CDC released several pieces of updated guidance on Tuesday. Some general “public health recommendations” are applicable to our communities, such as travel guidance and masking. Additionally, CDC updated specific healthcare guidance, which includes nursing homes and assisted living communities. CMS also released 2 revised memos (QSO-20-39-NH and QSO-20-38-NH) consistent with CDC’s recommendations.

• International travel: International travel should be delayed until you are fully vaccinated. A negative COVID test is required for international travelers seeking entry/re-entry into the US, regardless of vaccination status. Fully vaccinated individuals are no longer recommended to quarantine upon return from international travel and are no longer recommended to be tested within 3-5 days of return from international travel. This means that staff may return to work without quarantine following international travel if they are fully vaccinated. Unvaccinated individuals must continue to quarantine for 7 days, test upon return, and avoid contact with individuals are increased risk for 14 days. This means that unvaccinated staff should be restricted from work for 14 days following international travel. More info is available here.
• Masking: CDC is loosening recommendations on masking. In most cases, fully vaccinated individuals are no longer recommended to mask up outdoors, provided they are not in crowded outdoor spaces, like at concerts or sporting events. Unvaccinated individuals can forego the mask outdoors if they are attending small gatherings with fully vaccinated individuals or exercising (walking, running, biking, specifically). More information and a helpful infographic are available here. It’s important to note that some cities/counties/states have mask mandates in place and individuals must adhere to mask mandates in those areas.
• Healthcare visitation: Fully vaccinated individuals may now remove their masks when visiting indoors in healthcare settings (like nursing homes, inpatient hospice, and assisted living) provided both the resident and the visitor are fully vaccinated and they are alone in the resident’s room or visitation space. The visitor must continue to mask around other residents, staff, and individuals in the healthcare setting.
• Activities and dining: CDC is loosening recommendations for masking and social distancing in activities and dining for fully vaccinated individuals. In the healthcare setting, if all individuals attending an activity are fully vaccinated, they may choose to forego masking and social distancing during the activity. If all individuals in the dining area are fully vaccinated, they may choose to forego masking and social distancing during dining. If any individuals in the activity or dining setting are unvaccinated, including healthcare personnel, all must wear masks and social distance. CDC recommends asking individuals to sign up for activities/dining ahead of time so that vaccination status may be determined privately and expectations on masking and social distancing determined. We note that CDC does not recommend separate activities or separate dining for vaccinated vs. unvaccinated residents. CDC also recommends that if an individual’s vaccination status is unknown, recommendations for “unvaccinated” should be followed.
• Healthcare personnel: Healthcare personnel may follow the guidance above regarding masking and social distancing as it relates to activities such as breaks rooms/staff lounges or in-person meetings. If all present are fully vaccinated, healthcare personnel may forego masking and social distancing. If any are unvaccinated, or if vaccination status is unknown, masks and social distancing are recommended.
• Testing: Protocols for testing of symptomatic individuals and testing staff and residents in the event of an outbreak have not changed. Recommendations around “expanded screening testing” (routine testing) of staff have been changed. CDC now recommends that fully vaccinated staff may be excluded from expanded screening testing (routine testing of staff according to county positivity rates). Unvaccinated staff must continue to be tested routinely according to county positivity rates. CDC offers additional guidance that individuals who require testing due to exposure should be tested immediately and again within 5-7 days of exposure. CMS has updated regulatory guidance to be consistent with these recommendations, available here. Please remember, if your LHJ has a different recommendation for testing cadence, you should be following the LHJ guidance.

We are continuing our work with RCS and other stakeholders to update the Safe Start Plan for Long-Term Care.  Until this is updated, you will need to continue to follow the current plan. There are several issues we are trying to work through, including dining and activities guidance, current county phases and the possibility of some counties going back to phase 2 with increased community transmission and hospitalizations. We expect to know more in the next couple of days from Dept. of Health and Residential Care Services

Questions?

Contact:

Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804