COVID-19: Patient Transfer from Hospital to Long-Term Care Facilities
IDPH Guidance on Patient Transfer to LTC Facilities
The Illinois Department of Public Health recognizes that it is necessary to provide guidance to skilled and intermediate long-term care facilities regarding the transfer of patients from a hospital setting to a skilled or intermediate long-term care facility (“skilled long-term care facility”) licensed under the Nursing Home Care Act, 210 ILCS 45.
In all situations care should be provided consistent with CDC and IDPH guidance regarding COVID-19, including but not limited to the following:
CMS Guidance: COVID-19 Long-Term Care Facility Guidance (April 2, 2020) available at https://www.cms.gov/files/document/4220-covid-19-long-term-care-facility- guidance.pdf.
CDC Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance) available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html.
CDC Guidance: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Setting, available at:
https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control- recommendations.html
CDC Guidance: Preparing for COVID-19: Long-term Care Facilities, Nursing Homes, available at:
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long- term-care-facilities.html
CDC Recommended Guidance for Extended Use and Limited Ruse of N95 Filtering Facepiece Respirators in Healthcare Settings: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
Transfer of Patients With No Clinical Concern for COVID-19
All hospitalized patients should be assessed for COVID-19 prior to transfer to a skilled long-term care facility. If a test is not indicated per CDC testing criteria, and the patient has no clinical concern for COVID-19, new and returning residents may be discharged to a skilled long-term care facility. At a minimum, care is to include monitoring vital signs to include pulse oximetry readings and screening for a respiratory illness.
Transfer of Patients Investigated for Possible COVID-19 with a Negative Test Result
New and returning residents that tested negative during the acute care stay, can be transferred to a long-term care facility following clinical discharge from the hospital. At a minimum, the care to be provided by the skilled long-term care facility should include implementing Transmission Based Precautions (TBP) for a minimum of seven days following the date the test specimen was obtained, or at least three (3) days have passed in which the patient has been afebrile without the use of fever reducing medication and does not exhibit any signs of respiratory symptoms.
Transfer of Patients Who Have Received a COVID-19 Positive Test While in Hospital
Patients who have received a COVID-19 positive test while in a hospital setting may be transferred to a skilled long-term care facility as long as the facility can follow CDC guidance for Transmission-Based Precautions.
Patients who resided in a skilled-long term care facility prior to transfer to the hospital that receive a COVID-19 positive test should be discharged back to the facility of residence once they are medically stable. Patients that tested positive for COVID-19 prior to admission should be transferred back to their facility of residence per CDC guidance as follows:
If Transmission-Based Precautions are still required upon discharge, the facility must adhere to infection prevention and control recommendations for the care of COVID- 19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19, such as a unit or wing designated to house COVID-19 residents.
If Transmission-Based Precautions are to be discontinued, but the patient has persistent symptoms from COVID-19 (e.g. persistent cough), resident should be placed in a single room, be restricted to their room, and wear a face mask during care activities until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer.
If Transmission-Based Precautions have been discontinued and the patient’s symptoms have resolved, patient should be admitted without further restrictions.
Patients not living in a skilled long-term care facility prior to hospitalization who receive a COVID-19 positive test and require discharge to a skilled long-term care facility should be admitted to a COVID-19 dedicated skilled long-term care facility. The facility should follow CDC guidelines based on whether Transmission-Based Precautions are still required. If a COVID-19 dedicated skilled long-term care facility is not available, then the patient should be admitted to a skilled long-term care facility with a COVID-19 dedicated wing or unit. If this is not available, then patient should be admitted to a skilled long-term care facility able to follow the CDC’s guidance on Transmission-Based Precautions.
Transfer of Patients Investigated for Possible COVID-19 With No Test Results
Returning residents under investigation for COVID-19 who are ready for hospital discharge but do not have test results available and need skilled nursing long-term care should be discharged to a skilled long-term care facility following the CDC’s guidance for when Transmission Base Precautions are required.