Residential Care Strike Team FAQs

Facility admissions

If a residential facility admits a new resident who has tested positive for COVID-19 and the resident does not meet the criteria for discontinuation of isolation (Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)), the facility must place the resident in isolation and contact local public health for guidance. The facility may continue the provision of outdoor visitation ONLY if the facility has a separate isolation wing or unit or appropriate accommodations in a space that is separately staffed and designated for the admission of residents who require COVID-19 care and/or isolation precautions (transmission-based precautions).

Facilities need to follow the 14 day observation period for new admissions. All new or readmitted residents must be isolated in a private room or separate area for 14 days to observe for symptoms of COVID-19. Testing does not shorten this 14 day observation period. A symptomatic new admission should be tested if not tested prior to admission and placed in isolation until the patient meets discontinuation of isolation pursuant to guidelines.

CMS questions

On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant. More information on this memo can be found here:

Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency

Residents leaving the facility

The outing should be planned such that only the number of residents which can be on the bus in a socially distanced manner are included.

According to the current State order (9/10/2020), all individuals at risk of severe illness from COVID-19 should Stay at Home or In The Vast, Great Outdoors away from others as much as possible, and continue to limit their social interactions, remain at least six (6) feet from others not in their household, and wear facial coverings in public. Currently, Colorado is under Safer at Home, some counties and cities are still under Stay at Home. Please check with your local (county) public health department as to which phase and restrictions apply.

 
Individuals who are safe to be in the community, have the ability to access the community and the desire to access the community, have the right not to be restricted from making choices about how and when they want to go out into the community.

 
When individuals leave the facility and then return there may be other individuals who would be considered more vulnerable and at risk for COVID-19. The facility should have plans in place to address the risk factors for others, which may include self-isolation or some other means of separation from those that are more vulnerable for a prescribed amount of time to observe for signs or symptoms of COVID-19.

 
The facility may want to consider a policy which includes staff assessment of a resident’s risk of COVID-19 exposure following day trips or overnight visits, and when a 14-day observation period would be appropriate.

According to the current State order (9/10/2020), all individuals at risk of severe illness from COVID-19 should Stay at Home or In The Vast, Great Outdoors away from others as much as possible, and continue to limit their social interactions, remain at least six (6) feet from others not in their household, and wear facial coverings in public. Currently Colorado is under Safer at Home, some counties and cities are still under Stay at Home. Please check with your local (county) public health department as to which phase and restrictions apply.

 
Individuals who are safe to be in the community, have the ability to access the community and the desire to access the community, have the right not to be restricted from making choices about how and when they want to go out into the community.

 
When individuals leave the facility and then return there may be other individuals who would be considered more vulnerable and at risk for COVID-19. The facility should have plans in place to address the risk factors for others, which may include self-isolation or some other means of separation from those that are more vulnerable for a prescribed amount of time to observe for signs or symptoms of COVID-19.

 
The facility may want to consider a policy which includes staff assessment of a resident’s risk of COVID-19 exposure following day trips or overnight visits, and when a 14-day observation period would be appropriate.

Connect to care

You can verify if a person is a QMAP at the following website: QMAP Verification

There is not a fee for a facility to use ConnectToCare.

To begin using the Connect to Care Jobs site you must first pre-register with the State so that we can verify your license (ensuring only licensed facilities are using the site). To pre-register, go to this site and select 'looking to hire professionals to fill open positions?'- There are further instructions on the next steps located at Connect to Care Jobs Colorado.

COVID-19 data

All types of COVID-19 outbreak data can be found here: COVID-19 data

For federally certified facilities county-level data can be found on this CMS website: COVID-19 Nursing Home Data

Archived information is located here: COVID-19 Nursing Home Data - Test Positivity Rates

For all other facilities and agencies, county-level data can be found on this CDPHE website: COVID-19 data

Once on this page, select Incidence and Epidemic Curve, then select Two Week Cumulative

Colorado Public Health Order 20-20 and other public health orders (e.g, Protect Our Neighbors) refer to incidence rates to determine the extent of community spread of COVID-19. CMS based its surveillance requirements on the percent of positive tests. Therefore, both metrics are necessary at this time.

Information on county COVID-19 case counts can be found on this CDPHE website: COVID-19 data

Once on this page, select Incidence and Epidemic Curve, then select Two Week Cumulative

The two-week county incidence is the number of new cases of COVID per 100,000 persons in the last 2 weeks. The county positivity is the percent of COVID-19 tests that had positive results.

Statistical information on COVID-19 cases can be viewed on this CDPHE website: COVID-19 data. Presently, this data does not sort by size of facility.

The Public Health Order and indoor guidance directs the facility to consider the COVID-19 case count for the county in which the facility is located. A facility may consider the COVID-19 case count for a county the visitor resides in as part of their screening process, but it is not required.

Essential services

Essential health-care services are those which are necessary to address a medical issue or medical concern for an individual resident, regardless of the type of care. Typically, this care or service is accompanied by an order from a medical professional who is directing the specific care/service and, when an order has been issued we have directed facilities that they are compelled to comply with.

According to the Third Amended Public Health Order 20-20 (9/3/2020), “Staff” are defined to include employees, consultants, contractors, volunteers, students, caregivers, and others who provide care and services to residents. Facilities should prioritize testing for those individuals who are regularly in the facility (e.g., weekly) and have contact with residents or staff."

Any facility that would like to offer surveillance testing must have a protocol to do regular testing surveillance for staff and residents. The facility should test, arrange or verify testing of all staff (including essential workers) in accordance with the published indoor visitation guidance.

Essential service providers of residential care and services are defined in the indoor visitation guidance as employees, consultants, contractors, volunteers, students, caregivers, and others who provide care and services to residents. Facilities should prioritize testing for those individuals who are regularly in the facility (e.g., weekly) and have contact with residents or staff.

Essential workers are those that are necessary for the operation of the facility and the provision of ongoing care and services within the facility and can include, housekeeping, cooks, maintenance staff, and others.

Personal protective equipment

A face shield is a form of eye protection, if they wear a face shield they do not need to also wear goggles.

Masks need to be worn whenever in the building. The risk to transmit the COVID-19 virus does not change when the residents are sleeping.

Everyone within the facility should wear a mask regardless of the type of work they are doing. This not only applies to health care but in all businesses. The exception would be if someone is in an office by themselves with the door closed.

For guidance information on the considerations and recommendations for those who are unable to wear a mask, please refer to this website: CDC Considerations for wearing masks.

Resident socialization

The criteria for allowing differing levels of group activities and communal dining can be found here: COVID-19 LTCF Checklist.

Information on county COVID-19 case counts can be found on this CDPHE website: COVID-19 data

Once on this page, select Incidence and Epidemic Curve, then select Two Week Cumulative

Screening

CDPHE has developed a template form for screening. Facilities should complete the entire Employee Health Screening Form, Visitor Health Screening Tool, or a similar form, when screening staff and visitors.

No. Staff screening and temperature checks should be taken on-site under the supervision of facility staff.

Facilities should retain documentation of individual screening results for a period of no less than 3 months. 

Staff must be screened (including current temperature) daily upon arrival, and allowable visitors must be screened prior to entering the building.

Every individual regardless of reason entering a facility (staff, visitors, outside healthcare workers, vendors, etc.) should be screened for COVID-19 symptoms daily upon arrival and the facility must document the results of these screenings at the time they are conducted.

The failure to screen persons in accordance with public health guidance could be viewed as a failure to fully implement appropriate infection control measures and could be cited as an area of facility non-compliance. The failure to screen is also a violation of Public Health Order 20-20, which carries additional penalties.

There are currently no recommendations for re-screening an individual who leaves the building and returns the same day.

Enforcement

The Residential Strike Team consists of staff from the Department of Public Health and Environment (CDPHE), Human Services (DHS), Health Care Policy and Financing (HCPF), Department of Public Safety and Regulatory Agencies (DORA). The goal of the Residential Care Strike Team is to mitigate the spread of COVID-19 in all high-density environments serving older adults and people with disabilities.

Resources utilized by the Residential Strike Team include information from COVID-19 outbreak and incidence data, EMResource, outcomes in relation to federal/state inspection surveys and engagement with providers and stakeholders.

Staffing

Staff who test positive for COVID-19 are prohibited from entering the facility until they have met the return to work criteria. For the most current criteria for healthcare workers returning to work visit this web page:

CDC Criteria to Return to Work for Healthcare Providers.

Reporting and Notification

Facilities should notify staff, residents and their responsible parties as soon as a positive case of staff or resident infected with COVID-19 is identified. The facility should complete appropriate notifications within 24 hours of identifying the case but under no circumstance should the notification extend beyond 72 hours.

Indoor and outdoor visitation

Resident or staff with a new diagnosis of suspected or confirmed COVID-19 and have no prior positive test in the past 90 days. Residents with a known diagnosis of COVID-19 prior to admission and who are admitted to a dedicated COVID-19 would not be considered a recent case in the facility.

Facilities which share two different provider types which have separate entrances and separate staff, can proceed with visitation so long as the individual facility meets the requirements for visitation (indoor or outdoor or both). If the entryway/reception area to the building is also shared, the facilities should have a solid divider between the two facilities, such as a doorway.

For the test to be used by a visitor, it must have occurred within 48 hours from the time of the test being collected and the time of the visit.

No, visitors are required to wear masks during the entirety of the visit. Residents should wear masks unless it is medically contraindicated.

It is important to note that dogs can be carriers of and/or can aid in the transmission of COVID-19. With a scheduled visit and facility permission, pets may accompany a visitor for a visit with a single resident. The pet must be kept away from other people (staff and residents) during the visit (inside or outside). The facility should have policies and procedures regarding the safety and parameters for pet visitation, including criteria for infection control. 

For more information on pets in relation to COVID-19 visit:

Helpful Questions and Answers about Coronavirus (COVID-19) and Your Pets

COVID-19 and Animals

Compassionate care visitation

In addition to terminal end-of-life situations, Compassionate Care visitation may be allowed to provide personal medical and emotional care for residents who have experienced a sharp decline in their overall health and well being due to COVID-19 isolation. 

Situations such as these can include any or all of the following:

  • a decline in overall status due to worsening mental health 

  • memory or cognitive conditions 

  • progressively worsening conditions of grief and/or depression, confusion, anxiety 

  • physical decline due to COVID-19 isolation restrictions. 

In some cases weight loss, weakness and decline in physical function accompany these circumstances.

State ombudsman and adult protective staff (APS)

Adult Protective Services (APS) workers and Long-Term-Care (LTC) Ombudsman have legal rights to enter the facility. As with anyone entering the facility from the outside, APS workers and LTC Ombudsman should undergo the facility’s screening process and conform to appropriate infection control measures prior to their entry and during their presence at the facility.

In addition to in-person visits, APS workers and LTC Ombudsman may conduct interviews by telephone or other electronic means when deemed appropriate by their respective organizations. Facilities must provide accommodation and access to these means of communication.

Essential indoor visitation related to healthcare services in facilities

Public Health Order 20-20 requires facilities to restrict indoor visitation of non-essential individuals. External healthcare providers are considered essential visitors and should be allowed to conduct individual visits with residents to provide medical assessments and essential services for the well-being of the resident. External healthcare provider services include, for example:

  • Medical services which includes individual resident visits for wound care, podiatry, dental, mental health services and dietary services.  

  • External hospice or home care and services which have been ordered by a physician.

EMResource

EMResource is a web-based tool used to assist the state with situational awareness and identification of a facility’s and providers' capacity and resource needs. The state monitors the data that providers enter EMResource several times each week to create critical needs reports to assist the state’s response to a crisis or state of emergency such as a pandemic.  Furthermore, this data can be used to help guide assistance to providers and agencies at the state, regional, and local level

Yes, per Public Health Order 20-20, regular reporting to the Colorado Department of Public Health and Environment (CDPHE) is now required for residential care settings.  The public health order can be found here: Public Health Order 20-20

  • Nursing Homes must begin reporting by August 5th

  • Assisted Living Residences must begin reporting by August 12th

  • Group Homes and ICFs must begin reporting by August 19th

Colorado residential care facilities should update EMResource daily by 10:00am MT and/or following any significant changes in Personal Protective Equipment (PPE) or other anticipated shortages in staff or space availability.

This information you provide in EMResource supports local, regional, and state level situational awareness and can assist the state in identifying trigger points for critical supply levels for staff, supplies, or space.

NO.  Once a facility identifies a needed resource(s) (PPE, staff, medical materials, etc), the facility must contact their Local Public Health Agency Emergency Operations Center (EOC) or Emergency Support Function 8 (ESF 8) Representative to discuss and review the resource request.  The list of LPHA contacts can be found here.

EMResource is provided by CDPHE to Colorado health and residential care facilities at no cost to the facility.

Once a long term care facility administrator or manager gains access to EMResource, this training document and video illustrate how to log in to EMResource and answer daily questions.

Once you have established your EMResource account and provided foundational information regarding your facility, updates to previously provided information can be made in approximately 10 minutes.

For questions regarding access to EMResource or technical assistance, please email CDPHE_EMResource@state.co.us 

There can be flexibility in the time of day that you report. If your answers to questions in EMResource tend not to change every day, you can indicate "no change" in the data in EMResource. In the question section, if you do not check the box next to the question, EMResource treats that as "no change." So, if there are no changes in all nine of your facilities, you can report that consistently by not checking the boxes.

As we receive questions from the community and providers we will post the questions and answers here. Some questions will be reworded for clarity and make take longer to answer. Questions have been organized by topic.

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