Hospital Stays, Outings for Medical Appointments, and Outings for Non-Medical Reasons
Facilities should establish a policy to address safety measures beyond additional testing to safeguard the spread of the virus from residents who leave the facility routinely 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.
Hospitals must conduct COVID-19 testing when a patient is being discharged from a hospital to a PCH, ALR, or ICF as per the
Guidance on Hospitals' Responses to COVID-19:
- Hospitals treating an inpatient who will be discharged to a PCH, ALR, or ICF must test the patient for COVID-19 prior to discharging the patient unless one of the following exceptions applies:
- A patient who is not currently exhibiting symptoms of COVID-19 and who tested positive for COVID-19 within the last 90 days does not need to be tested prior to discharge.
- If a test was administered upon admission to the hospital, and the resident is discharged in less than 72 hours, a second test is not required.
- If a patient tested positive for COVID-19 prior to admission to the hospital, the hospital does not need to test the patient again.
- The test must be administered within the 72-hour period prior to discharge, and the result must be obtained and communicated to the receiving facility prior to discharge.
- Patients with a positive COVID-19 test result should only be discharged to a PCH, ALR, or ICF with the ability to adhere to infection prevention and control recommendations of the Department and the CDC for the care of COVID-19 patients. PCHs, ALRs, and ICFs that meet these criteria may not refuse to accept or readmit a patient or resident with a positive COVID-19 test result but may refuse to accept a patient-resident if a COVID-19 test has not been administered. If a test has not been administered, the hospital is responsible for immediately performing a test and providing the result prior to discharge.
All PCHs, ALRs, and ICFs should have up-to-date policies to ensure adherence to infection prevention and control recommendations ensuring a patient/resident is able to return to their residence without interruption upon discharge from a hospital whenever possible. If assistance is needed for policy development or readmission of a resident, the appropriate regional office should be contacted.
Regional Congregate Care Assistance Teams (RCATs) can also assist with alternate care sites that can be utilized if a facility is unable to safely cohort.
Outings for Medical Appointments
Residents should continue to receive necessary medical care that is needed outside of the facility regardless of vaccine status. Typically, transportation for these appointments is provided by the facility. If the resident chooses to have a family member or friend transport them to the appointment, there should be no known risk of COVID-19 transmission in keeping with the facility's current screening and testing protocols. In all instances, the resident and those involved in the transportation should adhere to appropriate infection prevention and control protocols as outlined in
PA-HAN 524 including universal masking. If a mask can be tolerated, the resident should wear one during transport and the driver should be wearing a mask as well. All should be screened upon return to the facility as well.
Staff should be cognizant of residents who go off-site for outpatient medical care, including dialysis, and remain alert for notification of any known exposures. Such exposure would require testing, case identification, contact tracing, quarantine, observation, and any other necessary medical care, regardless of vaccine status.
Outings for Non-Medical Reasons
Each facility should develop a policy to include precautions for outings for non-medical reasons, although there will be those scenarios that need assessed on a case-by-case basis. Considerations for development of those policies and making those assessments include:
- The extent to which infection prevention and control precautions (including universal masking, hand hygiene, and physical distancing) are achieved based on the circumstances of the outing;
- Whether the resident is fully vaccinated;
- The resident's level of vulnerability due to vaccination status and any chronic or immunocompromised conditions; and
- Duration of the outing, including whether it includes an overnight stay or vacation to another state.
If the outing poses a high risk based on a number of factors (below), testing may be appropriate. Ideally, wait at least 2-3 days following the outing to perform testing. Transmission-Based Precautions should also be considered for residents with this type of high-risk outing upon return to the facility, and should always be implemented if exposure is known or highly suspected as per
PA-HAN 530. Factors of a high-risk outing include:
- Substantial community spread in the area(s) visited (≥10% county positivity rate) AND
- A gathering of more than 10 people.
Dining Services and Communal Activities
With adherence to infection prevention protocols, communal dining and group activities may occur with physical distancing for residents who are fully recovered from COVID-19 and those not in isolation for observation or Transmission-Based Precautions. Physical distancing, use of hand hygiene and face coverings should be utilized. Facilities should consider additional limitations based on status of COVID-19 infections in the facility.
Group activities may also be facilitated (for residents who have fully recovered from COVID-19, and for those not in isolation for observation or Transmission-Based Precautions) with physical distancing among residents, appropriate hand hygiene, and use of a face covering (except while eating). Facilities may be able to offer a variety of activities while also taking necessary precautions. For example, book clubs, crafts, movies, exercise, and bingo are all activities that can be facilitated with alterations to adhere to the guidelines for preventing transmission.
Precautions When Meals are Served in a Common Area|
- Stagger arrival times and maintain social distancing;
- Increase the number of meal services or meals in shifts to allow fewer residents in common areas at one time;
- Take appropriate precautions with eye protection and gowns for staff feeding the resident population at high-risk for choking, given the risk of cough while eating; and
- Staff members what are assisting more than one resident at the same time must perform hand hygiene with at least hand sanitizer each time when switching assistance between residents.
Facilities should adhere to the following guidance for dining and communal activities if there is an outbreak in the facility:
- Communal activities should be restricted until the first round of outbreak testing is completed and reveals no additional COVID-19 cases in other areas of the facility. Communal activities can resume in areas/units with no COVID-19 cases. However, the facility should suspend communal activities on the affected unit until the facility meets the criteria to discontinue outbreak testing described in
- Provide in-room meal service for residents who are assessed to be capable of feeding themselves without supervision or assistance.
- Identify residents at-risk for choking or aspiration who may cough, creating droplets. Meals for these residents should be provided in their rooms with assistance. If meals cannot be provided in their rooms, the precautions outlined below must be taken for eating in a common area in addition to ensuring the residents remain at least six feet or more from each other. If residents cannot be spaced six feet or more apart, roommate residents may be seated together.
- Residents who need assistance with feeding and eat in a common area should be spaced apart as much as possible, ideally six feet or more. Where it is not possible to have these residents six feet apart, then no more than one resident who needs assistance with feeding may be seated at a table. If residents cannot be spaced six feet or more, roommate residents may be seated together.
- Facilities which are unable to accommodate in-room meal services due to space or staffing issues should provide meals at alternate times to allow for six feet or more between residents and follow the precautions below.
Per CMS guidance provided to the states, facilities should continue to screen visitors and contractors, including beauty and/or barber shop staff and implement source control measures. Reopening the beauty and/or barber shop depends on the facility's ability to maintain
infection prevention and control measures including proper social distancing, hand hygiene, use of proper face coverings, and sanitation of equipment used between residents. Additionally, the facility must ensure that residents participating in the beauty and/or barber shop must also adhere to infection control practices by wearing a face covering and maintaining distance from other residents. If an outbreak occurs in the facility, the guidance in
QSO-20-39-NH (as updated March 10, 2021) regarding outbreaks applies to accessing services in beauty and/or barber shops as well.