Screening
Please note: Visitation hours vary but are usually 8am to 8pm.
đ An ALF must screen all individuals who enter the facility prior to entry (except for emergency personnel), including staff at the start of their shift, any visitors, new residents, and residents returning to the facility for:
đ Fever, defined as a temperature of 100.4 Fahrenheit and above.
đ Signs and symptoms of COVIDâ19, see attached screening log on pages 40â42 for example of questions asked during screening process. Some communities may require different screening logs to be in use mandated by their local Health Departments. Texas no longer requires screening logs to be retained as of 4/3/22 for visitors and/or staff but still requires the screening to take place. Residents need to be screened once daily in FL/GA for COVIDâ19 symptoms Texas Residents are no longer required to be screened unless exposed to COVIDâ19, symptomatic, or under quarantine per CDC guidelines.
đ If a resident meets any of the screening criteria, implement increased infection control measures including quarantine as applicable and monitor for symptoms of COVIDâ19 according to State and Local guidelines. (Use CDC quarantine tool to determine if needed and length of quarantine) https://www.cdc.gov/coronavirus/2019âncov/ifâyouâareâsick/quarantine.html
đ All visitors must wear a medical mask (no cloth masks allowed), no masks are required in Texas at this time unless an outbreak occurs. If an outbreak occurs, then masks will be required until under control.
đ The screening log might contain protected health information and must be protected in accordance with applicable state and federal law. The information should include at least:
the date, the personâs name, current contact information, and the data from the screening (presence or absence of fever and symptoms). assisted living facility is not required to screen emergency services personnel entering the facility in an emergency.
Post signage at all entrances of the facility reminding individuals not to enter the facility prior to being screened. Do not restrict surveyors. HHSC is constantly evaluating their surveyors to ensure they donât pose a transmission risk when entering a facility.
For example, surveyors might have been in a facility with COVIDâ19 cases in the previous 10 days, but because they were wearing PPE effectively per the CDC guidelines, they pose a low risk to transmission in the next facility and must be allowed to enter.
However, there are circumstances under which surveyors should not enter, such as if they have a fever or any additional signs or symptoms of illness and must still be screened at the sign in log.
Visitors
Persons providing critical assistance must be allowed to enter the facility provided they pass required screening.
These include:
⢠Family members and loved ones of residents at the endâofâlife;
⢠Essential caregivers;
⢠Emergency responders (do not screen in an emergency);
⢠Persons with legal authority to enter, including:
o Government personnel performing their official duties, including HHSC
surveyors whose presence is necessary to ensure the ALF is protecting the health
safety of residents and providing appropriate care;
o Law enforcement officers (do not screen in an emergency) and
o Representatives of the Longâterm Care Ombudsman’s Office and representatives
of Disability Rights Texas; and
⢠Providers of essential services which include contract doctors, contract nurses, home health and hospice workers, health care professionals, contract professionals, clergy members and spiritual counselors, whose services are necessary to ensure resident health and safety.
This list is not exhaustive. A facility must use its best judgment to determine which persons are “essential” to protect the health and safety of a resident.
Personal Visitors
ALFs must allow all residents who are COVIDâ19 negative to have personal visitors. Visits can occur where adequate space is available as necessary to ensure physical distancing between other residents and visitors, including the resident’s room. The facility must ensure a comfortable and safe outdoor visitation area, considering outside air temperature and ventilation.
Visitors and residents are no longer required to wear masks or face coverings or PPE in Texas ONLY, unless working with a COVIDâ19 positive/symptomatic/COVIDâ19 unknown or Local/State mandated. Florida and Georgia are still requiring masks at this time.
Visits are not required to be scheduled in advance. An ALF can have scheduled visits and unscheduled visits. ALFs can schedule personal visits in advance or permit personal visits that are not scheduled in advance, or both. Scheduling in advance must not be so restrictive as to prohibit or limit visitation for residents.
See Expansion of Reopening Visitation at 26 TAC §553.2003 (Texas) for all requirements.
All ALFs must:
â offer a complete series of a oneâ or twoâdose COVIDâ19 vaccine to residents and staff and document each residentâs choice to vaccinate or not vaccinate (âOfferâ in this context means to administer, arrange/assist, OR educate/give information about the COVIDâ19 vaccine AND document the residentâs choice to vaccinate or not vaccinate);
â allow visitors of any age;
â develop and enforce written policies and procedures related to visitation, including whether visitors and residents must wear a face mask, face covering, or appropriate PPE during visits.
â inform residents and visitors of the facilityâs infection control policies and procedures related to visitation.
â limit the movement of visitors through the facility to minimize interaction with other persons. â give all residents equal access to personal visitors, endâofâlife visitors and essential caregivers. â ensure comfortable and safe outside visitation areas, considering outside air temperature and ventilation.
â provide handâwashing stations or hand sanitizer to visitors and residents before and after visits. â facilitate visits in a way that allows cleaning and cleaning and sanitizing common visitation areas.
Salon Services Visitors
An ALF can allow a salon services visitor (barber, beautician, or cosmetologist providing hair care or personal grooming services to a resident) to enter the facility to provide hair care or personal grooming services to COVIDâ 19 negative residents.
The salon requirements for salon visits.
(A) inform the salon services visitor of applicable policies, procedures, and requirements; (B) maintain documentation of the salon services visitorâs agreement to follow
policies, procedures and requirements;
(C) maintain documentation of the salon services.
(D) document the identity of each salon services visitor in the facilityâs records;
(E) prevent visitation by the salon services visitor if the resident has an active COVIDâ19 infection; (F) cancel the salon services visit if the salon services visitor fails to comply with
the facilityâs policy regarding salon services visits.
(j) If an executive order or other direction is issued by the State and or Local government, the President of the United States, another applicable authority, that is more restrictive than this rule the community in that area will abide by that rule.
Vaccination Status
The ALF can ask about a visitorâs COVIDâ19 vaccination status but must not require any visitor to provide documentation of their COVIDâ19 vaccination status as a condition of visitation or to enter the facility. A personal visitor may refuse to provide information about their vaccination status. Sodalis is NOT currently requiring vaccinations. A facility is a private business and should consult with their Legal and Human Resources area to address state and federal mandates regarding vaccines.
Visual Aid:
See below for the visitors allowed according to resident COVIDâ19 status
Essential Caregivers (EC) ALFs are required to allow for all residents with any COVIDâ19 status Personal Visitors (not EC) ALFs are required to allow for residents with COVIDânegative status EndâofâLife Visitors ALFs are required to allow for all residents with any COVIDâ19 status Providers of Critical Assistance ALFs are required to allow for all residents with any COVIDâ19 status Salon Service Visitors ALFs can allow for residents with COVID negative status
Infection Control
See Attachment 1: ALF COVIDâ19 Response Infographics &
Flowcharts, for visual aids outlining ALF response activities. Comply
with all CDC guidance related to infection control.
Establish infection control zones to keep resident cohort groups
separate from each other and to limit movement of staff between
the separate zones.
â Cold Zones for COVIDâ19 negative residents
â Warm Zones for monitoring residents with unknown COVIDâ19 status
â Hot Zones for COVIDâ19 positive residents
An ALF must have spaces for staff to doff and dispose of PPE used in a warm zone or hot zone, and wash hands or use hand sanitizer before entering a cold zone in the facility:
PPE
Maintain a twoâweek supply of PPE. Make necessary PPE available in areas where care is provided to residents with COVIDâ19 and residents with unknown COVIDâ19 status. Put a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room.
Cleaning and Disinfecting
Increase environmental cleaning. Clean and disinfect all frequently touched surfaces such as doorknobs/handles, elevator buttons, bathroom surfaces/fixtures, remote controls, and wheelchairs.
Make sure EPAâregistered hospitalâgrade disinfectants are available. Refer to List N on the EPA website for EPAâregistered disinfectants that have qualified under EPAâs emerging viral pathogens program for use against COVIDâ19.
Provide supplies for recommended hand hygiene. Have alcoholâbased hand sanitizer with 60â95 percent alcohol easily accessible. Make sure sinks are wellâstocked with soap and paper towels for handwashing.
Review your infection control policies and procedures. Review your emergency preparedness and response plan and update as needed.
Ensure that any emergency plans specific to hurricanes or other natural disasters account for COVIDâ19.
Staff
Staff must always wear proper PPE when caring for residents with COVIDâ19 or unknown COVIDâ19 status.
Assisted living facilities should minimize the movement of staff between facilities whenever possible.
To encourage staff who are ill to stay home ALFs should enforce sick leave policies that do not penalize them with loss of status, wages, or benefits per company policy.
Require staff with symptoms of COVIDâ19 to report sick by phone or other virtual method consistent with facility policy. Staff must not enter the facility until they meet the current CDC Guidance Risk Assessment at: https://www.cdc.gov/coronavirus/2019â ncov/hcp/guidanceâriskâassesmentâhcp.html
If a staff member has a confirmed case of COVIDâ19 they must not enter the facility until they meet the current CDC return to work criteria. (Go to link listed above)
Staff must always wear a facemask while inside the facility at all times in Florida and Georgia. At this time Texas is face mask free unless thereâs an outbreak or deemed otherwise by Local/State mandate. Staff should not use cloth face coverings while inside the facility. The CDC does not consider cloth face coverings to be PPE, nor adequate to prevent the spread of COVIDâ19. Develop a staffing contingency plan to implement if a significant number of staff are unavailable to work. Enforce sick leave policies for ill staff and health care providers.
If a staff member has a confirmed case of COVIDâ19 they must not enter the facility until they meet the current CDC return to work criteria. Use this linkâ GuidanceâRisk Assessment.
Per CDC guidance, asymptomatic staff who have higher risk of exposure do may not need to be restricted from work.
Web Links are highlighted in yellow
GuidanceâRisk Assessment and CDC Strategies to Mitigate Healthcare Personnel
Staffing Shortages recommendations for Healthcare Personnel During the COVIDâ19
Pandemic for possible exceptions and additional information.
Note: If a staff member was diagnosed with a different illness (e.g., influenza) and
was never tested for COVIDâ19, base their return to work on the criteria associated
with that diagnosis, use above Guidance Risk Assessment.
Residents
Ask residents to report if they feel feverish or have symptoms of respiratory infection and coronavirus. Actively monitor all residents upon admission and at least daily for fever and symptoms of COVID19 in accordance with State and Local guidance. If a resident has fever or symptoms, implement increased infection control measures including quarantine as applicable.
Unknown Status or Overnight Stays out of Community
Residents with unknown COVIDâ19 status must be quarantined per the CDC guidance on https://www.cdc.gov/coronavirus/2019âncov/ifâyouâareâsick/quarantine.html
All other residents who are new admissions, readmissions, or spent one or more nights away from the ALF, are considered to have unknown COVIDâ19 status. Use the link above to work through whether the resident needs to be quarantined or not per the CDC recommendations.
Per CDC guidance, an asymptomatic resident who is either fully vaccinated or had COVIDâ19 in the previous three months and has fully recovered, does not have to quarantine, even if they had close contact with someone who has COVIDâ19.
Keep in mind that quarantine does not mean the resident must remain in their room for the duration of the quarantine period. Daily monitoring is a must, as well as following infection control protocols.
If no symptoms develop during daily monitoring, quarantine can end after day 10 without testing; or after day 7 with a negative COVIDâ19 test result (test must occur on day 5 or later). Continue to monitor the resident for a total of 14 days after potential exposure.
Fully vaccinated people who do not quarantine should still watch for symptoms of COVIDâ19 for 14 days following an exposure. If they experience symptoms, they should be clinically evaluated for COVID19, including testing for COVIDâ19, if indicated.
Leaving and returning
Residents have the right to leave and return to the facility for any reason, and the facility cannot restrict residents from exercising this right. The facility has a responsibility to inform residents of the increased risk of contracting COVIDâ19 and the importance of safety precautions like avoiding crowds, washing hands often and maintaining physical distancing from others whenever possible, so ensure that the resident is making an informed decision.
Same day
A resident who leaves the ALF and returns the same day is not necessarily considered to have unknown COVIDâ 19 status. The resident’s COVIDâ19 status is the same as it was when they left.
Activities and Dining
Entertainers, families and volunteer groups can enter the facility if they and the ALF adhere to the following: â The ALF must screen each person entering the facility prior to entry. Only persons who pass the screening can enter the facility.
â The ALF must document visitors in a log at the entrance of the facility
â All individuals who enter the facility for the purposes of activities or dining are
bound by the rules for personal visitors
Some examples of visitors joining in activities and dining:
â A small group, such as members from a local club or a group of high school
students who volunteer to participate in an activity with residents, such as
putting up decorations or putting on a performance.
â Family joining a resident for a meal at an individual family table that is adequately distanced from other residents’ family tables.
â ALF staff taking residents in community buses to an event or an outing
Memory Care Units and Alzheimer’s Certified Units
Infection prevention strategies to prevent the spread of COVIDâ19 are especially challenging to implement in dedicated memory care units and Alzheimer’s certified units where numerous residents with cognitive impairment reside together. These residents can have a difficult time following recommended infection prevention practices.
Changes to resident routines, disruptions in daily schedules, use of unfamiliar equipment, or working with unfamiliar caregivers can lead to fear and anxiety, resulting in increased depression and behavioral changes such as agitation, aggression, or wandering.
Follow recommended guidance below from the CDC for considerations regarding residents with dementia, in memory care or Alzheimer’s certified units.