The level of COVID-19 activity in the community surrounding a long-term care facility has a direct impact on the risk of COVID-19 introduction into the facility. The following table outlines the Department’s recommended approach to continued testing in PCHs, ALRs, and ICFs, which are not experiencing an outbreak, to increase detection and prevent transmission of COVID-19.
This recommendation applies only to testing of asymptomatic individuals. Individuals with a prior confirmed diagnosis of COVID-19 do not need to be retested. However, based on CMS guidance, testing should be considered for those with a prior confirmed diagnosis three months after the date of onset of the prior infection if deemed necessary based on the following recommended testing intervals in the chart below. Prompt testing of any resident or staff experiencing COVID-19 compatible symptoms is required.
Facilities experiencing an outbreak should immediately begin universal testing, ideally of all staff and residents, but unit, wing, or floor specific testing is acceptable, if the facility has dedicated staff to units, wings, or floors.
Facilities should monitor their county positivity rate every other week (e.g., first and third Monday of every month) and adjust the frequency of performing staff testing according to the table below.
Facilities should identify County Percent Positivity Rate using the COVID-19 Early Warning Monitoring System Dashboard or CMS Data.
- If the county positivity rate increases to a higher level of activity, the facility is encouraged to begin testing staff at the frequency shown in the table below as soon as the criteria for the higher activity are met.
- If the county positivity rate decreases to a lower level of activity, the facility is encouraged to continue testing staff at the higher frequency level until the county positivity rate has remained at the lower activity level for at least two weeks before reducing testing frequency.
In addition to this regular screening testing, all previous guidance on testing of symptomatic and exposed individuals as indicated in PA-HAN-530 should be followed regardless of activity level.
Residents who leave the facility routinely should be considered for regular testing. In the table below, the Department refers to residents who leave the facility routinely as having “outside contact,” which could include but is not limited to outpatient health care visits including dialysis treatment, social visits in the community, day programs, employment, and return after admission to another health care facility.
Developing an appropriate screening testing strategy for each facility may depend on many local factors, including presence and availability of testing supplies and clinical support. Facilities that may need clinical support can complete the Universal Testing Needs Assessment form at Universal Testing Needs Assessment Form. For certain facilities, there may be other factors that they should take into consideration when devising a screening testing strategy. For example, the Department believes that certain facility factors, such as the presence of a dementia unit or a larger number of residents, may make a facility more prone to outbreaks, and such facilities should consider a more frequent screening testing strategy, more closely modeling the Guidance for Screening Testing in Skilled Nursing Facilities.
|Recommended Testing Intervals for PCHs, ALRs, and ICFs Vary by Community COVID-19 Activity Level|
|Level of Community |
|Rountine Testing of Asymptomatic Residents||Rountine Testing of Asymptomatic Staff|
|Low||Less than 5%||Not recommened||Testing is encouraged of all staff members every 4-6 weeks.|
|Moderate ||Less than 5% |
to Greater than 10%
|Weekly testing is encouraged of all residents with outside contact in the last 14 days, if they have not otherwise been tested during that period.||Testing is encouraged of all staff that have not been tested in the past 30 days and repeat testing evey 30 days.|
|Substantial||Greater than 10%||Weekly testing is encouraged of all residents with outside contact in the last 14 days, if they have not otherwise been tested during that period||Testing is encouraged of all staff member once per week.|