Long Term Care and Group Living Settings

Long Term Care and Group Living Settings

person helping older woman put mask on

The Health Department works closely with the Department of Disabilities, Aging and Independent Living and long-term care facilities to help them prepare for cases of COVID-19. Other types of group living settings, also called congregate care settings, can follow strategies to detect and prevent the spread of respiratory viruses like the new coronavirus.
 

WHAT WE ARE DOING

Outreach
The Health Department has contacted all long-term care facilities, nursing homes, assisted living facilities, and senior housing facilities proactively to review strategies to prevent COVID-19 infection and develop plans to respond immediately if an infection is identified. We complete an in-depth assessment by phone and provide guidance about personal protective equipment and other infection prevention and control recommendations. We continue to stay in touch for any technical assistance needs and additional questions.

Rapid Response
If a case of COVID-19 is associated with a long​ term care facility, a rapid response team, including staff from Health Department as well as other State partners, is quickly activated. They contact the facility to provide recommendations and infection control support. The team begins an investigation ­to determine the source of the infection and how it may be spreading. They ask questions and collect information to help identify anyone the patient had close contact with. The team communicates with facility staff to ensure containment measures are being implemented, which will differ depending on the type of setting.

Universal Testing at Facilities
Vermont is taking additional measures to slow the spread of COVID-19 in certain types of group living facilities, including nursing homes, assisted living residences, residential care homes, therapeutic community residences, residential treatment centers, correctional facilities, state psychiatric care facilities, and homeless shelters.
 
If a staff member or resident tests positive for COVID-19, testing of staff and residents, potentially facility-wide might be recommended in consultation with the Health Department. If testing is recommended, the Health Department provides technical assistance to make sure that the facility is connected with testing resources and provides guidance on when additional rounds of testing should take place. The Health Department also works closely with the facility to provide infection control guidance and resources.
 
Additionally, many long-term care facilities are conducting ongoing staff surveillance testing. For related guidance, read the Long Term Care Guidance for Operations During COVID-19 Health Emergency from the Department of Disabilities, Aging and Independent Living (DAIL) and Testing Recommendations for Long-term Care Facilities from the Health Department.
 
Residents and staff of group living facilities (for example, long-term care facilities or correctional facilities) and new admissions to nursing homes, assisted living residences and residential care homes must complete the full 14-day quarantine. Fully vaccinated new admissions and exposed staff do not need to quarantine.
 
Vaccines

Residents and staff of licensed long-term care facilities were among the first to be vaccinated in Vermont, through the Federal Pharmacy Partnership for Long-Term Care.

Today, residents and staff of state licensed skilled nursing facilities, assisted living residences, residential care homes, and therapeutic care homes are still eligible for the COVID-19 vaccine as part of priority group 1A. At some point soon, the Health Department will be stepping back from coordinating vaccinations for long-term care facilities and our long-term goal is that you will connect with a pharmacy that will be able to meet your COVID-19 vaccination needs going forward. However, during this transition period these are the options available to facilities. See the options for vaccination. 
Vaccination Options for Long-Term Care Facilities

Pharmacy Relationship 

This is the preferred option for all licensed long-term care facilities. Many licensed Long-Term Care Faciliies (LTCFs) are already connected with a pharmacy. As more pharmacies join, we anticipate more facilities will be able to get vaccines through their existing relationships. The expectation is that LTCFs will establish a relationship with a local pharmacy to meet their on-going COVID-19 vaccine needs. Please stay in contact with your existing pharmacies to find out if they anticipate being able to provide vaccine and when that might be. If you are a LTCF and do not already have a pharmacy relationship contact AHS.VDHCOVIDLTCVax@vermont.gov for a list of options.

Community Clinics or Emergency Medical Services (EMS) 

For Licensed Skilled Nursing Facilities (SNFs) Not Yet Connected to a Pharmacy

Community Clinics

Having staff sign up for a vaccine at a local hospital, community clinic or local retail pharmacy will usually be the fastest way to make sure staff are vaccinated. This is especially true if you do not have residents who need a vaccine or if EMS cannot include staff vaccinations during their visit (see below). Find information on accessing these clinics at healthvermont.gov/myvaccine.

EMS

The Health Department is collaborating with EMS to ensure that residents of SNFs are vaccinated. EMS service is limited to residents and cannot be used for staff only. However, if EMS is coming to a SNF to vaccinate residents, staff may be able to get vaccinated during the visit. Whether EMS can vaccinate staff depends on vaccine availability and other factors. You will need to discuss this with EMS when they contact you.

SNFs that need EMS services for vaccination and are not yet connected, should contact the Health Department Immunization Program at AHS.VDHCOVIDLTCVax@vermont.gov to request vaccination. Once the initial referral has been made, SNFs will work directly with EMS for future resident vaccination needs.

For Licensed Assisted Living Residences, Residential Care Homes, and Therapeutic Care Homes Not Yet Connected to a Pharmacy

Community Clinics

This is the preferred option for licensed ALRs, RCHs and TCRs not already connected to a pharmacy. Community clinics are the fastest and most cost-effective way to make sure staff and residents are vaccinated. Find information on accessing these clinics at healthvermont.gov/myvaccine.

EMS

The Health Department will refer licensed ALRs, RCHs and TCRs to EMS for vaccinations only when residents are not able to get to a community clinic or local pharmacy for their vaccination. If EMS comes to your facility to vaccinate residents, staff and other residents may be able to get vaccinated during the visit. Whether EMS can vaccinate additional residents or staff depends on vaccine availability and other factors. You will need to discuss this with EMS when they contact you.

Please contact the Health Department Immunization Program at AHS.VDHCOVIDLTCVax@vermont.gov

Second Dose Needs

  • If you have residents or staff that received a first dose of vaccine through the Federal Long Term Care Facility Pharmacy Partnership Program at an on-site clinic at your facility (in most cases, this would be that the person received their first dose at your third and final clinic) please contact us at AHS.VDHCOVIDLTCVax@vermont.gov  so that we can work directly with you to come up with a solution.
  • If you have residents or staff that received their first dose some other way, not at one of your on-site clinics offered through the Federal LTCF Pharmacy Partnership Program, please have the individual return to the place where they received their first dose.  If for some reason you run into difficulties, please contact us at AHS.VDHCOVIDLTCVax@vermont.gov.
 
Federal Vaccine Pharmacy Partnerships

Vermont participated in the Pharmacy Partnership for Long-term Care (LTC) Program. This program operated from December 2020 through April 2021 and was coordinated by the CDC. The program enabled pharmacy partners to go to long-term care and other congregate settings to provide on-site vaccination clinics for residents and staff. Eligible facilities included licensed skilled nursing facilities, assisted living residences, residential care homes and therapeutic community residences as well as some senior independent living buildings or communities that are funded through the federal HUD Section 202 program for low-income older adults. The pharmacy partners included CVS, Walgreens and Health Direct. 

The overall uptake of vaccines during the program was excellent. 291 long-term care facilities and senior independent living communities were eligible for the program and 274 participated. As of March 23, 2020, 84% of residents and 61% of staff in licensed long-term care facilities have been fully vaccinated. Since the program has ended, we are working with the licensed long-term care facilities to transition toward working directly with a local pharmacy for their on-going needs. We have put in place some interim vaccination options while pharmacies join the program or another plan is put in place.

COVID-19 in Long-Term Care Facilities Report  (updated monthly)

Guidance

Visitors

Facilities may offer visitation with residents. Check with the facility before planning a visit. Visitors should be screened before entry. Visitors' movements and interactions with people in the facility should be limited. There may be some situations where indoor visitation is limited, but medically necessary personnel and visitors for residents receiving end-of-life care are always allowed inside.

Personal protective equipment and infection control

The Health Department recommends that all health care personnel in long-term care facilities and other congregate care living settings where health care is provided wear face masks, regardless of the presence of COVID-19 in the facility. 

Encounters with asymptomatic or presymptomatic patients with COVID-19 are more likely in the context of moderate (400-799 cases/million) or substantial (800+ cases/million) community transmission. In such instances, the use of universal eye protection reduces the potential for high-risk exposure (and exclusion from work and quarantine recommendations) among providers.

Unvaccinated residents and staff of congregate care settings with exposures and unvaccinated new admissions to nursing homes must complete the full 14-day quarantine period. Testing out of quarantine on or after day 7 is an option for fully vaccinated residents with exposures.

The CDC recommendations for preventing the spread of COVID-19 in long-term care facilities include many of the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.

Antigen testing

For more information on antigen testing see the following resources:

Health Alert Network documents from the Vermont Department of Health

Guidance from the Vermont Department of Health

Guidance and resources from device manufacturers

Testing Guidance for CMS-Certified Nursing Homes

Routine Testing of Staff

Routine staff testing is required for CMS-certified nursing homes. CMS established minimum testing frequencies based on county positivity rate, but these may be supplemented by recommendations from the Department of Health or the Department of Disabilities, Aging and Independent Living.

Minimum Routine Testing Frequency by Community COVID-19 Activity Level
 
Community COVID-19 Activity County Positivity Rate Minimum testing frequency
Low <5% Once a month
Medium 5% - 10% Once a week
High >10% Twice a week

For more information, see CMS Memo QSO-20-38-NH: Long-Term Care Facility Testing Requirements.

Testing Guidance for Other Long-Term Care Facilities

Long Term Care Guidance for Operations During COVID-19 Health Emergency, from the Department of Disabilities, Aging and Independent Living, in consultation with the Department of Health, identifies phases of operation that are based on the community burden of COVID-19 and cases within a facility. Each phase outlines visitation guidance, congregate activity limits, and testing requirements that apply to all long-term care residential facilities (nursing homes, residential care homes, assisted living residences, and therapeutic community residences).

The phases correspond to county positivity rates. Facilities should monitor their county positivity rate at least every other week. Community incidence should also be considered when making decisions about proactive testing, visitation, and activities within a facility.

Use the CDC's Antigen Test Interpretation flow chart which has the most current guidance to help you interpret the antigen test.

Find more guidance on antigen testing from the CDC.