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AFL 20-33 From the California Department of Public Health
April 1, 2020
TO: Skilled Nursing Facilities
SUBJECT: Interim Guidance for Transfer of Residents with Suspected or Confirmed Coronavirus Disease (COVID-19)
All Facilities Letter (AFL) Summary
This AFL clarifies California Department of Public Health (CDPH) expectations and provides interim guidance for skilled nursing facilities (SNF) for transfer and continuity of care of residents with suspected or confirmed COVID-19 infection, including admission of COVID-19 positive residents following hospitalization who still require transmission-based precautions.
California is experiencing increasing numbers of COVID-19 cases and hospitalizations, and there is an urgent need to ensure hospital capacity to be able to meet the demand for patients with COVID-19 requiring acute care. Patients hospitalized with COVID-19 can be discharged to a SNF when clinically indicated. Meeting criteria for discontinuation of transmission-based precautions is not a prerequisite for discharge from the hospital.
All California SNFs should be implementing the guidance outlined in AFL 20-25.1 Preparing for Coronavirus Disease 2019 (COVID-19) in California Skilled Nursing Facilities, including preparations to be able to safely:
- Receive residents with suspected or confirmed COVID-19 infection;
- Care for residents with suspected or confirmed COVID-19 infection;
- and Prevent spread of COVID-19 within their facility.
Considerations for Transfer of Patients from Hospitals to SNFs
SNFs should prepare to receive patients that are clinically stable for discharge from hospitals in the following scenarios:
- Patients with no clinical concern for COVID-19 may be transferred from hospitals to SNFs following usual procedures.
- SNFs may not require a negative test result for COVID-19 as criteria for admission or readmission of residents hospitalized with no clinical concern for COVID-19.
- Hospitals are NOT required to perform COVID-19 testing on patients solely for discharge considerations unless they develop new respiratory infection symptoms, in which case the patient is not likely to be ready for discharge.
- Patients investigated for possible COVID-19, with negative test results may be transferred from hospitals to SNFs following usual procedures.
- Hospitals should conduct influenza testing as appropriate, and communicate results and any indication for continued transmission-based precautions upon transfer.
- Patients with confirmed or suspected COVID-19 should not be sent to a SNF via hospital discharge, inter-facility transfer, or readmission after hospitalization without first consulting the local health department (LHD).
- SNFs can be expected to accept a resident diagnosed with COVID-19 and who is still requiring transmission-based precautions for COVID-19 as long as the facility can follow Centers for Disease Control and Prevention (CDC) infection prevention and control recommendations for the care of COVID-19 patients, including adequate supplies of personal protective equipment (PPE).
- LHD may direct placement of the patient at a facility that has already cared for COVID-19 cases, or that has a specific unit designated to care for COVID-19 residents.
- Hospital discharge planners should provide advanced notice to the SNF for any transfer of a patient with COVID-19. If transmission-based precautions have been discontinued* AND patients’ symptoms have resolved, patients can be discharged back to the facility they came from, regardless of the facility’s PPE supply and ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients.
- SNFs can be expected to accept a resident diagnosed with COVID-19 and who is still requiring transmission-based precautions for COVID-19 as long as the facility can follow Centers for Disease Control and Prevention (CDC) infection prevention and control recommendations for the care of COVID-19 patients, including adequate supplies of personal protective equipment (PPE).
- Patients under investigation (PUI) for COVID-19, but test results pending: At this time, PUIs should NOT be transferred to SNFs until test results are available.
Considerations for care of residents with suspected or confirmed COVID-19 infection who do not clinically require hospital transfer
SNFs should only transfer residents with suspected or confirmed COVID-19 infection to higher acuity healthcare settings when clinically indicated. Prior to transfer, SNFs must notify transport personnel and receiving facility about the suspected diagnosis. If clinically stable, residents with suspected or confirmed COVID-19 should remain at the SNF with appropriate infection prevention and control measures. SNFs should review CDPH guidance on facility preparations, and management of suspect or confirmed COVID-19 resident care outlined in AFL 20-25.1.
*Transmission-based precautions for COVID-19 should be used for at least 7 days from symptom onset AND 3 days of recovery, defined as being afebrile without fever-reducing medication and improvement in respiratory symptoms (e.g., cough, shortness of breath). Lingering cough after 72 hours would not be an indication for continuation of transmission-based precautions. Consideration should be given to extending transmission-based precautions for individuals with immunocompromising conditions.
Sincerely,
Original signed by Heidi W Steinecker
Heidi W. Steinecker
Deputy Director