Prevention At Long Term Care Facilities

The general strategies CDC recommends to prevent the spread of COVID-19 in LTCF are the same strategies LTCF use every day to detect and prevent the spread of other respiratory viruses like influenza.

Prevent the introduction of respiratory germs INTO your facility

Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.
Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
Assess residents’ symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.

Prevent the spread of respiratory germs WITHIN your facility

  • Monitor residents at least once per shift and employees at least once prior to starting their shift for fever or respiratory symptoms.
  • Restrict residents with fever or acute respiratory symptoms to their room. If they must leave the room for medically necessary procedures, have them wear a facemask (if tolerated).
  • In general, for care of residents with undiagnosed respiratory infection use Standard, Contact, and Droplet Precautions with eye protection unless suspected diagnosis requires Airborne Precautions (e.g., tuberculosis).
  • Healthcare personnel should monitor their local and state public health sources to understand COVID-19 activity in their community to help inform their evaluation of individuals with unknown respiratory illness. If there is transmission of COVID-19 in the community, in addition to implementing the precautions described above for residents with acute respiratory infection, facilities should also consult with public health authorities for additional guidance.
  • Post signs throughout the facility describing ways to prevent the spread of germs.
  • Support hand and respiratory hygiene as well as cough etiquette by residents, visitors, and employees.
  • Ensure employees clean their hands according to CDC guidelines, including before and after contact with residents, after contact with contaminated surfaces or equipment, and after removing personal protective equipment (PPE).
  • Put alcohol-based hand rub in every resident room (ideally both inside and outside of the room).
  • Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing.
  • Identify dedicated employees to care for COVID-19 patients and provide infection control training.
  • Provide the right supplies to ensure easy and correct use of PPE.
  • Post signs on the door or wall outside of the resident room that clearly describe the type of precautions needed and required PPE.
  • Make PPE, including facemasks, eye protection, gowns, and gloves, available immediately outside of the resident room when it’s determined PPE is needed for the resident.
  • Position a trash can near the exit inside any resident room to make it easy for employees to discard PPE.
  • Perform hand hygiene upon exiting patient rooms.

Prevent the spread of respiratory germs BETWEEN facilities

  • Notify facilities prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19, to a higher level of care.
  • Report any possible COVID-19 illness in residents and employees to the local health department, including your state Healthcare-associated Infections and Antimicrobial Resistance (HAI/AR) coordinator.

Emergency Preparedness Plans

  • Facilities should develop or review current emergency preparedness plans.
  • One part of an overall emergency plan is preparedness. Preparedness includes organizing, training, gathering resources, exercising and evaluating plans.
  • Contact local public health and emergency planning partners to understand current community response plans.


In an effort to reduce fear and anxiety about the COVID-19, facilities should describe what actions the facility is taking to protect staff and residents.

  • Communicate about COVID-19 with your staff. Share information about what is currently known about COVID-19 and your facility’s preparedness plans.
  • Communicate about COVID-19 with your patients and family members. Provide updates about any changes to your policies regarding appointments and visitors and any guidance to patients about providing non-urgent patient care by telephone. Consider using your facility’s website or social media pages to share updates.
  • Communicate about COVID-19 with service providers (e.g., vendors, doctors, service organizations and government contacts) about what is currently known about COVID-19 and your facility’s preparedness plans.

Training for Facilities and Staff

  • Facilities should provide education and training on proper hand hygiene and donning and doffing of personal protective equipment.
  • Training should include information on cleaning and disinfection practices.


  • Facilities should evaluate their supply chain and ensure availability of PPE and cleaning and disinfection products. If facilities are unable to obtain necessary resources, contact your local health department.
  • It is critical that facilities not stockpile supplies.
  • If vendors are unable to supply facility orders for PPE, facilities should reach out to other vendors to obtain necessary PPE.
  • Other options may include the use of reusable isolation gowns.
  • To conserve PPE, staff should attempt to perform more than one task when they enter the resident’s room (e.g., medication administration, vital signs, bathing, toileting).
  • Review of current CDC guidance, “Healthcare Supply of Personal Protective Equipment.” This guidance is specific to Coronavirus and PPE availability and includes recommendations for:
  • Follow-up with your local health department and local emergency management for resource needs, such as PPE.


  • For technical assistance, facilities should contact local/regional emergency preparedness members or healthcare coalitions (i.e., members of your local emergency planning committee, like local health department, local emergency management, hospitals, transportation, community groups).
  • Consider scenarios of potentials events to ensure emergency plans are effective.
  • Determine the gaps and take corrective actions to address them.