Covid-19 Information and Updates

The NH Department of Health vaccine education outreach team shared this instructional video

Covid-19 Information and Updates

Strafford County Complex COVID-19 update July 26, 2021

 

Strafford County Community Transmission Rates

The Strafford County community transmission rate of COVID-19 has started to trend back up. Across NH and the Nation there has been increasing reports of fully vaccinated individuals testing positive. Health officials are reporting that vaccinated individuals have a less severe illness; however, little information is available on how contagious the virus is in vaccinated persons. NH DHHS reports the current positivity rate for Strafford County is 2.1%.

 

Vaccinations

Vaccines are now available for all NH residents and individuals that work in NH. NH Vaccine information, and to register for a vaccine, can be found at www.vaccines.nh.gov. The CDC continues to lift restrictions for individuals fully vaccinated. Strafford County travel policies (March 2021) currently reflect some of these changes. At this time Strafford County continues to take the overabundance of caution approach; current screening and mask use policies remain in effect.

 

Please be mindful that COVID-19 continues to be a threat to the health and well-being of everyone on this complex. Regardless of vaccination status please continue to monitor yourself and report any new symptoms of, or exposure to, COVID-19.

 

Riverside Rest Home:

Mandatory testing of unvaccinated employees was conducted on 7/21/21 due to some individuals that were not available for testing that day, a few other employees were tested after. Vaccinated employees were able to voluntarily test.

96 Employee tests, all negative. (This number includes vaccinated and unvaccinated employees)

An increasing number of individuals have started reporting contact with confirmed COVID-19 cases in the community. RRH continues to take the abundance of caution approach regarding quarantines and testing of employees reporting close contact and exposure to COVID-19. At this time there are no active cases of COVID-19 amongst the residents or employees of RRH.

Masks: Vaccinated employees/visitors/vendors/volunteers = surgical/procedure mask

            Unvaccinated employees/visitors/vendors/volunteers = KN95.

 

Strafford County Department of Corrections:

The SCDOC continues to offer and administer vaccines to eligible employees and eligible housed individuals.

 

The SCDOC had 1 employee, with mild symptoms, test positive for COVID-19; this individual is fully vaccinated. This person was immediately restricted from work. The DOC has performed a combination of PCR and Rapid Antigen tests on all employees and individuals housed, no further positives have been identified.

 

The DOC will continue response testing as a part of mitigation efforts against COVID-19.

Masks: KN95’s for all employees as a heightened level of protection/source control.

 

Court House Operations and Sheriff’s Department:

Operations within the court house continue to be free from any active COVID-19 cases.

Masks: Vaccinated = not required to mask, but encouraged

            Unvaccinated = encouraged to mask however not enforced.

Masking and vaccination status in the Court House Building is an honor system of those entering.

 

The Strafford County Complex remains vigilant at decreasing the risk of exposure to COVID-19, within all operations.

 

Best Wishes and Be Safe!

 

Brianna Haskins-Belanger, RN, BSN

 

Riverside Rest Home
Policy and Procedure During COVID-19 Pandemic
Accepting Admission and Residents Who Leave the Facility
This policy is to be
instituted and maintained for the entirety of the COVID-19 Pandemic, unless
updated.

 

Updates
identified in orange.

 

DEPARTMENT:

 

POLICY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PURPOSE or INTENT:

 

 

 

 

 

 

 

 

 

 

PROCEDURE:

Responsible Person(s):

ALL

 

 

All

 

During the COVID-19 pandemic all new admissions,
readmissions and current residents who leave the facility will be
admitted/return to the facility in accordance with CDC guidance for Nursing
Homes, at minimum. The COVID-19 infection and COVID-19 vaccination status
will be taken into consideration on an individualized basis, per this policy,
to determine if quarantine is required. Quarantine may be required beyond
this policy, due to close contact with a positive person or symptom
development. Quarantine may be required at the discretion of the Director of
Resident Services in collaboration with the Infection Control Nurse and
Director of Nursing Services. In accordance with CMS/CDC/NCAL/AHCA guidance,
unless a person is tested for COVID-19 and negative before admission, the
person is presumed to be positive for COVID-19 regardless of their having or
not having symptoms.

 

·        
To accommodate for single occupancy room
during quarantine period.

·        
To limit contact with other residents and
staff.

·        
To monitor for fever and respiratory symptoms.

·        
To minimize the risk of potential widespread
exposure in the event the person(s) is positive for COVID-19.

·        
To accommodate for the community’s need for
continued admissions to Long Term Care.

·        
To provide steps to be taken to reduce the
spread of COVID-19 in the LTC facility.

 

Procedure:

 

1.      Follow
Table 1 in accordance with each individual’s situation regarding
admission/readmission/return from the hospital.

a.       Licensed
Nurse is responsible for monitoring for fever and respiratory symptoms with
appropriate documentation.

b.      All
departments/personnel are required to follow appropriate precautions.

2.      Follow Residents Leaving the Facility(page4) in accordance with each individual’s
situation regarding leaving the facility.

a.       Residents who
leave the facility must be provided education and reminded to follow all
recommended infection control practices including: source control (masks),
physical distancing, and hand hygiene.

b.      Individuals
accompanying residents (e.g., transport personnel, family members) must also
be educated about the infection control practices as noted in 2.a.

                                     
i.     
Employee such as social worker or other
identified individual, arranging for resident to leave the facility must
document the education provided. Include vaccination status of the people the
resident is visiting with, if they are willing to provide this information.

Note: RRH cannot
“force/make” a visitor disclose/provide vaccination or test information.

                                  
ii.     
Screening regarding if the resident is going to
be where someone is positive is to be asked by the person arranging the
visit.

c.      
Upon return
to the facility the resident will be screened to determine risk of exposure
to COVID-19 and screening for symptoms including documented temperature.  Documentation to reflect that the resident
and/or family/friend was asked if the resident had exposure to someone
positive for COVID-19 or suspected of COVID-19. If yes immediately notify
supervisor prior to resident return to the unit/room. [Likely the nurse on
the unit will be the person the resident is signed in with.]

 

 

 

Continued on
pages 3 and 4.

 

d.                  
 

 

 

 

 

 

 

 

Table 1: New Admissions, Readmissions, and
Return from the Hospital.

1.      Documented
temperature, oxygen saturation level, absence or presence of COVID-19 symptoms
at minimum once daily.

2.      Requires 14-day
Quarantine, admit to single occupancy room on the Hyder unit.

3.      May be admitted
directly to the appropriate unit in the main building of Riverside Rest Home.

4.      Place
in contact precautions per RRH contact precaution guidance based on new
Strategies to optimize PPE supplies.

5.      Limit
contact with other residents as much as possible.

6.      Limit
the number of different staff interacting with a resident as much as possible
and limit the number of times each staff enters a resident’s room.

7.      As
the rooms on the Hyder unit are single occupancy rooms and bathrooms, this unit may
effectively manage individuals on Quarantine and those positive for COVID-19.

8.      Place
on droplet precautions per RRH droplet precaution guidance based on new
Strategies to optimize PPE supplies. Requires isolation until discontinuation of transmission
based precautions is determined in collaboration with the Director of Resident
Services and Infection Control Nurse. Isolation for a minimum of 10 days past
the start of symptoms or positive test.

 

NOTE:
PPE requirements are subject to change due to the status of a unit, building,
or whole facility. Please be advised that MEMO’s or e-mails may indicate a
different level of precautions required, those are to be followed in lieu of
this policy when increased levels of PPE are identified.

Resident is tested
& COVID-19 negative with no or unknown prior infection and/or vaccination
status.

Resident overnight
or ≥ 24 hours out of the facility.

Resident COVID
positive, with symptoms, within the prior 90 days and has met CDC criteria to
end transmission based precautions. i.e. Recovered positive. Fully Vaccinated
resident i.e. 14 days past 2nd dose of 2 dose COVID-19 vaccines or
14days past 1st dose of 1 dose COVID-19 vaccines.

Resident tests
positive for COVID-19 or has COVID symptoms.

·        
#1 per shift

·        
#2

·        
#4 & #5

·        
#6

·        
#7

·        
Run HEPA 500 Air Scrubber continuously at half air flow.

·        
Keep Door Closed*

 

·        
#1

·        
#3

·        
Rapid test upon arrival, if not done within 48hours prior
to
admission/readmission/return.

·        
If positive move to identified COVID positive
isolation room.

·        
If negative keep on unit.

·        
Precautions as directed for facility and unit.

 

Facility Resident Returning

·        
#1 per shift

·        
#5

·        
#6

·        
#7

·        
#8

·        
Run HEPA 500 Air Scrubber continuously at maximum air flow.

·        
Keep Door Closed

New admission

·        
Do Not Admit unless to COVID positive floor. Will
be determined on a case by case situation by admissions team.

*as appropriate, with regards to the resident’s physical
safety

 

 

Residents
Leaving the Facility:

 

Medical
appointments:

·        
Regular communication between the medical facility and the
nursing home is essential to help identify residents with potential exposures
or symptoms of COVID-19 before they enter the facility so that proper
precautions can be implemented.

·        
Generally, does not require quarantine upon return unless
risk of exposure has been identified and the resident is not fully vaccinated.

·        
Masks, Hand Hygiene, and Physical Distancing should be
practiced, as able, during transportation to and from the appointment as well as
during the appointment.

 

Community
Outings with Family or Friends less than 24 hours:

·        
Masks, Hand Hygiene, and Physical Distancing should be
practiced, as able, during transportation to and from the visit/outing, as well
as during the outing.

·        
Screening of resident/family or friend, to determine if
exposure of COVID-19 occurred.

·        
RRH may consider quarantining the resident upon return
based on screening and risk of exposure determined when resident returns to the
facility.

 

Community
Outings with Family or Friends greater than 24hours (LOA):

·        
Masks, Hand Hygiene, and Physical Distancing should be
practiced, as able, during transportation to and from the visit/outing, as well
as during the outing.

·        
Screening of resident/family or friend, to determine if exposure
of COVID-19 occurred.

·        
RRH may consider quarantining the resident upon return
based on screening and risk of exposure determined when resident returns to the
facility.

·        
Residents leaving the facility greater than 24 hours will
be managed as described in Table 1.

 

Additional points to
remember:

·        
At this time Strafford County has community
transmission of COVID-19 and individuals have been positive without any known
contact or travel.

·        
Always refer to COVID-19 pandemic policies
specified for the duration of the pandemic

·        
Any questions or if unsure contact the Director
of Resident Services.

·        
Riverside Rest
Home highly encourages residents, that are not fully vaccinated, to remain in
the facility to ensure that they are in an environment that is controlled to
ensure infection control practices are adhered to.

·        
Riverside Rest
Home highly encourages All residents that choose to leave the facility to only
go with family/friends/others that are also fully vaccinated.

 

Abbreviations:

AHCA: American
Health Care Association

NCAL: National
Center for Assisted Living

CDC: Centers for
Disease Control

CMS: Center for
Medicare and Medicaid Services

LTC: Long-term
care (Riverside Rest Home for purposes of this policy)

 

 

 

 

Riverside Rest Home
Policy and Procedure
Visitations
EFFECTIVE Tuesday June 29, 202
This policy is to be instituted and maintained
for the entirety of the COVID-19 Pandemic, unless updated.
Changes identified in orange.

Click Here to Download the Visitation Attestation Form updated 06-25-21

Riverside Rest Home (RRH) will allow in-person visitation in accordance with guidance provided by the Centers for Medicare and Medicaid Services (CMS), New Hampshire Public Health Department of Health and Human Services, and in accordance with Centers for Disease Control and Prevention (CDC).

 

This policy outlines compassionate care and social visitation requirements for residents of Riverside Rest Home.

 

Visitations:

  • Compassionate care visitation is permitted at all times. The way in which compassionate care visitations occur may change dependent on facility COVID-19 status and community positivity rates.
  • RRH will permit indoor social visitation for all residents, except:

·         Unvaccinated resident cannot have indoor social visits if:

o   The COVID-19 county positivity rate is >10% and

o   <70% of residents in the facility are fully vaccinated.

§  NOTE: at the time of this policy at RRH >90% of residents are fully vaccinated. RRH will continue to offer vaccination, when available, to those residents who choose to be vaccinated and have not yet had the opportunity to do so.

o   Residents on isolation (regardless of vaccination status)

o   Residents on quarantine (regardless of vaccination status)

o   During response/outbreak testing

·         Social visitation will be suspended when response/outbreak testing is needed due to a new case of COVID-19. Visitation will only resume when approved, through coordination with the NH Department of Public Health officials.

·         Social and Compassionate care visits should be conducted using social distancing. Visitors are asked to maintain a 6-foot distance from all residents and employees.

o   During a compassionate care visits, physical contact can be allowed as long as both resident and visitor wear a well-fitting face mask and perform hand hygiene before and after contact. Regardless of resident or visitor vaccination status.

§  A resident at end-of-life (an unresponsive resident) is not required to wear a mask. At end-of-life RRH focus’ on a resident’s comfort during stages of transition. A mask can negatively impact the comfort during the transitional phases at end-of-life.

o   Fully vaccinated residents can choose to have close contact (including touch) with their visitor during social and compassionate visits as long as both the resident and visitor wear a well-fitting face mask and perform hand-hygiene before and after contact.

o   Unvaccinated residents may not have physical contact with their visitors during a social visit.

o   Visitors are asked to please limit the amount of time contact occurs during the visit. The CDC identifies prolonged contact as being within 6 feet for 15 minutes in a 24-hour period.

 

RRH may reasonably limit the length of any visit, the days on which visits will be permitted, the hours during a day when visits will be permitted, and the number of times during a day or week a resident may be visited.

  • Visits must be scheduled (means of scheduling are always subject to change).
  • The day, time, number of visits, and length of visit will be established by the employee scheduling the visit. This is to ensure that all residents are afforded the opportunity to have visitors.
  • The number of visitors in the building at one time must be limited to ensure that social distancing is achieved and to ensure the safety and well-being of all those living and employed at RRH.
  • The facility must have adequate staff present to allow for safe transit of the resident to the designated visitation location and environmental cleaning and disinfection after visitation.
    • Resident safety and care are the priority of Riverside Rest Home. Therefore, a visit may be cancelled with little to no notice should a staffing shortage arise.
    • Visits may be conducted in the resident’s room. If the resident has a roommate permission from the roommate and/or roommate’s representative must be obtained and documented.
      • If in-room visitation occurs, an unvaccinated roommate should not be present during the visits. If neither resident is able to leave the room visitation may occur with social distancing being achieved.
    • All individuals in the room during the visit are to wear a well-fitting face mask.
  • Residents and visitors may go on a walk together.
    • The resident and visitor must wear a well-fitting mask at all times during the walk.

The following criteria must be met:

 

Facility Requirements:

1.      The visit must be scheduled in advance with social worker and/or activities staff. (Hyder Unit: visit may be scheduled by the Clinical Liaison if the Social Worker is unavailable).

  1. Adequate staff trained in patient safety and infection control measures must be present to allow for safe transit of resident outdoors or to identified indoor area and environmental cleaning after visitation.
  2. Facility must have adequate personal protective equipment (PPE) to provide all parties to wear during visit and transit to and from visit. The resident, staff, and visitors must wear at minimum a surgical/procedure mask for the entirety of the visit. Riverside Rest Home will make masks available for all parties.
    1. The mask must cover the nose and mouth of all parties during the transit to and from the visit space as well as throughout the visit.
    2. PPE requirements are determined by facility issued memo’s. The requirements are subject to change often due to the community transmission rates, facility status, vaccination status, quarantine status, etc.
  3. Staff must carry alcohol-based hand sanitizer with them to the visitation, and everybody (staff, resident, visitors) must sanitize their hands before and after visitation.
  4. Facility must maintain a log with contact information for all visitors to enable accurate public health contact tracing should there be a need.

6.      Visitors must keep the mask in place for the entirety of the time within the building. Mask should cover the nose and mouth. Visitors are not permitted to eat or drink in the facility at this time, as to allow for the mask to be worn properly for source control.

a.       End of life situations when a visitor is sitting vigil with the resident:

                                                              i.      The resident does not have a roommate;

                                                            ii.      Resident is fully vaccinated;

                                                          iii.      Visitors may briefly remove the mask to eat or drink;

                                                          iv.      Visitors must have the mask in place when any staff enter the room.

7.      Therapy and Service animals are permitted.

a.       RRH asks that companion animals do not enter at this time. RRH will re-evaluate this restriction once visitations have been established and re-opening continues.

b.      All therapy and service animals must be leashed throughout the visit.

 

Resident Requirements:

  1. A resident who is suspected or confirmed to be infected with COVID-19 cannot be visited except for compassionate care situations.
    1. Visitors will be provided education and required to sign that they understand the risks associated with the visit and will honor the state quarantine requirements after close contact with someone suspected or confirmed of COVID-19.
  2. Residents who have recovered from infection (e.g. COVID-19) may be visited as long as they no longer require transmission-based precautions.
  3. The Resident must be able to comply with wearing a well-fitting face mask throughout duration of visit.
    1. The health and well-being of the resident must be taken into consideration for the visit. Example: if the resident is unable to breathe while wearing a mask this resident will not be able to participate in an in-person visit. This resident and visitor(s) will be offered a closed window/door visit (only if the resident does not have to leave their room or unit to achieve the visit) or video/phone visit. There may be other health factors that inhibit this resident from having a safe in-person visit.
  4. Fully vaccinated residents who are not on quarantine or isolation may have a visitor assist them with eating their meal (ensure all other policies regarding assisting a resident to eat are followed).
    1. Individual assisting the resident to eat must:

                                                              i.      Wear a well-fitting face mask covering the nose and mouth;

                                                            ii.      Perform hand hygiene before and after assisting with the meal;

                                                          iii.      Must maintain social distancing (6ft) from other residents and staff. 

    1. At this time unvaccinated residents that require assistance with meals may not be assisted by visitors.
  1. Residents must perform hand hygiene with an alcohol-based hand sanitizer immediately before and after visitation.

Visitor Requirements:

  1. All visitors must be screened for symptoms or risk factors for exposure prior to the visit, including a temperature check.  Visitor Attestation Form must be completed.
    1. If either the resident and/or visitor(s) has symptoms of COVID-19, the visitation must not occur. If the visitor reports risk factors for COVID-19 exposure in the prior 14 days, including travel then the visitation must not occur.
  2. Visitors must adhere to standard infection control measures:
    1. Must wear a well-fitting mask at all times during the visit, indoor and outdoor visits.

                                                              i.      RRH may restrict visitors that do not comply with mask wearing.

                                                            ii.      RRH may restrict visits to residents who are not able to comply with mask wearing.

1.      These residents will be offered a window/door visit.

    1. Must use an alcohol-based hand sanitizer upon entry to the building, before and after contact with the resident, their belongings, or any other items within the building.
    2. Maintain social distancing (6-feet or greater) from all residents and employees. With the exception of situations outlined above.

                                                              i.      If 6 feet of separation is unable to be maintained, a window or door visit will be offered.

    1. Visitors must not wander throughout the facility or areas outside of the designated visitation areas, or direct route to the resident room/visitation area.

3.      Visitors must keep the mask in place for the entirety of the time within the building. Mask should cover the nose and mouth. Visitors are not permitted to eat or drink in the facility at this time as to allow for the mask to be worn properly for source control.

a.       End of life situations when a visitor is sitting vigil with the resident:

                                                              i.      The resident does not have a roommate

                                                            ii.      Resident is fully vaccinated

                                                          iii.      Visitors may briefly remove the mask to eat or drink.

                                                          iv.      Visitors must have the mask in place when any staff enter the room.

  1. Visitors may be limited to no more than two individuals per visitation dependent on the size of the visitation space, to ensure social distancing can be achieved.
    1. Outdoor visitation may have an increased number of visitors as space permits. RRH requests that outdoor visitations, gatherings, and/or celebrations remain small (ideally 10 individuals total or less).

                                                              i.      Social distancing, source control (masks), and hygiene must still be followed.

    1. Special considerations may be made to accommodate for an increased number of visitors for in-room visitation, if the resident is in a room without a roommate. In room gatherings of visitors with the resident should be limited to end of life visitations.
    2. General compassionate and social visits may have special considerations to increase the number of visitors at a time; such as 2 visitors bringing an elderly visitor who can not visit without their assistance, or individuals bringing someone who is unable to drive.
  1. Visitors are only to visit with the Resident that the visit was scheduled with.
  2. RRH requests that during this time, visitors are an age and/or with demeanor where the individual is able to wear a well-fitting face mask for the entire duration of the visit and does not “run/roam” around the building, unit, or rooms.
    1. Regardless of age the visitor must be able to wear a well-fitting face mask for the entirety of the visit.
  3. Visitors are encouraged to disclose their vaccination status.
    1. Although encouraged, this is not a requirement for visitation.
    2. Vaccination status will be recorded along with screening questions.
  4. Visitors are encouraged to participate in testing.
    1. A visitor will be asked about their last test date and result.
    2. If the visitor has not had a test for the SARS-CoV-2 in the 5 days leading up to a visit, the visitor will be offered and encouraged to have a Rapid Antigen test for COVID-19 performed at the facility.

                                                              i.      If the visitor chooses to have a test at the facility, they will sign a testing consent form and results will be kept on file with their screening questions.

                                                            ii.      A visitor may request a copy of their results; the copy of results will be available 2 business days after the visit.

 

    1. Although encouraged, this is not a requirement for visitation.
    2. A positive test result in the 14 days leading up to visitation, the individual will not be permitted entry to the building and the visit will not occur, regardless of indoor or outdoor visitation.