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Coronavirus Disease 2019

Facility Transfers &
Home Discharge Guidelines


INTERFACILITY TRANSFER RULES DURING COVID-19 PANDEMIC Updated 9-18-20

These transfer rules were updated on 9-18-20 to include the following significant changes:

  • Updated the categories of receiving facilities to the following: Skilled Nursing Facilities, Dedicated COVID-19 Facilities, and Congregate Residential/Care Facilities.
  • Revised the transfer rules of laboratory-confirmed COVID-19 to SNFs and Congregate Residential/Care Facilities to align with current CDC discontinuation of transmission-based precautions recommendations.

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.

Dedicated COVID-19 Facility is any SNF approved by the Los Angeles County Department of Public Health (LAC DPH) to be designated as COVID-19- only facility. These facilities can accept COVID-infected patients once they are medically stable and then transfer patients out to other facilities when no longer infectious .

Congregate Residential/Care Facilities include congregate care facilities 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


Patient Transfer Criteria from Hospitals

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

Patient may be transferred when clinically indicated

  • Continue standard, contact, and droplet transmission-based precautions at the receiving facility

Transmission-based precautions should be continued for 20 days after hospital admission. 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.

While facilities experiencing outbreaks are closed to new admissions, they are not closed to returning cases .

Patients with confirmed COVID-19 may be transferred if they meet any one of the 2 criteria below.

  1. 10 days have passed since symptoms first appeared (or since date of first positive viral test) AND no fever x 24 hours without the use of fever reducing medications AND symptoms have improved.
    • Continue standard, contact, and droplet transmission-based precautions at the receiving facility
      Transmission-based precautions should be continued for 20 days after hospital admission. 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.
  2. 20 days have passed since symptoms first appeared (or since date of first positive viral test) AND no fever x 24 hours without the use of fever reducing medications AND symptoms have improved.
    • No transmission-based precautions required for transfer.
    •  The patient may be admitted directly to the non-COVID cohort.
  • If the patient was admitted for non-infection related reason, (i.e. cerebrovascular accident or fall) and had no fever or respiratory symptoms of infection
    • the patient may be transferred to accepting facility.
  • If the patient was admitted for infectious syndrome not consistent with COVID-19 and another etiology is established (e.g. cellulitis, bacteremia)
    • the patient may be transferred to accepting facility.

Receiving SNF may not require a negative test result for COVID-19 as criteria for admission or readmission of residents hospitalized with no clinical concern for COVID-19.

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.

If the patient was admitted for an infectious syndrome possibly consistent with COVID-19 (e.g. fever, shortness of breath, cough) and they meet ALL of the following criteria:

  1. Low pre-test probability of COVID-19 (no known contact with a confirmed or suspect case; transferred from a healthcare facility not experiencing a COVID-19 outbreak); AND
  2. Alternative diagnosis established, confirmed with microbiologic or virologic testing; AND
  3. Clinical improvement and no fever x 24 hours without the use of fever reducing medications; AND
  4. One negative SARS CoV-2 test.
    • the patient may be transferred to accepting facility.

Receiving SNF may not require a negative test result for COVID-19 as criteria for admission or readmission of residents hospitalized with no clinical concern for COVID-19.

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.

If patient tests positive, follow interfacility transfer rules for laboratory confirmed COVID-19

If patient does not meet all 4 criteria but tests negative for SARS CoV-2, then follow Patients Investigated for Possible COVID-19 below.

If the patient was admitted for an infectious syndrome possibly consistent with COVID-19 (e.g. fever, malaise, cough) and there is an exposure risk for COVID-19 such as a contact with a confirmed or suspect case or transferred from a healthcare facility experiencing a COVID-19 outbreak

Patient may be transferred if they meet the following criteria:

  • Two serial negative tests for SARS CoV-2, drawn at least 24 hours apart

Transmission-based precautions must be continued at the receiving facility until the patient has been a febrile for 24 hours without the use of fever reducing medications AND there is clinical improvement.

If patient’s departure from the SNF was less than 14 days prior, patient should be allowed to return to SNF. While facilities experiencing outbreaks may be closed to new admissions, they are not closed to returning asymptomatic patients within the 14 day exposure period.

If the patient’s departure from the SNF was greater than 14 days prior and the patient has remained asymptomatic, the patient should be transferred to a different facility, if their original facility is still closed to admissions.

Facilities should be prepared to accept patients when the Transfer Requirements are met.

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.
Interfacility Transfer Rules for Patients to Congregate Residential/Care Facilities

Patients with confirmed COVID-19 may be transferred if they meet the following criteria.

  1. 10 days* have passed since symptoms first appeared (or since date of the first positive viral tests if asymptomatic) AND no fever x 24 hours without the use of fever reducing medications AND symptoms have improved.
    • No transmission-based precautions required for transfer.

* For persons who were severely/critically ill with COVID-19 or who are severely immunocompromised (chemotherapy for cancer, untreated HIV infection with CD4 T lymphocyte count < 200, combined primary immunodeficiency disorder, hematopoietic stem cell or solid organ transplant, receipt of prednisone >20mg/day for more than 14 days), transfer should be postponed for 20 days. Transfer after 10 days can be considered if receiving facility can maintain transmission-based precautions.

A negative COVID-19 test result should not be condition 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. Patients are considered non-infectious once they meet the above criteria for time since symptom onset (or date of initial positive test).

  • If the patient was admitted for non-infection related reason, (i.e. cerebrovascular accident or fall) and had no fever or respiratory symptoms of infection;
  • OR
  • If the patient was admitted for infectious syndrome not consistent with COVID-19 and another etiology is established (e.g. cellulitis, bacteremia)
    • Then the patient may be transferred to accepting facility without transmission-based precautions and requires quarantine for 14 days.

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

If the patient was admitted for an infectious syndrome possibly consistent with COVID-19 (e.g. fever, shortness of breath, cough) and they meet ALL of the following criteria:

  1. Low pre-test probability of COVID-19 (no known contact with a confirmed or suspect case; transferred from a healthcare facility not experiencing a COVID-19 outbreak); AND
  2. Alternative diagnosis established, confirmed with microbiologic or virologic testing; AND
  3. Clinical improvement and no fever x 24 hours without the use of fever reducing medications; AND
  4. One negative SARS CoV-2 test.
    • the patient may be transferred to accepting facility and requires quarantine for 14 days.

If the patient tests positive, follow interfacility transfer rules for laboratory confirmed COVID-19

If the patient does not meet all 4 criteria but tests negative for SARS CoV-2, then follow Patients Investigated for Possible COVID-19 below.

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

If the patient was admitted for an infectious syndrome possibly consistent with COVID-19 (e.g. fever, shortness of breath, cough) and there is an exposure risk for COVID-19 such as a contact with a confirmed or suspect case or transferred from a healthcare facility experiencing a COVID-19 outbreak

Patient may be transferred if they meet the following criteria:

  • Two serial negative tests for SARS CoV-2, drawn at least 24 hours apart –AND—
  • The patient has been afebrile for 24 hours without the use of fever reducing medications AND there is clinical improvement.

Facilities should be prepared to accept patients when the Transfer Requirements are met.

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.

Interfacility Transfer Rules for Patients WITH COVID-19 to a Dedicated SNF
Patients with confirmed COVID-19 may be transferred when clinically indicated.

Facilities should be prepared to accept patients when the Transfer Requirements are met.

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
  • Advise any household members that they will need to self-quarantine for at least 14 days after last contact with this patient. Provide home quarantine instructions
  • If the patient lives with others and is not able to adequately self-isolate advise that:
    • The quarantine period of all household members will be extended to 14 days after the end of the patient’s isolation period
  • 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), 2020.


Patient Transfer Rules Between SNFs and/or Congregate Residential/Care Facilities

Transfers from one SNF to another SNF or to other Congregate Facilities
  • SNFs experiencing confirmed or suspect outbreaks of COVID-19 should not transfer asymptomatic residents 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 receiving facility should be notified prior to transfer that the patient is potentially COVID-19 exposed and
    • Upon arrival at the receiving facility, the patient should be maintained in quarantine for 14 days after date of transfer prior to resuming normal activities.
  • SNFs not experiencing confirmed or suspect outbreaks of COVID-19 may transfer asymptomatic 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.
    • Receiving facilities must place transferred patients into quarantine for 14 days.
    • SNFs should not transfer COVID-19-unexposed patients into facilities with active outbreaks of COVID-19 unless first cleared by LAC DPH.


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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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