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Nursing Homes and COVID-19

Health & Benefits

Roughly 93,000 Texans live in licensed nursing homes throughout the state. On March 13, 2020, Governor Abbott declared a state of disaster for all Texas counties due to the COVID-19 pandemic and directed state agencies to restrict visitation at nursing homes to protect those most vulnerable to COVID-19. As Texans continue to navigate the pandemic, this article explains updates to nursing home and infection prevention guidelines.

Texas’s Department of Health and Human Services has updated COVID-19 response protocols in nursing homes. These updates expand visitation guidelines while preserving proper safeguards to protect vulnerable populations from the spread of COVID-19. Please review the Health and Human Service’s COVID-19 Response for Nursing Facilities guidelines, most recently updated in November of 2022.

What are nursing facilities supposed to do when they believe someone has been exposed or infected?

Long-term care facilities in Texas are required to maintain strong infection prevention and control programs to prevent the spread of communicable diseases. If a facility believes a resident, visitor, or employee might have been exposed or infected with COVID-19, it is required to immediately report it to their local health department or to HHSC. Nursing homes need to call ahead to the hospital if they are transferring a resident with respiratory symptoms. They should work closely with local hospitals and health authorities to share all information needed to protect residents, health care workers, and hospital patients.

Can residents receive visitors and visit on nursing home property?

Yes. As of the 2021, updates to nursing facility visitation guidelines allow for flexibility in visitation. While continuing to follow COVID-19 protocols, including the wearing of face masks, Texas nursing facilities can now permit:

  • Close/personal contact during any visitation for fully vaccinated residents.
  • Outdoor visitation at all facilities, even when the facility has an outbreak (although not recommended). 
  • Up to two essential caregivers at the same time to visit a resident with any COVID-19 status.
  • All visitation without time limits, while adhering to infection prevention and control measures.
  • End-of-life visits for all residents regardless of their COVID-19 status in all nursing facilities. End-of-life visits are defined as residents receiving hospice services, residents at or near the end of life, with or without hospice services, and residents whose prognosis does not indicate recovery.

Nursing homes no longer need to:

  • Request general visitation approval from Health and Human Services.
  • Monitor visits or escort visitors to and from the visitation area.
  • Limit indoor visitation to areas with a plexiglass barrier or booth.
  • Require documentation of a negative COVID-19 test result for essential caregiver or salon services visitors.

See the HHS updated Visitation Guidelines for more information.

What protocols are facilities required to following during this pandemic?

Texas HHS is also requiring facilities to post signs at the entrance about access restrictions; check for fever of visitors, staff, and residents; continue to monitor and isolate residents with fever or acute respiratory symptoms; provide infection control training to staff; execute frequent handwashing; and provide personal protective equipment to residents or staff as needed.

If a nursing home resident tests positive for COVID-19, how are staff quarantined?

Providers will have to determine what kind exposure (risk) their staff had with a resident who tests positive. If it is determined exposure occurred, the facility should follow these CDC guidelines:

  • Staff who face high-risk exposure (prolonged close contact with a patient, visitor, or HCP with confirmed SARS-CoV-2 infection without respirator, eye protection, or other PPE protection) should take three viral tests, separated by 48 hours. If staff develops symptoms consistent with COVID-19, they should immediately self-isolate and arrange for reporting as well as testing.
  • Asymptomatic staff who are not moderately or severely immunocompromised can return to work after 7 days have passed since the date of their first positive viral test if a negative test is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7).
  • Staff with mild to moderate illness who are not moderately or severely immunocompromised can return to work after 7 days if a negative viral test is obtained within 48 hours prior to returning from work; and 24 hours have passed since last fever; and where symptoms have improved. 
  • Staff with severe to critical illness who are not moderately or severely immunocompromised can return to work after at least 10 days and up to 20 days since symptoms first appeared; and 24 hours have passed since last fever without the use of fever-reducing medicines; and symptoms have improved. 
  • Staff who are symptomatic and moderately or severely immunocompromised may return to work after fever resolves, symptoms improve, and results are negative from at least two consecutive respiratory specimens collected 48 hours apart.  
  • Staff who are not symptomatic and who are moderately or severely immunocompromised may return to work after results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

For more information, visit the CDC's Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2.

The CDC has also posted recommendation on Infection Prevention and Control in the event that staff are exposed to or have a confirmed case of COVID-19.

What are transmission-based precautions (TBP)?

Transmission-based precautions are precautions recommended by the CDC for individuals who have had close contact with someone with a confirmed case of SARS-CoV-2 infection. These precautions can include quarantine, isolation, or regular testing, among other preventative measures. 

Patients under transmission-based precaution should not be placed with patients with confirmed SARS-CoV-2 infection unless the individual under transmission-based precaution is confirmed to have the infection through tested.  

Learn more about transmission-based precaution and Infection Control Recommendations from the CDC.  

Should nursing home residents be confined to their rooms?

If a resident is under transmission-based precautions (i.e. isolation or quarantine), the individual should be confined to his or her room. The Center for Medicare and Medicaid Services has also directed the following: 

  • Residents under transmission-based precautions should not participate in communal activities until the proper criteria to discontinue transmission-based precaution is met.
  • While not recommended, residents under transmission-based precautions can still receive visitors. Visits should occur in the resident’s room and should wear a facemask. Visitors should be made aware of the risk of visiting, and precautions necessary to visit the resident. 
  • Implement active, daily screening of residents and staff for fever and respiratory symptoms;
  • Remind residents to practice social distancing and perform frequent hand hygiene.

For more information on visitation, The Center for Medicare and Medicaid has created and revised its Nursing Home Visitation guidelines.

Additional Information

Long-Term care (LTC) ombudsmen are advocates for resident rights. They help protect the quality of life and quality of care of anybody who lives in a nursing home or an assisted living facility. Ombudsmen can be volunteers or paid employees of agencies that are independent of any long-Term care facility. Services are free, confidential and available statewide. More information can be found at the Health and Human Services Office of the Long-Term Care Ombudsman. Call 1-800-252-2412 to speak with an LTC Ombudsman in your area.

The National Center on Law & Elder Rights (NCLER) has created this FAQ for guardians.

Disability Rights Texas has published this Nursing Homes and COVID-19 resource to help you navigate all the changes that impact nursing facility residents and their care and treatment during the outbreak.

Reliable sources of information include:

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