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COVID-19 Response Summary for Long-term Care Facilities

Template: COVID-19 Response Summary for Long-term Care Facilities

Use This Sample to develop a Summary for Your Facility

Long-term care facilities have put a tremendous amount of effort into keeping our most vulnerable Minnesotans safe from the virus that causes COVID-19. Use this template document to communicate with resident families about COVID-19 cases that have impacted residents and staff in your facility and the actions that your team has taken to prepare for and respond to COVID-19.

The content contained in this template is just an example; edit the document any way that you see fit. Remove concepts that are not relevant for your setting, or add information not yet included. Consider adding a photo of your care team or of residents utilizing resources (e.g., video call devices, outdoor visit areas) put into place to support residents and families during this challenging time.

[Facility Name] COVID-19 Response Summary

Facility Information

Facility COVID-19 contact name and phone: [COVID-19 leader’s name]     [Phone number]

Number of resident beds in the facility: __________

Number of facility staff: __________

COVID-19 Case Summary

Cases in Residents
Date first resident case detected:
Total number of resident cases:
Number of resident cases in the last 14 days:

  • ☐ Accepting residents with known COVID-19 (i.e., already in isolation)

Cases in Staff
Date first staff case detected:
Total number of staff cases:
Number of staff cases in the last 14 days:

Action Taken by [Facility Name]

Preparation

Action Date(s) Implemented Comments
Dedicate time and resources to infection prevention and control. Establish facility policies and procedures for COVID-19.

Develop plans for a surge in numbers of COVID-19-positive residents.

   
Develop plans for surge in numbers of staff absences due to COVID-19 exposures and illness.    
Provide staff educational sessions on topics of: (example: transmission of COVID, hand hygiene, PPE use, etc.)    
Educate residents and families on measures to prevent and reduce transmission of COVID-19.    
Attend statewide (MDH) and national (CDC) calls.    
Stay informed of updated guidance and resources from CDC, MDH, and professional organizations.    
Collaborate with Regional Health Care Coalition, Local Public Health, and Provider Organizations.    
Develop internal and external communication process.    
Activate Incident Command when necessary.    
Monitor community and county prevalence of COVID-19 cases.    

Early Identification of Cases

Action Date(s) Implemented Comments
Monitor all staff for signs/symptoms of COVID prior to shift. Exclude ill staff from working.    
Monitor all residents for signs/symptoms of COVID-19  ___ times per day.    
Monitor all visitors (if permitted) up entry to the facility.    

Testing

Action Date(s) Implemented Comments
Develop a written testing plan.    
Establish a relationship with a laboratory for routine and outbreak testing.    
Test residents with a condition change or who develop signs of symptoms consistent with COVID-19.    
Test symptomatic staff and exclude from work while awaiting test results and until illness resolves.    
Test all staff members routinely in accordance with federal requirements. [remove information about federal requirements if not federally certified nursing facility]

☐ Twice weekly testing: [date range]

☐ Weekly testing: [date range]

   
Test all residents and staff every 3–7 days when a case is detected in any resident or staff member and until 14 days have passed without identifying a new case.    
Recommend testing of essential caregivers. [As applicable]    
Recommend testing of visitors. [As applicable]    

 Personal Protective Equipment (PPE) and Isolation

Action Date(s) Implemented Comments
Obtain adequate PPE supply as able.    
Optimize use of PPE per CDC guidance.    
Monitoring PPE supply on frequent basis. Communicate with Regional Healthcare Coalition and MDH if need assistance with obtaining urgent supply.    
Ensure staff are trained on proper use of PPE.    
Provide cloth masks to residents and educate on use.    
Promptly exclude ill health care workers and quarantine exposed health care workers.    
Quarantine of new/readmissions and residents exposed to a COVID positive persons (e.g., health care worker, essential caregivers).    
Immediately place residents with signs and symptoms and/or positive test in transmission-based precautions.    
Have dedicated area to care for (a) COVID-positive residents (b) residents exposed or potentially exposed to COVID and (c) residents who have recovered or have no suspicion of COVID.    

Inform

Action Date(s) Implemented Comments
Inform residents, families, and staff of visitor restrictions.    
Inform residents, families, and staff of cases in the facilities.    
Communicate and consult with MDH and local public health regarding outbreak.    

Response

[Consider including information in this section from your COVID-19 Action Plan]

Action Date(s) Implemented Comments
Audit of infection prevention and control practices (e.g., adherence to hand hygiene, PPE use, environmental cleaning).    
Increase environmental cleaning and disinfection of common areas and units.    
Ensure social distancing of residents, including during communal dining and hand hygiene performed.    
Implement visitor restrictions.    
Implement measures to address staffing shortages.

 

   

Additional Actions Taken

[Here is a place to document anything else you have done to support residents, staff, and families during the pandemic. This could be anything from COVID pay for staff, providing options for virtual visits between residents and families, enrichment for residents experiencing social isolation, any communications provided to families to apprise them of the COVID-19 situation.]

 

Minnesota Department of Health
Healthcare-Associated Infections & Antimicrobial Resistance Section
PO Box 64975
St. Paul, MN 55164-0975
651-201-5414
health.stewardship@state.mn.us
www.health.state.mn.us

12/17/2020

To obtain this information in a different format, call: 651-201-5414.

Residents admitted with known COVID-19 status are in isolation precautions upon admission, meaning there is minimal risk of transmission to staff and other residents.