MDH Publishes Guidance, Eases Restrictions in Congregate Care Settings

Posted on March 17, 2021 by Kari Everson

State and federal regulators provided updated guidance that allows for more visitors to enter our building with fewer restrictions and allows for vaccinated residents to leave our settings without the requirement of a 14-day quarantine in some instances. Just this morning, MDH posted updated Long-term Care Guidance for Non-medically Necessary Outings, Long-term Care Visitation Guidance for Nursing Facilities and Assisted Living–type Settings, and two flowcharts to inform congregate care settings of the guidance updates linked later in this story. In these guidance documents, MDH adopted the QSO 20-39-NH revised memo for assisted living communities; and, adopted the CMS recommendations for health care settings.

The definition for “fully vaccinated” is an important part of these guidance documents. For review, a fully vaccinated individual is two weeks past their second dose of Moderna or Pfizer vaccine; or, two weeks after their single dose of a one-dose vaccine such as the Johnson & Johnson Janssen Ad-Vac.

Non-Medically Necessary Outings & Quarantine
Quarantine recommendations for vaccinated residents changed significantly. If a vaccinated resident chooses to leave the building, they do not need to quarantine for 14 days when they return unless they spend 15 minutes or more in 24 hours within 6 feet of someone who has COVID-19. To know someone has COVID-19, they should have a positive COVID test.

MDH reminds us residents should continue to use infection prevention and control measures such as masking, follow social distancing, and good hand hygiene; and, organizations should continue to screen residents per our usual and customary screening processes developed during the pandemic. There is language in the guidance stating residents who are fully vaccinated may choose to have close physical contact with visitors. Group activities outside of the building are specifically discussed and it is recommended residents attend these group outings in an area where the 14-day county percent positivity rate is below 5%.

Unvaccinated residents should continue to follow the same guidance that has been in place. This includes an exception to quarantine for residents who have had COVID-19 in the past 90-days and meet certain criteria. This recommendation remains largely unchanged.

Facility In-Door Visitation
Indoor visitation should be allowed in all congregate care settings with three exceptions.

The biggest change to these exceptions is regarding county positivity rate. Previously, visitation relied on county positivity rate outbreak status within the organization for all residents. The updated guidance now states indoor visitation should be limited for unvaccinated residents if the county positivity rate is greater than 10% AND the resident vaccination rate in the organization is less than 70%. Visitation does not need to be limited for vaccinated residents in this circumstance.

The two other exceptions have been in place throughout the pandemic. Continue to limit indoor visitation for both vaccinated and unvaccinated residents if they are in transmission-based precautions for a positive COVID-19 test or COVID-19 symptoms and continue to limit visitation for both vaccinated and unvaccinated residents if they are in quarantine. A flowsheet for assistance with decision-making is available in the Long-term Care Visitation Guidance Flowchart for Exceptions to Indoor Visitation.

Visitation limitations for outbreak testing are also different. It is important to note that a facility on-set case is slightly changed if you admit or re-admit a resident who is fully vaccinated and do not require 14-day quarantine upon admission. If, during this time where they are not quarantined, the resident develops COVID-19 during the first 14 days after admission, this will be considered a new facility onset case. If the resident is quarantined during this 14-day time frame it will not be considered a new facility onset case.

If there is a new facility onset case of COVID-19, visitation should be immediately suspended, and outbreak testing should begin. Once one round of facility-wide testing is complete the action depends upon the outcome of that round of testing. Visitation can begin again:

• If there are no additional COVID-19 infections in other areas of the facility. Visitation may start again for residents in areas / units with no COVID-19 cases. If there more COVID-19 cases in the same area / unit as the initial new case, visitation may start again for residents in areas / units with no COVID-19 cases.
• If there are additional COVID-19 cases identified in other areas / units within the building, visitation should be suspended for the entire building, regardless of vaccination status until outbreak testing is complete.

The flowsheet in the Long-term Care Visitation Guidance Flowchart for Outbreak Status shows a decision tree for this and it does include a new-onset case for a staff member.

MDH states the guidance documents are silent on visitation during outbreaks if there is a positive case identified in a staff member. The department is continuing to try and obtain guidance from CDC on this topic and will update us when they receive this information.

This is positive information for our organizations and our residents. A few things to consider:

• The implementation date on this guidance is “immediately.” You should act quickly to review your policies, procedures, and processes and incorporate this guidance; but, you have a couple of days to go through and purposefully plan how to do this in a meaningful way.
• Many members have asked for assistance with messaging for residents, families, and staff. LeadingAge Minnesota has templates available to assist you with this.
  • Sample Staff Letter
  • Sample Resident and Family Letter
  • Sample Statement and Talking Points
  • Sample FAQs
• It is important to continue to follow infection prevention and control practices during this time of expanded visitation and quarantine guidance. The pandemic is not over, and we need to continue to adhere to good practices to mitigate transmission and spread within our communities.

This is a large amount of information and if you have any questions, please don’t hesitate to contact us!