A 14-day quarantine after admission is daunting for many residents.  Transitions may already be difficult and are now compounded by the necessary infection prevention and control practices in place during the pandemic.

This begs the very understandable question . . . can you eliminate or reduce quarantine time for new admissions and/or resident transfers.  The Minnesota Department of Health answered this question for LeadingAge Minnesota during one of our meetings this week.  The department pointed to three pieces of guidance we should use to guide our decision-making and policy creation for admission and transfer quarantine which include Long-Term Care Guidance For Non-Medically Necessary Outings, the LTC Tookit, and Principles Of Covid-19 Cohorting In Long-Term Care. MDH points out that while there is no one document that contains all of the information, these three documents have everything we need to determine quarantine processes for our communities.  As a reminder, there is no current exception to quarantine time or any other guidance change based upon the organization’s vaccination status of residents or staff.

New Admissions/Transfers that have had COVID-19 in the last 90-days

If you are admitting or transferring back a resident who has had COVID-19 in the last 90-days you may not have to quarantine the resident for all or part of the 14-day quarantine period.

No quarantine needed IF:

• Tested positive for COVID-19 in the last 90-days by RT-PCR testing – OR – Tested positive for COVID-19 by antigen test without confirmatory RT-PCR; and had symptoms during their illness; AND
• Meet the criteria to discontinue transmission-based precautions

Partial quarantine needed IF:

• Tested positive for COVID-19 in the last 90-days by RT-PCR testing – OR – Tested positive for COVID-19 by antigen test without confirmatory RT-PCR; and had symptoms during their illness; AND
• Meet the criteria to discontinue transmission-based precautions
• Time left on isolation with transmission-based precautions.  In this event, the resident should finish out the remaining isolation days.  For example, 8 days of isolation completed in the hospital then the resident would need to complete 2 isolation days in the long-term care community.

Co-located SNF/AL/HWS

If there are two buildings co-located on the same campus you may not have to quarantine transfers between the buildings if infection prevention and control policies are the same or largely similar.  Examples of those policies include staff and visitor screening, resident monitoring, testing, etc.

Transmission-Based Precautions

Transmission-based precautions can be discontinued in our settings if the following symptom-based criteria are met:

• At least 10 days passed after symptoms first appear
  • This increases to 20 days if the resident had severe to critical illness or severe immune compromise
• At least 24 hours since last fever without the use of fever-reducing medications
• Symptoms have improved

The test-based criteria are outlined in the Long-term Care Guidance for Non-Medically necessary outings.

If you have questions talking through specific situations, please contact Kari Everson – keverson@leadingagemn.org.

Reference Documents

• Long-term Care Guidance for Non-Medically Necessary Outings
• Principles for COVID-19 Cohorting in Long-term Care
• COVID-19 LTC Toolkit:  discontinuing transmission-based precautions located on page 25.