Georgia Department of Public Health Issues Additional Update on Reopening Guidance for Long-Term Care Facilities

On May 17, 2021, the Georgia Department of Public Health (DPH) issued an updated Administrative Order regarding reopening guidance for long-term care facilities. Commissioner Toomey previously issued an Order of reopening guidance on April 7, 2021, loosening some restrictions in light of COVID-19 vaccine distribution. The latest guidance further loosens restrictions, especially for vaccinated individuals.¹  The guidance also requires providers to create vaccination plans and update their respiratory protection programs. AGG’s overview of the April guidance can be found here.

The following is a summary of the resident and staff-related guidance, which is divided into Phase I and Phase II depending on virus levels, community spread, and vaccination rates:

• DPH previously announced that facilities should maintain a record of resident and staff COVID-19 vaccinations and post-COVID status, but the latest guidance adds that records of treatment administration impacting vaccine administration, such as monoclonal antibodies, should also be maintained.

• In the event of an outbreak within the facility, vaccinated staff who are asymptomatic do not need to be tested.

• All facility staff and essential healthcare personnel who may interact with residents or enter resident rooms should wear a respirator (preferred) or a surgical facemask. This departs from previous guidance allowing staff to wear well-fitting cloth masks.

• Vaccinated staff may be able to remove face coverings and relax social distancing for nonresident interactions, such as dining and socializing in break rooms and in-person meetings. However, if not all staff group members are vaccinated, face-covering restrictions and social distancing should be followed at all times.

• For new admissions and re-admissions, if the resident is not vaccinated, he or she should be placed in observation separate from the COVID-19 unit. The new guidance adds that this unit should be outside of any traffic pattern for non-quarantined residents.

• Under Phase II, gym equipment is to be cleaned and disinfected after each use. The gym is to be cleaned and disinfected at least daily.

Vaccination Plan and Respiratory Protection Program

• Facilities are required to create a written vaccination plan. The plan should outline key strategies to ensure all eligible residents, families, and staff are educated, encouraged, and supported to become vaccinated and maintain their vaccination status. The vaccination plan should include procedures to collect, protect, and communicate vaccination data for all residents, staff, and visitors so that appropriate protocols can be followed for vaccinated and unvaccinated individuals. Education to promote vaccination should address individual’s concerns through science-based findings and the benefits of vaccination. Due to limited data on vaccine efficacy in immunocompromised residents, CDC recommends these immunocompromised vaccinated residents follow conservative quarantine and testing guidelines for unvaccinated individuals.

• Facilities’ respiratory protection programs may need to be updated to clarify preference for N-95 respirators for healthcare workers who need protection from both airborne and fluid hazards. Facilities need to move toward “conventional use of NIOSH-approved N-95 respirators,” which includes:
  • Fit test all staff members who require respirator use per OSHA standards.
  • Order NIOSH-approved N-95 masks in various sizes readily available from suppliers. To resupply respirators, order N-95 masks for which staff have been fitted.
  • Although all facilities should be working toward conventional PPE use, those facilities working under contingency or crisis PPE capacity strategies may need to prioritize the use of NIOSH-approved N-95 respirator masks. Staff working in COVID-19 or Observation Units should wear full COVID-19 PPE.
  • Fully document program to move to using NIOSH-approved N-95 respirators and timeline for completion.

Visitation and Residents-Related Guidance

• The guidance updates the screening protocol, adding that facilities should request the vaccination status during each visitor’s initial visit. Any visitor that does not provide a response should be treated as unvaccinated. Facilities will need to include a process to protect and to communicate this information.

• Guidance now allows those residents who can tolerate mask-wearing to go maskless when alone or when alone in a resident’s private room or designated visitation room with vaccinated visitors. If the visitor is not vaccinated, the vaccinated resident may engage in limited close contact with an unvaccinated visitor while wearing facial covering, conducting social distancing, and performing frequent, appropriate hand hygiene before and after physical contact.

• Vaccinated residents may participate in group activities without facial coverings or social distancing. If any residents in the activity are not vaccinated or have unknown status, the facility should follow procedures for unvaccinated residents. Unvaccinated residents may engage in small group activities with no more than 10 people with social distancing, hand hygiene, and use of a surgical mask or well-fitted cloth mask. Social distancing should be maintained, and activities that encourage multiple residents to handle the same object(s) should be restricted.

• Visitors should wear masks regardless of vaccination status when in any area of the facility, other than when visiting alone with the resident in their room, as noted above.

• Regardless of the phase the facility is under, it is no longer a recommendation that non-medically necessary trips should be avoided and that telemedicine should be used whenever possible. It is no longer the recommendation that residents should not leave the facility. These outside trips should still be limited, along with previous guidance.

DPH has assembled a team of infection preventionists to support long-term care facilities in reopening, reviewing policies, and providing safe visitation practices. These individuals are assigned by district and available to answer a question regarding infection control in reopening. Contact information is available in a letter from DPH, available here.

For additional information, please contact Hedy S. Rubinger, Jessica T. Grozine, or Laura S. Dona.

[1] The DPH no longer uses “fully vaccinated” but only “vaccinated.” A vaccinated individual is someone who has received either a single dose of a one-dose vaccine, plus two weeks following; or both doses of a 2-dose series, plus two weeks following.