LAC | DPH | COVID-19 Interfacility and Home Discharge Rules

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 CDC and CDPH guidance and LAC DPH recent COVID-19 experience.

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 include congregate care facilities (CCFs) and a variety of other congregate residential facilities.

Included in this setting are the following mental health/psychiatric facilities: Crisis Residential Treatment Programs, Behavioral / Mental Health Urgent Care Centers, Enriched Residential Services (board and care w/ additional services) and Enriched Residential Care (board and care w/ FSP), and Short Term Residential Treatment Programs.

CCFs are congregate residential settings that provide some level of care to residents but are not skilled nursing facilities (SNFs). These facilities include residential care facilities for the elderly (RCFEs) and adult residential care facilities (ARFs), among other residential facilities licensed under the California Department of Social Services, Community Care Licensing Division (CCLD), as well as substance use treatment centers, behavioral and mental health treatment facilities, and licensed or unlicensed group homes.

Fully Vaccinated Definition

A person is considered fully vaccinated ≥ 2 weeks following the receipt of:

the second dose in a 2-dose series (Pfizer-BioNTech or Moderna)
one dose of a single-dose vaccine (Johnson and Johnson/Janssen).
A complete series of a COVID-19 vaccine that has been listed for emergency use by the World Health Organization [WHO]

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:

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).
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 COVID-19 recovered unit (Green Cohort).
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.

The receiving SNF must follow the COVID-19 Testing and Cohorting 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.

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 20-87

CDC Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance).

Interfacility Transfer Rules for Patients to Congregate Residential/Care Facilities

Patients with confirmed COVID-19 may be transferred 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 when clinically stable.

All new admissions and readmissions to the facility, regardless of vaccination status, should be placed in quarantine (Yellow Zone). ). See site specific protocols for clearance of quarantine and consult LAC DPH Guidance for CCFs.

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

CDC Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance), 2020.

Home Discharge Rules for Patients with Laboratory Confirmed COVID-19
('home' includes non-congregate/non-healthcare settings)

At least 10 days have passed since symptom onset AND no fever x 24 hours without the use of fever reducing medications AND symptoms have improved.

No restrictions. Patient is considered non-infectious for the purpose of discharge

Less than 10 days since symptom onset, still febrile, or no improvement in symptoms

Provide home isolation instructions
If the patient lives with others, advise household members that are not fully vaccinated that they will need to quarantine for 10 days after last close contact with this patient. Provide home quarantine instructions
Transport home by private conveyance or non-medical transport (Avoid public transportation, no rideshare/taxi)
- Patient should wear a surgical mask
- The driver should wear a surgical mask (isolation gown is optional, if available)
- Patient and driver should maintain a 6 ft distance at all times
- Vehicle should be disinfected with approved disinfectant (e.g. disinfectant wipes) after transport and not used/aired out for 2 hours.

CDC Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance).

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 suspect 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 per site specific protocols.
Asymptomatic residents in the Green cohort at the transferring facility with the outbreak, should be considered potentially exposed and placed into quarantine at the receiving facility for 14 days after date of transfer, regardless of vaccination status.

SNFs/CCFs not experiencing confirmed or suspect 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.

If resident is fully vaccinated and has not had close contact with a COVID positive individual, then receiving facilities can place in the Green Zone;
If resident is partially vaccinated or unvaccinated, then receiving facilities must place transferred patients into quarantine for 14 days.
SNFs/CCFs should not transfer COVID-19-unexposed patients into facilities with active outbreaks of COVID-19 unless first cleared by LAC DPH.

Coronavirus Disease 2019

Facility Transfers &Home Discharge Guidelines