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Coronavirus Disease 2019

Facility Transfers &
Home Discharge Guidelines


INTERFACILITY TRANSFER RULES DURING COVID-19 PANDEMIC 

Who this is for: Hospitals, Skilled Nursing Facilities (SNF), and any Congregate Residential/Congregate Care facility involved in the discharging, transferring, and accepting of patients with and without COVID-19.

What this is for: To allow hospitals to discharge medically stable patients while preventing the introduction of SARS-CoV-2 in receiving institutions and to enable interfacility transfers between SNF and other Congregate Residential/Care facilities.

What is provided: Discharge/transfer criteria for a variety of patient scenarios and receiving facility settings based on CDPH and Los Angeles County Department of Public Health (LAC DPH) COVID-19 guidance.

Receiving Facility Definitions

Skilled Nursing Facilities (SNFs) include nursing homes and skilled nursing facilities. All SNFs are required to be able to maintain Transmission-Based Precautions.

Congregate Residential/Care Facilities, also known as community care facilities (CCFs) include the following:

  • Licensed by Community Care Licensing Division (CCLD) of California Department of Social Services (CDSS): adult residential facilities (ARFs), residential care for the elderly (RCFEs), assisted living facilities (ALFs), continuing care retirement communities (CCRCs), board and care facilities, adult day programs (ADPs).
  • Licensed by Health Facilities Inspection Division (HFID): intermediate care facilities (ICFs) and congregate living health facilities (CLHFs).
  • Affiliated with Department of Child and Family Services: short-term residential therapeutic programs (STRTPs), community treatment facilities, transitional shelter care program facilities, emergency shelters
  • Office of Diversion and Reentry (ODR) facilities, psychiatric health facilities (including acute psychiatric hospitals), residential facilities for the chronically ill (RFCIs), social rehabilitation facilities, substance use disorder (SUD) treatment facilities, mental health/behavioral health residential facilities, community-based adult services (CBAS) facilities, and any other facility where people live and receive caregiving services.

Patient Transfer Criteria from Hospitals

Below, please select the Receiving Institution:
Interfacility Transfer Rules for Patients to SNF

If patient is a NEW ADMISSION to a SNF or is being RETURNED to the SNF of origin:

  1. Skilled nursing facilities must admit new residents from acute care hospitals or long-term acute care hospitals when clinically indicated who have tested positive for COVID-19 and are within their isolation period into the COVID-19 positive unit (Red Cohort).
  2. Skilled nursing facilities must admit new residents from acute care hospitals or long-term acute care hospitals when clinically indicated who have tested positive for COVID-19 and have completed their isolation period as per LAC DPH Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities. These residents should be directly admitted to the SNF without quarantine or COVID-19 transmission- based precautions.
  3. The above guidance should be followed unless the staffing level falls below CDPH required staffing ratios or the facility has been closed to admissions by CDPH due to unsafe patient care.

Transmission-based precautions should continue until isolation is completed starting from date of symptom onset or date of positive test. Patient should be placed in a location designated to care for COVID-19 patients. The patient may be placed in a shared room with other confirmed COVID patients.

Patient may be transferred when clinically indicated.

The receiving SNF may not require a negative test result for COVID-19 as criteria for admission or readmission of residents hospitalized without a diagnosis of COVID-19 as stated in CDPH AFL 22-31.

The receiving SNF must follow the COVID-19 testing instructions for the admissions and readmissions in LAC DPH Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities. .

Note: SNFs experiencing outbreaks may admit new patients without COVID-19 at the discretion of Public Health; they should continue to re-admit returning residents.

Per AFL 22-31, receiving SNFs may not require a negative test result for COVID-19 as criteria for admission or readmission of residents as stated in CDPH AFL 22-31. Additionally, hospitals should proactively communicate with SNFs early to facilitate transfers. SNFs should work collaboratively with hospital discharge planners and local Public Health to facilitate the safe and appropriate placement of SNF residents. SNFs should be prepared to provide care safely without putting existing residents at risk. Please contact LAC DPH at LTC_NCoV19@ph.lacounty.gov for questions and/or help with transfers related to COVID-19 infection control.

In cases of hospital overload, this discharge guidance may be adjusted by the Department of Public Health.

CDPH Movement of Patients/Residents in the Healthcare Continuum During Seasonal Surges and the Coronavirus Disease 2019 (COVID-19) Pandemic AFL 22-31 (supersedes AFL 20-87.1)

Interfacility Transfer Rules for Patients to Congregate Residential/Care Facilities

Patients with confirmed COVID-19 may be transferred to a receiving facility once they are clinically stable. Facilities must be willing and prepared to accept COVID-19 positive patients if they have the ability to appropriately care for them in isolation (Red Zone).

A negative COVID-19 test result should not be required for admitting or readmitting patients from hospitals.

Note: Persons with laboratory-confirmed COVID-19 can continue to have positive test results for several weeks after they resolve their infection therefore re-testing within 90 days of recovery is not recommended. With the exception of severely immunocompromised persons, patients are considered non-infectious once they meet the above criteria for time since symptom onset (or date of initial positive test).

The patient may be transferred to the receiving facility when clinically stable.

Refer to LAC DPH Community Care Facilities guidance for placement of new admissions and readmissions.

In cases of hospital overload, this discharge guidance may be adjusted by the Department of Public Health.

Home Discharge Rules for Patients with Laboratory Confirmed COVID-19
('home' includes non-congregate/non-healthcare settings)
When the patient being discharged has already completed isolation. See duration of isolation.
  • No restrictions. Patient is considered non-infectious for the purpose of discharge. NOTE: patients leaving isolation early due to testing negative are strongly recommended to wear a mask when indoors around others through Day 10.
When the patient being discharged has not yet completed isolation. See duration of isolation.
  • Provide home isolation instructions
  • If the patient lives with others, provide household members instructions for close contacts
  • Transport home by private conveyance or non-medical transport (avoid public transportation, no rideshare/taxi)
    • Patient and driver should wear a highly protective mask.
    • Patient should sit in the back seat with windows down if possible.
    • Vehicle should be disinfected with approved disinfectant (e.g. disinfectant wipes) after transport and not used/aired out ideally for 2 hours.

Please refer to the LAC DPH COVID-19 Provider Isolation and Quarantine Guidelines for more details.


Patient Transfer Rules Between SNFs and/or Community Care Facilities (CCFs)

Transfers from one SNF to another SNF or to other Congregate Facilities
  • SNFs/CCFs experiencing confirmed or suspected outbreaks of COVID-19 should not transfer residents to another SNF/CCF unless first cleared by the LAC DPH contact managing the outbreak.
    • If a resident is cleared for transfer to another facility by LAC DPH, the transferring facility should notify the receiving facility of the COVID-19 status of the resident prior to transfer, which can be done using LAC DPH’s Infectious Organism Transfer Form. The receiving facility should place the resident in the appropriate cohort or isolate in-place per site specific protocols.
    • Asymptomatic residents without COVID-19 from the transferring facility with an outbreak is considered potentially exposed and may be placed in quarantine at the receiving facility per site specific protocols.
  • SNFs/CCFs not experiencing confirmed or suspected outbreaks of COVID-19 may transfer residents without prior approval of LAC DPH as long as the resident has not had fever or respiratory symptoms for at least 3 days prior to transfer. See Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities and LAC DPH Community Care Facilities Guidance for more information.

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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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