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Nursing home residents are among those most at-risk for COVID-19. Here’s how Mass. is responding.

"We are taking measures to protect some of our most vulnerable populations."

Guilherme Gomes sanitizes a nurses station at the South Shore Rehabilitation and Skilled Care Center, Friday, March 6, 2020, in Rockland, Mass. Staff at the 96-bed nursing home held an informational meeting for residents and have been stockpiling supplies, stepping up their daily disinfection routine and screening visitors for potential illness in recent days. AP Photo/David Goldman

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Although there is still more to learn about coronavirus, health officials know this so far: some people are at higher-risk of contracting the contagious respiratory illness than others.

Older adults and people with chronic medical conditions are particularly susceptible to the virus, they say.

So as the number of positive cases continued to surge across Massachusetts this week, the state Department of Public Health unveiled new guidelines for residential healthcare and skilled nursing facilities geared toward managing visitors and employees alike.

The guidance builds upon direction the DPH released to those centers late last month.

“We are taking measures to protect some of our most vulnerable populations: nursing homes,” Marylou Sudders, the state’s secretary of Health and Human Services, said during a press conference Tuesday.

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The changes came partnered with Gov. Charlie Baker’s state of emergency declaration, as the commonwealth logged 92 COVID-19 cases Tuesday, including the first instances of community-level spread — cases where a chain of transmission cannot be found — in Berkshire County.

In a statement Wednesday, Tara Gregorio, president of the Massachusetts Senior Care Association — which represents nearly 400 nursing, assisted living, rehabilitation, and other care facilities — said the organization supports the updated guidance.

The association is continuing to work with the Baker administration “to implement statewide protocols aimed at protecting frail elderly and nursing home staff from a potential outbreak of the COVID-19 virus that poses a life threatening danger to our elderly residents,” she said.

According to Gregorio, the protections will affect 100,000 residents and staff.

“The threat posed to our residents and staff is extremely serious and we are taking every extraordinary precaution that we can while this crisis continues to unfold,” Gregorio said. “We believe these measures will help us manage this threat by slowing or halting its spread.”

Here’s what to know:

Facilities are directed to screen visitors on arrival

“Nursing homes will be directed to actively screen and to restrict access to visitors to ensure the safety of residents and staff,” Sudders said.

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According to officials, visitors can be banned from entering a facility if they:

  • Show signs or symptoms of a respiratory illness: fever, cough, shortness of breath, or a sore throat.
  • Had contact in the last 14 days with someone who has a confirmed case of COVID-19.
  • Had contact in the last 14 days with someone who is “under active investigation for COVID-19” or had a respiratory illness, Sudders said.
  • Traveled internationally within the last 14 days.
  • Live in an area where community-based spread of coronavirus is occurring.

“We will also require nursing homes and rest homes to actively screen visitors who do not meet the above criteria for signs of illness, including employees and vendors,” Sudders said.

According to the DPH, facilities must also urge visitors to use hand sanitizer and wash their hands often and must disinfect all shared surfaces before and after they are used.

Visitors who are admitted should limit their time in each facility, should keep six feet away from patients and refrain from visiting dining rooms and cafeterias, and should not share drinks, food, and utensils, the DPH said.

“During this public health emergency, we respectfully urge the public to support these temporary visitation restrictions that are being implemented out of a critical necessity to protect our nursing home residents,” Gregorio said in the statement.

Employees must confirm they are healthy

Nursing and skilled nursing facility operators will have to confirm that their employees are not sick themselves, Sudders said.

Staff members will also have to confirm they haven’t traveled recently and that they have not been near a sick person that’s under investigation for COVID-19 in the last two weeks, she added.

“We obviously will encourage individuals to wash their hands, use hand sanitizer often and of course nursing homes and rest homes will continue to disinfect their surfaces before and after use,” Sudders said. “We will obviously make exceptions for individuals who are in end-of-life care and hospice care.”

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Sudders said state officials would also roll out guidance Wednesday “to different congregant care settings (that are) 24/7, like group homes … home health and home visiting programs regarding protective protocols.”

Gregorio said the senior care association “will continue to work with our member nursing facilities and state policymakers to support our dedicated and vital workforce to ensure that there is no interruption in pay should a nursing home employee need to self-quarantine.

“We also are working to ensure that facilities have a sufficient amount of protective supplies, and to urge hospitals to conduct necessary COVID-19 screenings before transferring a patient to a skilled nursing facility,” she added.

What the CDC is saying

The DPH has also reiterated that facilities follow guidance from the U.S. Centers for Disease Control and Prevention, including for how to manage personnel who treat confirmed or suspected COVID-19 patients, protective equipment, and other precautions.

Healthcare personnel should stay home if they’re sick and, should they develop symptoms while on the job, they should immediately put on a face mask, tell their supervisors, and leave work, the CDC says.

“When transmission in the community is identified, nursing homes and assisted living facilities may face staffing shortages,” the agency says. “Facilities should develop (or review existing) plans to mitigate staffing shortages.”

Would-be visiting family members and friends should be encouraged to find alternative methods of contacting patients, such as through video conferencing “during the next several months,” according to the CDC.

Many of the instructions for handling visitors in the face of the coronavirus from the CDC are similar to those issued by state officials.

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“Because of the ease of spread in a long-term care setting and the severity of illness that occurs in residents with COVID-19, facilities should discourage visitation and begin screening visitors even before COVID-19 is identified in their community,” the CDC says.

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