Testing and Contact Tracing
In the event of a pandemic that involves a highly contagious infectious disease, resuming “normal” operations for an aging services provider will greatly depend on reliable testing and contact tracing. Scientific study and research will drive this purpose, as will understanding about the disease itself, and how it can be detected, improves and solidifies. Organizations will need to identify reliable sources of infectious disease information/data and will need to collaborate closely with state and local health agencies to ascertain the appropriate methods for testing and contact tracing.
Many aspects of testing must be considered and provided: testing methodology, testing supplies, labs for test processing, reliability, speed and accuracy of testing results, frequency of testing, stakeholder groups that will be required or requested to participate in testing, and reporting of test results, to mention a few. The question of what entities will bear the burden of immediate and ongoing testing costs must be negotiated. Organizations should expect to work closely with their trade associations and advocacy groups to ensure that their needs and expenses are well represented to regulatory and legislative bodies with decision-making authority.
Contact tracing will also be of key concern to individuals, organizations, and state and local agencies. Aging services providers will need to be prepared to participate in and report on individuals’ contacts with others, should an exposure to a highly contagious, infectious disease occur within their stakeholder groups. State and local health departments will likely request this information, and providers of care and services will need to be prepared to monitor and protect such information accordingly.
- Coronavirus Testing Basics (FDA)
- Contact Tracing (CDC)
- Case Investigation and Contact Tracing: Part of a Multipronged Approach to Fight the COVID-19 Pandemic (CDC)
- Contact Tracing: A Critical Component in Combatting COVID-19 (Lippincott NursingCenter Blog)
- Texas senior living facilities using wearable tech for COVID-19 contact tracing (KXAN News, Austin, TX)
- Testing Guidelines for Nursing Homes (CDC)
- From swabs to antibodies: How to understand your coronavirus test results (Washington Post)
- Table of Testing, Visitation, and other LTC COVID Considerations by State (National Governors Association)
- HHS to Send Rapid Point-of-Care Testing to Nursing Homes (LeadingAge)
- Diagnostic Testing Support for Affordable Housing Communities (LeadingAge)
- Infection control policies for reopening: FAQs from AMDA
- LeadingAge audio interviews:
- April 23, 2020: Dr. Nicole Lurie of CEPI Offers Facts and Cautions About COVID-19 Testing. (Article based on the interview: Expert Insight from Dr. Nicole Lurie: The State of COVID-19 Testing)
- May 29, 2020: Minnesota Testing Spotlight with Sharon Zehe of the Mayo Clinic and Karen Martin and Diane Rydryc of MN Dept. of Health
- June 10, 2020: Gus Keach-Longo of The Towers at Tower Lane on Testing, Tracing, and a “Soft Opening” in Elder Housing.
- Template Letter for Communities Who Are Testing for COVID-19 (Word document)
- Template Letter for Communities With a Positive COVID-19 Case in Resident or Employee (Word document)
- Editable sample documents based on forms by Hebrew Home at Riverdale:
Alignment of Federal and State Guidelines
Organizations may find that guidelines for resuming their operations will differ between federal and state agencies; multi-state organizations may discover that guidelines are marginally or markedly different between states. Navigating these differences may present a considerable challenge, and organizations should be prepared to allot significant time and resources to distilling these guidelines down to the essential requirements that must be met to ensure compliance with regulatory bodies such as CMS, OSHA, Life Safety codes, and others. Beyond those compliance-driven requirements, organizations will need to navigate guidelines that leave their implementation to the discretion of organizations themselves.
As organizations plan to resume operations, they may find it necessary to help residents, persons served, staff, and other stakeholders grieve the loss of life precipitated by the pandemic. Funerals, celebrations of life, and other customary memorial events that may be initially postponed due to the pandemic may now be possible as services and supports return to normal.
Organizations will need to be aware and considerate of these changes, and ensure they are prepared to implement whatever transitional supports or requirements are necessary in End-of-Life situations.
- Advanced Care Planning, Grief, and Serious Illness Communication Resources (LeadingAge)
- Audio interview: April 17, 2020, Dr. Danielle Doberman on Advance Care Planning and Coronavirus
- Visitor Decision Flowchart for End-of-Life (LeadingAge)
- Special Visitor and Infection Control Guidance for Hospice (LeadingAge)
Organizations may find that guidelines for resuming their operations will differ between federal and state agencies; multi-state organizations may discover that guidelines are marginally or markedly different between states.
If a pandemic involves a highly contagious, infectious disease, admission of visitors and the general public to aging services providers may be completely restricted or permitted only in end-of-life or compassionate care circumstances. When the time comes to resume visitation, organizations should plan to do so in phases that ensure the safety of all involved, and minimize the risk of disease transmission. Policies and protocols must be developed that thoroughly prepare staff, persons served and family members for the visitation experience. Organizations should refer to their state and local health agencies and governing bodies for guidelines on how to permit safe visitation.
- Screening Tips for Nursing Homes (LeadingAge)
- CMS Updates Guidance on Healthcare Worker and Visitor Entry (LeadingAge)
- ‘Thoughtful approach’ to reopening necessary to balance risks, benefits (McKnight’s Senior Living): Taking a measured approach to resuming visitation and group activities, advocating for COVID-19 vaccines, continuing visitor screenings, and requiring masking and social distancing are among the recommendations that AMDA is making to long-term care facilities as operators consider lessening restrictions that in many places have been in effect for almost a year.
- Verified Vaccinated Visitors program allows unrestricted access in senior living (McKnight’s Senior Living): Weighing the risks versus benefits of loosening up restrictions in the independent living part of its life plan community, one New Hampshire long-term care provider is launching a new visitation program for vaccinated individuals.
- Interim Recommendations for Communal Activities and Visitation in Post-Acute and Long-Term Care Facilities (AMDA PDF): This guidance covers the need for continued masking, physical distancing, and use of other essential infection control precautions, and discusses risks from vaccine hesitancy, continued community outbreaks, and more.
Congregate Dining Programs
To reduce the risk of disease transmission, aging services organizations may elect to pause, alter or reconfigure dining services programs in the event of a pandemic. Congregate meal programs may change significantly or be temporarily halted.
Undertaking the resumption of dining services and/or a congregate meal program will require careful planning and coordination. Organizations that plan to do so should seek guidance from state or local health departments, governing bodies, the Food and Drug Administration, the Centers for Disease Control and Prevention, and other agencies as appropriate.
- The Food System Can’t Survive this Crisis, but a Better System Can Be Built (Ideo)
- Preparing to Resume Dining Services (LeadingAge QuickCast)
- Seniors COVID-19 Guide for Reopening Dining Rooms (Sodexo)
- Reimagining European Restaurants for the Next Normal (McKinsey & Co.)
- LeadingAge Member Ideas and Inspiration stories:
- Meals Delivery, Grab-and-Go, and Grocery Delivery for Residents
- A Partnership to Ensure Food for Affordable Housing Residents
- Staff Stepping Up to Ensure Passover Meal Deliveries
- Pop-Up Groceries Allow Residents to Stay Home
- In-House Grocery, Frozen Meal Services Instituted
- A Large Meals Program Ramps Up Dramatically
Lessons Learned: Reopening Guidance
In the midst of an emergency as impactful as a pandemic, we must often act first and reflect later. It’s common for leaders to ask themselves retrospective questions, such as:
- Did I act too quickly or too slowly?
- What could I have done differently?
- Did my approach of choice work as well as I anticipated it would?
- How can I improve my responses if a pandemic recurs?
And then, of course, there are a lengthy series of “What ifs?” that we ponder.
LeadingAge has received numerous Lessons Learned tips from members during the COVID-19 pandemic, which we are sharing at the conclusion of each related Playbook Section. In addition, a compilation of shared Lessons Learned may be referenced in the Playbook Appendix.
- 5 Ways to Reopen America Safely (LeadingAge LTSS Center research report)
- How to Think about Long Term Strategy When You can Barely See Past Tomorrow (Ideo)
- Innovating from Necessity: The Business-Building Imperative from the Current Crisis (McKinsey & Co.)
- Creating a Path Towards the Next Normal in Senior Living (International Council on Active Aging white paper)
When the time comes to resume visitation, organizations should plan to do so in phases that ensure the safety of all involved, and minimize the risk of disease transmission.
LeadingAge Member Ideas and Inspiration stories:
- A Unit to Nurse COVID-Positive Residents Back to Recovery
- A Partnership to Bring COVID-19 Testing to At-Risk Elders
- Transitional Care Center to Operate as a COVID-19 Post-Acute Care Center
- Provider Innovates in Face of Multiple Challenges
- Independent Living Meals Delivery Schedule Changes
Audio interviews from LeadingAge Daily Calls:
- April 30, 2020: Sharon Wilson-Geno of VOA on How VOA Pivots to Cope With COVID-19.
- May 4, 2020: Dr. Paul Katz of FSU College of Medicine on Containing Outbreaks, Testing, and Workforce Challenges
- May 7, 2020: Dr. Nimalie Stone of CDC on the Role of CDC and Difficulties That Face Aging Services Providers
- May 11, 2020: Neal Buddensiek, M.D., of Benedictine on a Multi-State Provider’s Pandemic Preparation, and Concerns About Testing
- May 26, 2020: Kate Shepard of Reformed Church Home on Recovered Residents, Maintaining Positivity, and Testing.
- May 28, 2020: Ami Schnauber of LeadingAge NY on the Nightmare of Coronavirus in New York
- June 17, 2020: Tina Sandri of Forest Hills of DC on Coping With COVID-19 Early, Plus Workforce and Testing Difficulties
- June 25, 2020: Kim Brooks of Hebrew SeniorLife on How HSL is Thinking Through Reopening.
- July 1, 2020: Deke Cateau of A.G. Rhodes on Morale, Testing, and Reopening.
- July 6, 2020: Nancy Evans of CSI Support and Development on How a Large Housing Provider Copes and Thinks About Reopening
- July 10, 2020: Allison Salopeck of Jennings on PPE, Testing, and Managing Outdoor Visitations.
- July 23, 2020: Dr. Noah Marco of Los Angeles Jewish Home on Letting Residents Decide Their Own Risk Tolerance; Plus Testing
- “Reopening” to Visitors: A Review of CMS and States’ Guidance to Nursing Homes (LeadingAge)
- “Reopening” to Visitors: A Review of States’ Guidance for AL (LeadingAge)
- Advice on Re-Opening from Senior Options
- Reopening Guidance for COVID-19 Available by State (HHS)
- Eldercare staff keep the good times rolling amid lockdowns (Catholic Health World)
- Succeeding Despite the 2020 Pandemic (McKnight’s Power Planning e-book; registration required)
- FEMA Exercise Starter Kit for Resuming Operations Post-COVID: Includes sample documents to conduct your own planning workshop to navigate returning to full operations during the pandemic. The Kit includes a sample facilitator guide and conduct slides designed to be adapted and customized for your own needs. Suggested discussion questions for the workshop build upon reconstitution planning principles and relevant White House guidance for employers included in the Guidelines for Opening Up America Again.
- Restart Readiness Checklist (CDC): A guide (for non-health care employers) to resuming business operations as safely and healthy as possible for you, your employees, and the public. Includes a resources section for links and QR codes to web resources.
- Considerations for Balancing Seniors Housing Residents’ Safety as Communities Reopen (American Seniors Housing Assn., fee based resource): Research and advisory services firm ATI Advisory and CEO Anne Tumlinson present the results of case studies and interviews across the industry that reveal how seniors housing operators are gradually restoring resident engagement, allowing non-essential visitors, and enabling new move-ins while taking a strategic public health approach to balance multiple competing priorities and risks.
- State Strategies for Ongoing Post-Acute and Long-Term Care Resident and Staff COVID-19 Vaccination (PDF): This guidance helps prepare for ongoing vaccination programs to cope with the usual turnover in residents and staff in a long-term care community. (On The AMDA Update on COVID-19 page, a one-stop site for a wide variety of AMDA’s pandemic resources.)