Grace Assisted Living

COVID 19 Guidelines

Section 1: Admission and Readmission

  1. All admissions & readmissions will be treated as a suspected/positive case and thus will enter the facility under 14-day isolation regardless of current/prior location. Facilities will obtain a negative test result prior to admission.
  2. Facilities will obtain a negative test result prior to resident admission into community.
  3. PCR testing to discontinue isolation-based precautions is no longer an acceptable practice. Discontinuation will be dictated by symptoms and minimum timeframe.
  4. We will continue to swab new admissions for identification purposes. We will continue to request 1 swab within 48 hours prior to DC from an acute care facility.
  5. Every effort will be made to maintain isolation in MC units. An emphasis will be placed on behavior management plans and PRN medications, as indicated.

Section 2: System Monitoring

  1. All personnel entering the facility will be screened upon entry.
    Temperatures will be taken and the following screening questions will be asked;

    1.  Have you travelled out of state?
    2. Have you had any cold/flu like symptoms?
    3.  Have you been exposed to anyone with COVID-19?
    4. Have you had a COVID test?
    5. DO you have any upper respiratory infection symptoms?
  2. All staff has been educated on not reporting to work if they are having any cold/flu like symptoms.
  3. If temperature is > 100.0 F, or if someone answers yes to any question, they will be directed not to enter the Community and will be taken off the schedule. These personnel will not be allowed to enter Community unless cleared by nursing, or the appropriate provider.

Section 3: Suspected and Confirmed Cases

  1. If you have a resident you suspect has been infected, they will immediately be placed into quarantine and be treated as a positive case. Contact Regional Nurse for PCR testing while coordinating and obtaining a physician order for the NP swab collection. Testing will be conducted through Cole Diagnostics unless otherwise specified.
  2. Regional Nurse will communicate with Public Health in the event of a positive/confirmed case.
  3. Cohorting Strategy:
    1. Resident with signs and symptoms will be sent to the hospital for evaluation
    2. .If staffing cannot accommodate a COVID 19 resident, the resident will be sent to a COVID unit.
    3. A designated staff member will be assigned to the COVID 19 resident(s) if the resident is retained.

If unable to care for the resident in their current setting, they will be transferred to the appropriate acute care setting. Transport and acute care facility will be notified prior to transfer.

Section 4: PPE Considerations

  1. The state of Idaho requires a mask be worn at all times within a RALF (nose must be covered).
  2. PPE preservation methods remain in place. Examples include: gowns to be re-used unless wet, soiled (with same guidance applied to masks).- If caring for a resident in isolation adhere to the following options:
    – If utilizing re-usable gowns – they will be laundered after each shift.
    – If utilizing disposable gowns – each staff member will have their own gown. Will be used for multiple shifts and stored in a paper bag just inside the resident’s room (until wet or soiled).
    – If using cloth facemasks, be sure to launder them frequently.
  3. All PPE requests should go through your Regional Nurse.
    If unable to obtain PPE through local channels, corporate purchasing will supply adequate amount of PPE.

Section 5: Return to Work

  1. Adhere to these CDC Guidelines when clearing positive/suspected personnel for return to work – must get authorization from Regional Nurse prior to return.
    THE CRITERIA BELOW ALSO APPLIES TO DISCONTINUATION OF ISOLATION-BASED PRECAUTIONS – PER CDCAsymptomatic employees:
    – If positive result is confirmed via PCR swab, then;
    – The employee will remain off work (continue isolation) until 10 days have passed since first specimen collection.Symptom-based strategy (exclude from work/continue isolation until):
    – At least 24 hours have passed since recovery defined as, resolution of fever without the use of fever-reducing medications, and improvement in respiratory symptoms (e.g., cough, shortness of breath) and;
    – At least 10 days have passed since symptoms first appeared.Those who show severe signs and symptoms may require an isolation period of up to 20 days. A Test-based strategy is no longer recommended unless the employee is immunocompromised, or symptoms persist for > 20 days.https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html

Section 6: Leaving the facility

  1. Residents should only exit the facility for medically necessary appointments (in Ada County). Facility nurse, in collaboration with the resident and/or resident representative to determine what is “necessary.” Resident should wear a mask, and practice hand hygiene upon departure and arrival. Also encourage them to abide by social distancing, where able. Temperature and symptom monitoring will be required. No 14-day isolation.

Section 7: Activities, Communal Dining and Outside Providers

  1. Group activities will be allowed, ONLY IF social distancing (6 feet) measures are feasible and in place.
  2. Communal dining will be allowed ONLY IF social distancing (6 feet) measures are feasible and in place. (Meridian Grace)
  3. Foot/Eye Clinics/beautician will be allowed, ONLY IF;
    1. Deemed essential by administrator/nursing and;
    2. Guests are competent in handwashing, sanitation, and disinfecting equipment between residents, and;
    3. They are wearing appropriate PPE.
    4. Care provided to one resident at a time.
    5. Facility nurse will identify those individuals who require the service prior to visit.
    6. A designated area will be specified and only 1 resident at a time will be serviced at once.
  4. Home Health, Hospice, and other essential providers should don a surgical mask, or a KN95/N95 respirator when delivering cares.

Section 8: Memory Care

  1. Routines are very important for residents with dementia. Try to keep their environment and routines as consistent as possible while still reminding and assisting with frequent hand hygiene, social distancing, and use of cloth face coverings (if tolerated). Cloth face coverings should not be used for anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
  2. Dedicate personnel to work only on memory care units when possible and try to keep staffing consistent. Limit personnel on the unit to only those essential for care.
  3. Continue to provide structured activities, which may need to occur in the resident’s room or be scheduled at staggered times throughout the day to maintain social distancing.
  4. Provide safe ways for residents to continue to be active, such as personnel walking with individual residents around the unit or outside.
  5. Limit the number of residents or space residents at least 6 feet apart as much as feasible when in a common area, and gently redirect residents who are ambulatory and are in close proximity to other residents or personnel.
  6. Frequently clean often-touched surfaces in the memory care unit, especially in hallways and common areas where residents and staff spend a lot of time.
  7. Continue to ensure access to necessary medical care, and to emergency services if needed and if in alignment with resident goals of care.https://www.cdc.gov/coronavirus/2019-ncov/hcp/memory-care.html

Section 9: Visitation

  1. Visitation will only be granted if there have been no diagnosed cases within the community. Visitation specifics vary from facility to facility (please contact your facility for details). Visitors must maintain social distance, wear a mask during visits. Use of telecommunication will remain the preferred approach. If there are extenuating circumstances, contact your Regional Nurse for direction. Social distancing measures (at least 6’) will be in place at all times, regardless of visit location. Symptom monitoring and screening questions will be posed to any and all guests. This information is applicable to all visit types.For all communities in Ada County facility internal visits are currently prohibited.Courtyard, and window visits will be allowed. This visit type will be encouraged whenever possible (weather permitting).

Section 10: Testing Details

  1. The facility will handle all testing of residents and staff using Cole Diagnostic Laboratories.
  2. The facility must receive written consent from a power of attorney prior to testing residents with cognitive impairment. This practice will also be used for resident unable to make health care decisions independently. The facility will not test a resident without a signed consent form.