than 40 infectious diseases. As of February 6, 2020, emergency regulatory issuance was approved by the Public Health and Health Planning Council after emergency action by the Commissioner of Health on February 1, 2020 adding coronavirus to the list: “Severe or novel coronavirus - 2019-Novel Coronavirus (2019-nCoV).” The emergency regulatory issuance was published in the State Register on February 26 and explained: 

If 2019-nCoV spreads in the general population, there could be severe public health consequences. On February 1, 2020, the New York State Commissioner of Health determined that 2019-nCoV is communicable, rapidly emergent and a significant threat to the public health, and designated 2019-nCoV as a communicable disease under 10 NYCRR Section 2.1. This designation will expire at the next scheduled meeting of the Public Health and Health Planning Council on February 6, 2020. This emergency regulation is necessary to confirm the Commissioner’s designation and permit the Department of Health (Department) to systematically monitor for this disease and permit decisions about isolation or quarantine of suspect or confirmed cases to be made on a timely basis.

Compliance Requirements:

Hospitals, clinics, physicians, nursing homes, clinical laboratories that are small businesses and local governments will utilize revised Department of Health reporting forms and existing laboratory referral forms.

Local health officers receiving reports from physicians in attendance on persons with, or suspected of being affected with, 2019-nCoV, will be required to immediately forward such reports to the State Health Commissioner and to investigate and monitor the cases reported. Local health officers may also need to isolate or quarantine individuals to stop the spread of disease.

In addition to the CDC web sites noted above, available emerging information is available on a DOH website which has established contact information for further questions: Call 1-888-364-3065 for information about coronavirus. Further information is available here.