Specialized Information for:

Nursing HomesAssisted Living/Board & Care Home and Community Based Services

Coronavirus Prevention in LTC Facilities: Information for Long-Term Care Ombudsman Programs

Updated April 3, 2020

As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is important for Ombudsman programs and other advocates to be informed and take precautions in order to prevent the spread.

According to the Centers for Disease Control and Prevention (CDC), the health risk of COVID-19 for the general public in the United States is low currently.  However, just as with influenza and other viral infections, older adults and some individuals with preexisting medical conditions are at an increased risk for more severe illness.


ACL

ACL recently published Frequently Asked Questions (FAQs) and an overview about COVID-19 and the Ombudsman program. 

CMS

NEW! On April 2, 2020 CMS issued revised guidance and a press release to nursing homes.

NEW! On March 23, 2020 CMS issued revised guidance for surveyors (QSO-20-20-All)

On March 13, 2020 CMS issued revised guidance and a press release that says the following:

The new measures CMS announced today, which supersede prior CMS guidance, constitute the agency’s most aggressive and decisive recommendations with respect to nursing home safety in the face of the spread of COVID-19. They include:

  • Restricting all visitors, effective immediately, with exceptions for compassionate care, such as end-of-life situations;
  • Restricting all volunteers and nonessential health care personnel and other personnel ;
  • Cancelling all group activities and communal dining; and
  • Implementing active screening of residents and health care personnel for fever and respiratory symptoms.

The guidance directs nursing homes to restrict visitation except in certain compassionate cases, like end-of-life. In those cases, visitors will be equipped with personal protective equipment (PPE) like masks, and the visit will be limited to a specific room only. 

CMS Coronavirus (COVID-19) Partner Toolkit
CMS released a Coronavirus (COVID-19) Partner toolkit on March 17, 2020. The toolkit has links to up-to-date information for partners, beneficiaries, caregivers, and clinicians. 

Coronavirus Aid, Relief and Economic Security (CARES) Act

Coronavirus Aid, Relief and Economic Security (CARES) Act Signed into Law
The President signed the Coronavirus Aid, Relief and Economic Security Act, or CARES Act, into law. The Act provides a total of $2.2 trillion, with $955 million directed to Administration for Community Living (ACL) programs, which includes $20 million for the Ombudsman Program under Title VII of the Older Americans Act (OAA). ACL staff are developing FAQs and other technical assistance materials which will be available on the ACL COVID-19 page. Read more on the CARES Act on the ACL website.

The information below includes tips for preventing the spread of COVID-19, alternative ways to stay in touch with residents, and links to additional information.  


General Tips for Preventing the Spread of COVID-19

  • Review these resources to help stop the spread:
  • Remind staff and volunteers to contact their supervisor and/or State Ombudsman if they are sick. Recommend that they contact their healthcare provider if they are sick for medical advice. 
  • Advise staff and volunteers that if they travel internationally, or to areas impacted by COVID-19 in the United States, to monitor for symptoms (coughing, sneezing, or fever) and contact their healthcare provider for advice if they have symptoms and/or want to be tested.

Communicating with Residents, Families, and Others

Review the FAQs and memo from ACL for additional information for Ombudsman programs.

  • Ombudsman programs are to serve as a resource and refer individuals to appropriate public health entities, not attempt to answer specific questions about COVID-19.
  • Share information from the CDC with facilities and others by phone, email, mail, social media, and program websites.
  • During the quarantine, communication can occur by other means such as phone, email, video conferencing with individual residents, Resident Council leadership, staff, and families.
  • Obtain resident census lists, contact information for resident representatives, and contact information for Resident and Family Council leadership. If possible, identify 2-3 residents in each facility and establish regular calls/emails/videocalls to check in.
    • Ask if residents have access to a computer, tablet or a smart phone, and if they are interested in video chats or conferences. Confirm with your host agency if video chats and conferences can be an option to communicate with residents, families, and others.
    • Ask residents if they have email addresses and if they would like to receive email updates or correspond through email.
    • Ask residents if they prefer that you contact a representative for ongoing communication.
  • Post Ombudsman program contact information on front door. Make brochures available outside by the front door, if practical.
  • Send business cards and program brochures to long-term care facilities to share with residents, family members, and others.
  • Encourage facility staff to distribute your email address as an alternate way to communicate with residents and family members or legal representatives. You may experience higher call volume due to COVID-19 and email may allow a shorter response time.
  • Provide information regarding visitation restrictions from the recent CMS guidance and how to contact your program on your program’s website, via email, e-newsletters, and social media. 

Examples of Resident Support and Communication

Pennsylvania Virtual Visits of Cheer and Support Facebook Page
Pennsylvania  Ombudsman program representatives started a new Facebook page titled Virtual Visits of Cheer and Support. On the page people are creating and posting videos to say hi and support nursing home and personal care home residents.

Children can participate in the Maine Notes for Seniors initiative by writing notes, uploading a drawing, or sending a short video to residents in nursing homes and assisted living facilities. 

Michigan Attorney General, Dana Nessel, made a video on visiting at the window of a nursing home. 

CMS Actions to Prevent Spread of COVID-19 for Facilities and Surveyors

 NEW! On March 23, 2020 CMS issued revised guidance for surveyors (QSO-20-20-All).

CMS issued guidance for surveyors (QSO-20-12-All) and a call to action to long-term care providers (QSO-20-14-NH REVISED March 13) and hospitals to assist in preventing the spread of COVID-19. 

Effective immediately, CMS is suspending non-emergency surveys of all healthcare facilities and has directed that states focus surveys to the following activities (in Priority Order):

1. All immediate jeopardy complaints and allegations of abuse and neglect.

2. Complaints about infection control.

3. Statutorily required recertification surveys. 

4. Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years.

5. Surveys of facilities/hospitals that have a history of infection control deficiencies at lower levels than immediate jeopardy.

Review the memo (QSO-20-12-All) for more details regarding the protocols for the survey process in facilities with actual or suspected cases of COVID-19 and visit this CMS page for updates.

Stay Informed

We recommend checking the CDC website for the most timely, comprehensive information about the national response to the outbreak. Links to additional information are below.

Taking Care of You

SAMHSA’s Disaster Distress Helpline Toll-Free: 1-800-985-5990 (English and español)
SMS: Text TalkWithUs to 66746 SMS (español): “Hablanos” al 66746 TTY: 1-800-846-8517
Website: (English) (Spanish)

SAMHSA’s National Helpline Toll-Free: 1-800-662-HELP (24/7/365 Treatment Referral Information Service in English and español) 
Website:  (English)

National Suicide Prevention Lifeline Toll-Free (English): 1-800-273-TALK (8255)
Toll-Free (español): 1-888-628-9454 TTY: 1-800-799-4TTY (4889)
Website: (English) (Spanish)

What to Do in These Stressful Times: A Blog by Susan Wehry, MD

Free Online Class from Yale: The Science of Well-Being
In this course you will engage in a series of challenges designed to increase your own happiness and build more productive habits. As preparation for these tasks, Professor Laurie Santos reveals misconceptions about happiness, annoying features of the mind that lead us to think the way we do, and the research that can help us change. You will ultimately be prepared to successfully incorporate a specific wellness activity into your life. 


CDC Resources

NEW! Coronavirus Disease 2019 (COVID-19) Preparedness Checklist for Nursing Homes and other Long-Term Care Settings

CDC: Frequently Asked Questions on COVID-19 Testing at Laboratories

CDC: Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities


CMS Resources

NEW! Revised Guidance for Nursing Homes (press release) - April 2, 2020

CMS: COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers - March 2020

Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit - March 28, 2020

Revised Guidance for Surveyors (QSO-20-20-All) - March 23, 2020

Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes (QSO-20-14-NH REVISED) REVISED - March 13, 2020

Press Release: CMS Announces Actions to Address Spread of Coronavirus

Suspension of Survey Activities

Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge

Coronavirus – Updates for State Surveyors and Accrediting Organizations 


ACL Resources

NEW! ACL - Long-Term Care Ombudsman Program Frequently Asked Questions – COVID-19

NEW! COVID-19 overview answers many of the questions we have received from the states. - March 10, 2020

Emergency Preparedness and Response:  Model Policies and Procedures for State LTCO Programs - Nov. 23, 2015

Coronavirus disease 2019 (COVID-19)


NORC Resources

NORC Infection Control Issue Page

NEW! - Long-Term Care Ombudsman Program Postcard
This postcard is available in three versions and can be used by long-term care Ombudsman programs or long-term care facilities to share information about the Ombudsman program. Programs can personalize the postcards and/or print and share them with residents and family members.

NEW! NORS FAQs on Documenting Activities During COVID-19 (View the FAQs as a PDF)


Consumer Voice Resources

COVID-19 and Nursing Homes: What Residents and Families Need to Know
This consumer fact sheet is designed to inform both residents and their families about steps the federal government has taken to reduce the spread of the virus, what nursing homes should be doing to prevent and control COVID-19, actions residents/families can take to promote safe care, visitation, and more.

Consumer Voice – Supporting Coronavirus Prevention in Long-Term Care Facilities

Email from Consumer Voice -  Prioritization of Survey Activities - New CMS Guidance (March 23, 2020)

Email from Consumer Voice - CMS Issues More Restrictive Guidance (March 13, 2020)

Email from Consumer Voice - CMS Revises Coronavirus Guidance for Nursing Facilities (March 9, 2020)

Email from Consumer Voice - CMS Coronavirus Guidance for Nursing Facilities (March 4, 2020)


Additional Resources and Information

AMDA: COVID-19 in PALTC settings

Long-Term Care Community Coalition: Protecting Vulnerable Residents from Coronavirus