Expert Practices in Long-Term Care for COVID-19 Prevention

July 23, 2020
Elderly man in a mask

Long-term care (LTC) facility populations have always been vulnerable to health issues, and COVID-19 is especially concerning. Once the coronavirus enters a LTC facility or senior living home, the organization must act immediately to protect residents and staff. 

Staff members who become infected pose a risk to their families, residents and others. Because residents are typically in a high risk group, facilities face unique challenges to protect against COVID-19. 

More than 4 million Americans are admitted to or reside in assisted living and skilled nursing facilities each year. While data about infections in LTC facilities is limited, it’s estimated that:

  • 1 million to 3 million serious infections occur every year in these facilities. They include urinary tract infections, diarrheal diseases, antibiotic-resistant staph infections and others.
  • Infections are a major cause of hospitalization and death; as many as 380,000 people die of infections in LTC facilities every year.

LTC facilities have been treating and preventing outbreaks for decades and have accelerated best practices and collaboration with healthcare professionals to help prevent COVID-19.


Provista recently surveyed its LTC members to ask what modifications they’re making to allow for better staff, resident and guest safety. Members said:

  • Elimination of common gathering areas
  • Entrance procedures/screening
  • Changes to the reception area

The CDC has been issuing recommendations for preventing and handling COVID-19 cases since the pandemic started. Every state has its own subset of regulations that incorporate, and in some cases supersede, CDC recommendations. States are controlling how and when LTC can reopen to visitors and vendors.

This presents a real challenge for LTC owner groups with large footprints because they’re tasked with establishing unique protocols for specific locations. What’s effective for facilities in one state may need to be changed to meet requirements in another state. Operators must manage best practices by location and can benefit by sharing information with others in the industry.

Representatives from Centers for Medicare & Medicaid Services (CMS), Health and Human Services and LTC associations were posting new findings and regulations daily at first, and have being doing this weekly since March to help operators exchange information and share updates. Peer best practices and successes are helping other LTC facilities implement effective processes.


Provista recently surveyed LTC members for input on which departments they anticipate posing their biggest staffing challenge in the next six to eight months. Members said dining and food services, daily care, and skilled nursing.
LTC facilities had been dealing with staffing challenges well before COVID-19 impacted operating procedures. The coronavirus made those existing pain points more distressing while introducing new ones. Challenges affecting LTC today include:

  • Operators working overtime
  • Owners wearing scrubs and working to fill gaps in the business
  • Dealing with new regulations and orders from CDC, CMS, multiple state organizations and other agencies
  • Ongoing COVID-19 testing of residents and employees
  • Sourcing personal protective equipment (PPE)
  • Unexpected cost increases

LTC facilities are trying to find a balance between infection prevention, resident safety and avoiding social isolation for residents. Implementing a COVID-19 prevention and response strategy, and updating that strategy as new best practices and guidelines become available, can help mitigate those challenges.

Memory care services, designed to meet the unique needs of LTC residents with dementia, are especially challenged to implement social distancing protocols and administer tests when needed. Memory care services are often provided in dedicated care units or wings of a facility. LTC facilities follow the latest infection prevention and control guidelines for their facilities and for memory care units.

Successful strategies include special guidance for memory care units and making sure all employees are familiar with new protocols. Under CDC recommendations and CMS regulations, facilities should assign at least one individual with training in infection prevention and control to provide on-site management of their COVID-19 prevention and response activities.


LTC and healthcare providers will most likely be impacted by COVID-19 through the rest of 2020 and into next year. CDC, CMS and local agencies are highly engaged with guidelines and regulations that will keep residents and employees safe during re-opening activities.

As LTC facilities evolve procedures to reflect best practices and any changes to federal and state guidelines, they should continue communicating and sharing information with their peers. Success stories can benefit all facilities. Communicating safety practices to staff, residents and families so they know protocols can help them feel safe and encourage them to follow established rules.

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