CDC Guidance for Routine Off-Site Appointments

Division of Community and Public Health (DCPH) recently reached out to the CDC for guidance regarding long-term care facility (LTCF) residents attending routine off-site appointments and received the following response:

CDC does not recommend LTCF residents who go off-site for routine appointments (such as hemodialysis or other routine appointments or treatments) be kept in observation, in part because the observation period could be permanent for residents who have to leave more than once every two weeks. Additionally, LTCF residents who leave and return for appointments should not be considered new admissions or be housed in a COVID-19 care unit in the LTCF when they return. Placing LTCF residents who return in the observation or COVID area within the facility could put them at higher risk of exposure to COVID-19. While not a CDC recommendation, some LTCFs have opted to manage residents who go off-site for routine appointments as potentially exposed and use full Transmission-Based Precautions and/or have cohorted these residents together into the same area of the building. In these examples, it is very important to ensure these residents, who may be at increased risk of acquiring COVID-19, are NOT being placed into a dedicated COVID-19 unit or with others who are symptomatic/have increased risk of having COVID-19. Doing so would increase the risk of exposing these residents who go off-site to others at even higher risk of COVID. We have also heard about significant challenges with moving residents repeatedly and recognize that determining exposures can be challenging. Additional recommendations: Residents going off-site for dialysis or other appointments should wear a cloth face covering (or facemask) for source control when they leave the LTCF and ideally in the LTCF if they are leaving their room. Regular communication between the dialysis facilities/medical offices where appointments occur and the LTCFs (in both directions) is essential to help identify patients with fever or symptoms consistent with COVID-19 before they enter the facilities and facilitate resident care. Social distancing measures should be implemented, such as minimizing movement of these residents within the facility as much as possible. LTCFs should comply with the infection prevention and control guidance for nursing homes and LTCFs.