DHS COVID-19 PROVIDER GUIDANCE // OLTL
Long-Term Care Facility (LTCF) Visitation Guidance
Issued: March 6, 2020
A new respiratory disease – coronavirus disease 2019 (COVID-19) – is spreading globally and
there have been instances of COVID-19 community spread in the United States. The general strategies
CDC recommends to prevent the spread of COVID-19 in LTCF are the same strategies these facilities use
every day to detect and prevent the spread of other respiratory viruses like influenza. One of the most
important strategies is to prevent the introduction of respiratory germs into your facility in the first
place through monitoring of visitors and healthcare workers.
From the Centers for Medicare and Medicaid Services
How should facilities monitor or limit visitors?
Facilities should screen visitors for the following:
- International travel within the last 14 days to restricted countries. For updated information on
restricted countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
- Signs or symptoms of a respiratory infection, such as a fever, cough and sore throat.
- Has had contact with someone with or under investigation for COVID-19.
If visitors meet the above criteria, facilities may restrict their entry to the facility. Regulations and
guidance related to restricting a resident’s right to visitors can be found at 42 CFR §483.10(f)(4), and at
F-tag 563 of Appendix PP of the State Operations Manual. Specifically, a facility may need to restrict or
limit visitation rights for reasonable clinical and safety reasons. This includes, “restrictions placed to
prevent community-associated infection or communicable disease transmission to the resident. A
resident’s risk factors for infection (e.g., immunocompromised condition) or current health state (e.g.,
end-of-life care) should be considered when restricting visitors. In general, visitors with signs and
symptoms of a transmissible infection (e.g., a visitor is febrile and exhibiting signs and symptoms of an
influenza-like illness) should defer visitation until he or she is no longer potentially infectious (e.g., 24
hours after resolution of fever without antipyretic medication).”
How should facilities monitor or restrict health care facility staff?
The same screening performed for visitors should be performed for facility staff (numbers 1, 2 and 3
- Health care providers (HCP) who have signs and symptoms of a respiratory infection should not
report to work.
- Any staff that develop signs and symptoms of a respiratory infection while on-the-job, should:
Immediately stop work, put on a facemask and self-isolate at home;
- Inform the facility’s infection preventionist, and include information on individuals,
equipment and locations the person came in contact with; and
- Contact and follow the local health department recommendations for next steps (e.g.,
testing, locations for treatment).
Refer to the CDC guidance for exposures that might warrant restricting asymptomatic healthcare
personnel from reporting to work (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-riskassesment-hcp.html).
Employees: Because healthcare personnel reside in the community and work in facilities, they have the
potential to introduce infections into PALTC populations. As with all situations, healthcare personnel
who are ill should stay home and seek healthcare advice through their regular provider. Those with mild
symptoms are encouraged to call, rather than going in person, for medical advice.
The Society for Post-Acute and Long Term Care (PALTC) Medicine strongly recommends that:
- Healthcare providers avoid working while ill.
- Healthcare facilities develop staff policies to allow and account for potential absenteeism
during community-wide outbreaks.
- If there is evidence of community-wide COVID-19 illness, we recommend facilities screen staff
at entry into the facility for respiratory signs and symptoms and fever.
Visitors: Like healthcare personnel, visitors may also inadvertently foster spread of infections in the
PALTC setting. Given the unique nature of the PALTC setting, it will not likely be possible to prohibit all
visitors in the event of community-wide COVID-19 illness. For example, individuals on hospice should be
able to visit with family members who are not ill.
The Society for Post-Acute and Long Term Care (PALTC) Medicine recommends that:
- Consistent with good routine practice, posting signs requesting that people with acute
respiratory illness to refrain from entering the PALTC facility. This applies whether or not there is
COVID-19 activity in the community.
- Individuals (regardless of illness presence) who have a known exposure to someone with a
COVID-19, or who have recently traveled to areas with COVID-19 transmission, refrain from
entering the nursing home.
- If there is community-wide transmission of COVID-19, facilities consider screening visitors at
entry to the facility.
Prevent the introduction of respiratory germs INTO your facility:
- Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory
- Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory
- Assess residents’ symptoms of respiratory infection upon admission to the facility and
implement appropriate infection prevention practices for incoming symptomatic residents.
Prevent the spread of respiratory germs WITHIN your facility:
- Keep residents and employees informed.
- Describe what actions the facility is taking to protect them, including answering their
questions and explaining what they can do to protect themselves and their fellow
- Monitor residents and employees for fever or respiratory symptoms.
- Restrict residents with fever or acute respiratory symptoms to their room. If they must
leave the room for medically necessary procedures, have them wear a facemask (if
- In general, for care of residents with undiagnosed respiratory infection use Standard,
Contact, and Droplet Precautions with eye protection unless suspected diagnosis
requires Airborne Precautions (e.g., tuberculosis).
- Healthcare personnel should monitor their local and state public health sources to
understand COVID-19 activity in their community to help inform their evaluation of
individuals with unknown respiratory illness. If there is transmission of COVID-19 in the
community, in addition to implementing the precautions described above for residents
with acute respiratory infection, facilities should also consult with public health
authorities for additional guidance.
- Support hand and respiratory hygiene, as well as cough etiquette by residents, visitors and
- Ensure employees clean their hands according to CDC guidelines, including before and
after contact with residents, after contact with contaminated surfaces or equipment
and after removing personal protective equipment (PPE).
- Put alcohol-based hand rub in every resident room (ideally both inside and outside of
- Make sure tissues are available and any sink is well-stocked with soap and paper towels
for hand washing.
- Identify dedicated employees to care for COVID-19 patients and provide infection control
- Provide the right supplies to ensure easy and correct use of PPE.
- Post signs on the door or wall outside of the resident room that clearly describe the type
of precautions needed and required PPE.
- Make PPE, including facemasks, eye protection, gowns and gloves available immediately
outside of the resident room.
- Position a trash can near the exit inside any resident room to make it easy for
employees to discard PPE.