Long Term Care and Group Living Settings

A COVID-19 exposure includes when:

• A staff member or visitor was in the facility while infectious with COVID-19 (two days before symptoms onset or from when they tested positive).
• A resident tests positive for COVID-19.
• Clusters of residents or staff have COVID- or flu-like symptoms. 

Report COVID-19 Cases and Tests 

Nursing and health care facilities are required to complete both of the following:

• Report all COVID-19 cases in your facility to the Health Department. This includes residents and staff who may have been in the facility while infected with COVID-19. This fulfills the statutory requirement to report any COVID-19 outbreaks. For more information, see 5.1 and 5.4 of the Reportable and Communicable Disease Rule.
  • Preferred way to report: All new COVID-19 situations can be reported online using the Vermont Department of Health Outbreak Report Form. A member of our team will follow up with you after submission. Do not use this link to update ongoing situations that have already been reported.
  • Call the Infectious Disease Epidemiology team at 802-863-7240 (option 2) or
  • Email AHS.VDHEpiCOVID19Program@Vermont.gov (monitored during business hours)
• Report any COVID-19 test results from CMS-certified long-term care facilities to the CDC’s National Healthcare Safety Network (NHSN). If your facility has another electronic lab reporting arrangement with the Health Department, that can also be used to submit results. This fulfills the requirement to report any COVID-19 laboratory results. This reporting does not automatically trigger a response from the Health Department, so it is still necessary to notify the Health Department of outbreaks. For more information, see section 6 of the Reportable and Communicable Disease Rule.

See more on Infectious Disease Reporting and Data

Managing Infections and People with Symptoms 

Isolation

• Positive and symptomatic staff should be excluded from work.
• Positive and symptomatic residents should be separated from people who aren’t known to be infected with COVID-19 to the extent that is safe and feasible. Residents who are infected with COVID-19 can generally be grouped together during their respective isolation periods, barring other health or safety concerns.
• Negative and asymptomatic residents can continue group activities and communal dining. However, there may be occasions where the Health Department recommends pausing communal activities on a larger scale when there is uncontrolled transmission.
• Facilities are recommended to defer non-urgent visitation when visitors have confirmed or suspected COVID-19, had a known exposure, or are symptomatic. 

Mask Wearing

• Positive and symptomatic individuals should wear a mask when around individuals who are not known to be infected. Universal masking is recommended in the unit or area of the facility experiencing a COVID-19 or other outbreak until 14 days have passed with no new cases.
• If visitors do come to the facility, they should be encouraged to wear a mask while visiting a resident who has tested positive for COVID or a unit or facility experiencing transmission.
• Face masks may be worn as a personal preference and should be worn by health care providers or personnel at the request of a patient or resident.

Monitoring and Treatment

• Plan to monitor the condition of the positive residents at least 3 times per day.
• Check other staff and residents for symptoms and have a low threshold for work exclusion and symptomatic testing.
• Consider therapeutic medication for all residents and any staff with health risks, in consultation with their providers.

Testing Recommendations

Admission or Discharge

• A COVID-19 infection should not prevent admission or discharge, but receiving or discharging facilities should report infections to the sending or receiving facility.
• Test residents on admission if they have symptoms or are suspected to recently have had high-risk contact with someone with COVID-19.
• Facilities may choose to test asymptomatic residents at their own discretion or based on Vermont’s Hospitalization Level or other public health guidance.

COVID-19 Exposure 

• For staff or residents with symptoms, consider administering point-of-care antigen tests immediately. If negative, test again after 48 hours, and again after a subsequent 48 hours.
• Test staff and residents who had close contact with the person who tested positive for COVID-19. If close contacts cannot be identified, test all staff and residents in the group or unit of the person who tested positive for COVID-19. Close contacts without symptoms should be tested on days 1, 3 and 5 post-exposure. "Day 0” is the most recent exposure date.
• Continue to notify the Health Department of new cases and suspected outbreaks, and report any COVID-19 test lab results. See Reporting COVID-19 Cases and Tests

Other Considerations to Prevent or Control Outbreaks

• Implement transmission-based precautions per CDC guidance.
• Follow licensing requirements about notifying family and potential visitors about infection(s)/suspected outbreaks in facility.
• Admissions and discharges should continue as planned. If discharging during a period of recent facility infection or outbreaks, please inform all receiving parties (facilities, families, etc.) of the potential exposure to the discharged person.
• Consider recommending masks for residents when they are:
  • Leaving the facility and Hospitalization Level is high or at other times recommended by the Health Department.
  • At higher risk, or for those who spend time in higher-risk units, during periods of medium Hospitalization Level or when other respiratory viruses are known to be circulating.
• Do not float staff between units to help prevent and control outbreaks.
• Provide training in infection control and hand hygiene for staff.
• Offer the COVID-19 vaccine to unvaccinated or under-vaccinated staff, residents, and new admissions on a regular basis.

Vaccines

The Health Department strongly encourages facilities to ensure that residents and staff are up to date with COVID-19 and other infectious disease vaccines. 

Facilities should have an established relationship with a pharmacy, though not all pharmacies can provide COVID-19 vaccine at this time. Facilities should confirm this capability with their existing partners. If your pharmacy has already been providing the COVID-19 vaccine, discuss their plan for booster doses. If your residents are mobile and can be transported, residents can also make an appointment to be vaccinated at local pharmacies or their primary care clinic.