Steps Health Care Facilities Can Take to Prepare for Coronavirus Disease 2019 (COVID-19)
March 6, 2020
All health care facilities should take steps to prepare for COVID-19 and protect both their patients and staff.
Stay informed about the local COVID-19 situation. Know where to turn for reliable, up-to-date information in your local community. Monitor the CDC COVID-19 website and your state and local health department websites for the latest information.
Develop or review your facility’s emergency plan. A COVID-19 outbreak in your community could lead to staff absenteeism. Prepare alternative staffing plans to ensure as many of your facility’s staff are available as possible.
Establish relationships with key health care and public health partners in your community. Make sure you know about health care and public health emergency planning and response activities in your community. Learn about plans to manage patients, accept transfers, and share supplies. Review any memoranda of understanding (MOUs) with affiliates, your health care coalition, and other partners to provide support or assistance during emergencies.
Create an emergency contact list. Develop and continuously update emergency contact lists for key partners and ensure the lists are accessible in key locations in your facility. For example, know how to reach your local or state health department in an emergency.
Coronavirus Outbreak: U.S. Healthcare System Under Pressure After Spike in Cases
March 19, 2020
Communicate with Staff and Patients
Communicate about COVID-19 with your staff. Share information about what is currently known about COVID-19, the potential for surge, and your facility’s preparedness plans.
Communicate about COVID-19 with your patients. Provide updates about changes to your policies regarding appointments, providing non-urgent patient care by telephone, and visitors. Consider using your facility’s website or social media pages to share updates.
Protect Your Workforce
Screen patients and visitors for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) before entering your health care facility. Keep up to date on the recommendations for preventing spread of COVID-19 on CDC’s website.
Ensure proper use of personal protection equipment (PPE). Health care personnel who come in close contact with confirmed or possible patients with COVID-19 should wear the appropriate personal protective equipment.
Conduct an inventory of available PPE. Consider conducting an inventory of available PPE supplies. Explore strategies to optimize PPE supplies.
Encourage sick employees to stay home. Personnel who develop respiratory symptoms (e.g., cough, shortness of breath) should be instructed not to report to work. Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
Protect Your Patients
Stay up-to-date on the best ways to manage patients with COVID-19.
Separate patients with respiratory symptoms so they are not waiting among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients and visitors to be separated.
Consider strategies to prevent patients who can be cared for at home from coming to your facility and potentially exposing themselves or others to germs, like:
- Using your telephone system to deliver messages to incoming callers about when to seek medical care at your facility, when to seek emergency care, and where to go for information about caring for a person with COVID at home
- Adjusting your hours of operation to include telephone triage and follow-up of patients during a community outbreak
- Leveraging telemedicine technologies and self-assessment tools
Preparing for COVID-19 in Long-Term Care Facilities and Nursing Homes
March 13, 2020
The general strategies the Centers for Disease Control and Prevention (CDC) recommends to prevent the spread of COVID-19 in long-term care facilities (LTCF) are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.
Symptoms of respiratory infection, including COVID-19:
- Shortness of breath
Long-term care facilities concerned that a resident, visitor, or employee may be a COVID-2019 patient under investigation should contact their local or state health department immediately for consultation and guidance.
COVID-19 Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings
Nursing homes and other long-term care facilities can take steps to assess and improve their preparedness for responding to coronavirus disease 2019 (COVID-19). This checklist should be used as one tool to develop a comprehensive COVID-19 response plan, including plans for:
- Rapid identification and management of ill residents
- Considerations for visitors and consultant staff
- Supplies and resources
- Sick leave policies and other occupational health considerations
- Education and training
- Surge capacity for staffing, equipment and supplies, and postmortem care
The checklist identiﬁes key areas that long-term care facilities should consider in their COVID-19 planning. Long-term care facilities can use this tool to self-assess the strengths and weaknesses of current preparedness efforts. This checklist does not describe mandatory requirements or standards; rather, it highlights important areas to review to prepare for the possibility of residents with COVID-19.
Access the checklist here.
Interim Additional Guidance for Infection Prevention and Control for Patients with Suspected or Confirmed COVID-19 in Nursing Homes
Summary of Changes to the Guidance:
Updated guidance to recommend that nursing homes:
- Restrict all visitation except for certain compassionate care situations, such as end-of-life situations
- Restrict all volunteers and non-essential health care personnel (HCP)
- Cancel all group activities and communal dining
- Implement active screening of residents and HCP for fever and respiratory symptoms
COVID-19 is being increasingly reported in communities across the United States. It is likely that SARS-CoV-2 will be identified in more communities, including areas where cases have not yet been reported. As such, nursing homes should assume it could already be in their community and move to restrict all visitors and unnecessary HCP from the facility, cancel group activities and communal dining, and implement active screening of residents and HCP for fever and respiratory symptoms.
Given their congregate nature and residents served (i.e., older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19. If infected with SARS-CoV-2, the virus that causes COVID-19, residents are at increased risk of serious illness.
These recommendations supplement CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Health Care Settings. These recommendations are specific for nursing homes, including skilled nursing facilities. Much of this information could also be applied in assisted living facilities. This information complements, but does not replace, the general infection prevention and control recommendations for COVID-19.
It is important to understand transmission dynamics in your community to inform strategies to prevent introduction or spread of COVID-19 in your facility. Consultation with public health authorities can help you better understand if transmission of COVID-19 is occurring in your community.
Nursing Homes, Senior Living Facilities Put Visitor Restrictions in Place
March 11, 2020
Ill visitors and health care personnel (HCP) are the most likely sources of introduction of COVID-19 into a facility. CDC recommends aggressive visitor restrictions and enforcing sick leave policies for ill HCP, even before COVID-19 is identified in a community or facility.
Things Facilities Should Do Now
Educate Residents, Health Care Personnel, and Visitors
- Share the latest information about COVID-19
- Review CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Health Care Settings
- Educate and train HCP
– Reinforce sick leave policies; remind HCP not to report to work when ill
– Reinforce adherence to infection prevention and control measures, including hand hygiene and selection and use of personal protective equipment (PPE); have HCP demonstrate competency with putting on and removing PPE
- Educate both facility-based and consultant personnel (e.g., wound care, podiatry, barber) and volunteers; including consultants is important because they often provide care in multiple facilities and can be exposed to or serve as a source of pathogen transmission
- Educate residents and families including:
– information about COVID-19
– actions the facility is taking to protect them and their loved ones, including visitor restrictions
– actions residents and families can take to protect themselves in the facility
Provide Supplies for Recommended Infection Prevention and Control Practices
- Hand hygiene supplies:
– Put alcohol-based hand sanitizer with 60–95% alcohol in every resident room (ideally both inside and outside of the room) and other resident care and common areas; e.g., outside dining hall, in therapy gym
– Make sure that sinks are well-stocked with soap and paper towels for hand washing
- Respiratory hygiene and cough etiquette:
– Make tissues and face masks available for coughing people
– Consider designating staff to steward those supplies and encourage appropriate use by residents, visitors, and staff
- Make necessary Personal Protective Equipment (PPE) available in areas where resident care is provided. Put a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room or before providing care for another resident in the same room. Facilities should have supplies of:
– face masks
– respirators (if facility has respiratory protection program with trained, medically cleared, and fit-tested HCP)
– eye protection; i.e., face shield or goggles
- Consider implementing a respiratory protection program that is compliant with the OSHA respiratory protection standard for employees, if not already in place; the program should include medical evaluations, training, and fit testing
- Environmental cleaning and disinfection:
– Make sure that EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment
– Refer to the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2
Evaluate and Manage HCP with Symptoms of Respiratory Illness
Sick Staff Fueled Coronavirus Outbreak in Seattle-Area Care Centers, CDC Report Says
March 19, 2020
- Implement sick leave policies that are non-punitive, flexible, and consistent with public health policies that allow ill HCP to stay home
- As part of routine practice, ask HCP (including consultant personnel) to regularly monitor themselves for fever and symptoms of respiratory infection
– Remind HCP to stay home when they are ill
– If HCP develop fever or symptoms of respiratory infection while at work, they should immediately put on a face mask, inform their supervisor, and leave the workplace
– Consult occupational health on decisions about further evaluation and return to work
- Screen all HCP at the beginning of their shift for fever and respiratory symptoms
– Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat; if they are ill, have them put on a face mask and leave the workplace
– HCP who work in multiple locations may pose higher risk and should be asked about exposure to facilities with recognized COVID-19 cases
- Restrict nonessential health care personnel (including consultant personnel) and volunteers from entering the building
- When transmission in the community is identified, nursing homes and assisted living facilities may face staffing shortages; facilities should develop (or review existing) plans to mitigate staffing shortages
Assessing Risk & Possible Restrictions for HCP
Refer to the Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Health Care Setting to Patients with Coronavirus Disease 2019 (COVID-19).
Policies and Procedures for Visitors
Because of the ease of spread in a long-term care setting and the severity of illness that occurs in residents with COVID-19, facilities should immediately restrict all visitation to their facilities except certain compassionate care situations, such as end of life situations.
- Send letters or emails to families advising them that no visitors will be allowed in the facility except for certain compassionate care situations, such as end of life situations; use of alternative methods for visitation (e.g., video conferencing) should be facilitated by the facility
- Post signs at the entrances to the facility advising that no visitors may enter the facility
- Decisions about visitation during an end of life situation should be made on a case-by-case basis, which should include careful screening of the visitor for fever or respiratory symptoms; those with symptoms should not be permitted to enter the facility; those visitors that are permitted must wear a face mask while in the building and restrict their visit to the resident’s room or other location designated by the facility; they should also be reminded to frequently perform hand hygiene
When to End Transmission-Based Precautions
Refer to the Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19.
Evaluate and Manage Residents with Symptoms of Respiratory Infection
- Ask residents to report if they feel feverish or have symptoms of respiratory infection
- Actively monitor all residents upon admission and at least daily for fever and respiratory symptoms (shortness of breath, new or change in cough, and sore throat)
– If positive for fever or symptoms, implement recommended IPC practices
- The health department should be notified about residents with severe respiratory infection, or a cluster (i.e., three or more residents or HCP with new-onset respiratory symptoms over 72 hours) of residents or HCP with symptoms of respiratory infections
- In general, when caring for residents with undiagnosed respiratory infection, use Standard, Contact, and Droplet Precautions with eye protection unless the suspected diagnosis requires Airborne Precautions (e.g., tuberculosis); this includes restricting residents with respiratory infection to their rooms; if they leave the room, residents should wear a face mask (if tolerated) or use tissues to cover their mouth and nose
– Continue to assess the need for Transmission-Based Precautions as more information about the resident’s suspected diagnosis becomes available
- If COVID-19 is suspected, based on evaluation of the resident or prevalence of COVID-19 in the community,
– Residents with known or suspected COVID-19 do not need to be placed into an airborne infection isolation room (AIIR) but should ideally be placed in a private room with their own bathroom
– Room sharing might be necessary if there are multiple residents with known or suspected COVID-19 in the facility; as roommates of symptomatic residents might already be exposed, it is generally not recommended to separate them in this scenario; public health authorities can assist with decisions about resident placement.
– Facilities should notify the health department immediately and follow the Interim Infection Prevention and Control Recommendations for Patients with COVID-19 or Persons Under Investigation for COVID-19 in Health Care Settings, which includes detailed information regarding recommended PPE
- If a resident requires a higher level of care or the facility cannot fully implement all recommended precautions, the resident should be transferred to another facility that is capable of implementation; transport personnel and the receiving facility should be notified about the suspected diagnosis prior to transfer.
– While awaiting transfer, symptomatic residents should wear a face mask (if tolerated) and be separated from others (e.g., kept in their room with the door closed); appropriate PPE should be used by health care personnel when coming in contact with the resident
Resource for Confirmed or Suspected COVID-19
Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19)
- Cancel communal dining and all group activities, such as internal and external activities
- Remind residents to practice social distancing and perform frequent hand hygiene
- Create a plan for cohorting residents with symptoms of respiratory infection, including dedicating HCP to work only on affected units
In addition to the actions described above, what facilities should do when there are cases in their community but none in their facility:
Health Care Personnel Monitoring and Restrictions:
- Consider implementing universal use of face masks for HCP while in the facility
In addition to the actions described above, these are things facilities should do when there are cases in their facility or sustained transmission in the community:
Health Care Personnel Monitoring and Restrictions:
- Implement universal use of face masks for HCP while in the facility
- Consider having HCP wear all recommended PPE (gown, gloves, eye protection, N95 respirator or, if not available, a face mask) for the care of all residents, regardless of presence of symptoms; implement protocols for extended use of eye protection and face masks
Resident Monitoring and Restrictions:
- Encourage residents to remain in their room; if there are cases in the facility, restrict residents (to the extent possible) to their rooms except for medically necessary purposes; if they leave their room, residents should wear a face mask, perform hand hygiene, limit their movement in the facility, and perform social distancing (stay at least 6 feet away from others)
- Implement protocols for cohorting ill residents with dedicated HCP
California Issues Directive to Fight COVID-19
March 16, 2020
Seniors and COVID-19 vulnerable residents directed to home isolate
Governor Newsom issues Executive Order redirecting California agencies to protect licensed facilities, staff & residents most vulnerable to COVID-19
Health care, residential, and non-residential facilities licensed by the state, especially those serving senior citizens and other COVID-19 vulnerable populations, will face significant challenges
Following the announcement that older adults and those at higher risk for serious illness from COVID-19 should isolate, California Governor Gavin Newsom issued an executive order to protect the health and safety of Californians most vulnerable to COVID-19 residing at health care, residential, and non-residential facilities licensed by the state. The order directs state health and social services agencies to redirect resources and staff to the facilities, focusing on providing technical assistance and supporting compliance with core health and safety requirements for caregivers and the cared for.
“These will be challenging times and California is mobilizing every part of government to protect and isolate residents most vulnerable to COVID-19. Those who are over the age of 65, Californians with underlying health issues, residential care patients, and all those who care for these individuals are uniquely at risk. In the coming weeks, our state must rally behind these Californians and work aggressively to ensure their needs are safely met.”
The Governor’s order also directs the Health and Human Services Agency to develop alternatives to leverage in home supportive services programs, adult protective services programs, area agencies on aging and regional centers, and other programs to support the home isolation of vulnerable Californians, including seniors and those with serious chronic conditions.
The order directs the following:
- The state must focus on protecting the health and safety of the most vulnerable in licensed facilities
- The state shall immediately identify health, community care facilities, and other sites that house populations that are most vulnerable to COVID-19; this includes, but is not limited to seniors and individuals who require assisted-living services due to chronic health conditions
- The state shall redirect resources and provide technical and compliance support to protect caregivers and those they care for
- Enforcement activities shall focus where there are allegations of the most serious violations impacting health and safety
- The Health and Human Services Agency, in consultation with counties and labor organization and consumers, shall leverage existing services and programs to support home isolation of vulnerable Californians, including seniors and those with serious chronic underlying health conditions
- To address the increased demand for health care workers and first responders, state Departments shall authorize first responders, care providers, and workers who are asymptomatic and taking precautions to prevent the transmission of COVID-19, to continue working during the period of this emergency
The full executive order can be viewed here.
“It is also important that older adults and those at elevated risk of serious illness from COVID-19 take immediate steps to reduce their risk. This includes staying at home as much as possible and practicing social distancing,” said Governor Newsom.
Based on the Governor’s announcement yesterday, older adults, individuals with compromised immune systems, and individuals who have serious chronic medical conditions like heart disease, diabetes, and lung disease should take the following steps:
1. Remain at home until order is rescinded, or until further guidance is issued.
- Cancel any non-essential travel, appointments, etc.
- For routine medical care, contact your health care provider to discuss rescheduling
2. Continue with outdoor activities.
- As long as you practice social distancing, we encourage you to continue your outdoor activities such as walks, runs and yard work, to the extent your health allows it
3. Practice social distancing.
- Maintain distance, at least six feet, between yourself and anyone who is coughing or sneezing
- Avoid handshaking, hugging, or other intimate types of greetings—greet others with a wave, nod, or bow instead
4. Stay in touch with others by phone or email
- Ask friends and family to do any essential grocery shopping, picking up medications, etc.
- You should ask for help from friends, family, neighbors, community health workers, etc. if you become sick
- Determine who can provide you with care if your caregiver gets sick
5. Family and Caregiver Support
- Family, friends, and caregivers who come to your home to provide you with support should be asymptomatic, meaning having no fever, cough, or other respiratory symptoms
- Know what medications your loved one or client is taking and see if you can help them have extra on hand
- Monitor food and other medical supplies (oxygen, incontinence, dialysis, and wound care) needed and create a back-up plan
- Stock up on non-perishable food items to have on hand in your home
6. Have supplies on hand
- Contact your health care provider to ask about obtaining extra necessary medications to have on hand
- If you cannot get extra medications, consider using mail-order for medications
- Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms
7. Have a plan for if you get sick:
- Consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19
- Stay in touch with others by phone or email; you may need to ask for help from friends, family, neighbors, community health workers, etc. if you become sick
- Watch for symptoms and emergency warning signs
– Pay attention to potential COVID-19 symptoms including fever, cough, and shortness of breath. If you develop symptoms, call your doctor or local public health department.
– If you develop emergency warning signs for COVID-19, get medical attention immediately; in adults, emergency warning signs include:
Difficulty breathing or shortness of breath
Persistent pain or pressure in the chest
New confusion or inability to arouse
Bluish lips or face
(This list is not all-inclusive. Please consult your medical provider for any other symptom that is severe or concerning.)
8. Hand washing
- Wash hands frequently for at least twenty seconds
- Encourage hand washing by family and friends, particularly children
- Provide alcohol-based hand sanitizers to supplement hand washing
- Avoid touching eyes, nose, or mouth with unwashed hands
- Clean frequently used devices, such as mobile phones
9. Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (e.g., tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and cell phones) with common cleaning supplies.
10. See the Center for Disease Control and Prevention’s guidance regarding the prevention of disease in homes and residential communities.
11. Use “respiratory etiquette.”
- Cover cough with a tissue or sleeve; see CDC’s Cover Your Cough page for multilingual posters and flyers, posted at the bottom of webpage
- Provide adequate supplies within easy reach, including tissues and no-touch trash cans
Officials: Assisted Living Facility Resident First to Die from COVID-19 in Sacramento County
March 14, 2020
Assisted Living—Or Sitting Ducks?
Carlton Senior Living has been cited 43 times for serious health and safety violations—can it contain the coronavirus?
By Raheem F. Hosseini – Sacramento News and Review – 19 Mar. 2020
News that the first coronavirus-related death in Sacramento County occurred in an Elk Grove home for the elderly raised the specter that the disease, which killed more than thirty residents across nearly a dozen senior living facilities in the Seattle area, could just be getting started.
California Gov. Gavin Newsom underscored that fear on Sunday, when he made an unprecedented appeal to the state’s 5.3 million seniors to stay home during the pandemic, and called upon assisted living facilities to limit visitors only for residents who are about to die.
But whether local officials can prevent a deadly outbreak from replicating here will largely depend on the competence of the people running these care homes—and the aggressiveness of those overseeing them.
No quarantine was ordered at Carlton Plaza of Elk Grove after a female resident in her 90s died of complications from COVID19 on March 10.
As for the company that runs the home and six others for the elderly in Northern California, Carlton Senior Living LLC has amassed 72 health and safety violations from the state, including 43 for serious violations.
The three Carlton homes in Sacramento County have had a clean record since 2017, when a female resident left outside for approximately three hours in 90-degree heat suffered a stroke that May. An investigation by the California Department of Social Services Community Care Licensing concluded that a lack of staff supervision was to blame. The state licensing evaluator also found that Carlton provided outdated records to the hospital where the woman was taken, indicating that she wanted to be resuscitated. The resident had updated her medical wishes with a “do not resuscitate” order in 2016.
It wasn’t clear from the report whether the woman survived.
Carlton ended up firing three employees and the state issued two citations, one for a serious “Type A” violation. The state also required a biannual audit of resident charts and emergency binders to make sure they stayed up-to-date.
More recently, in 2018, the state issued a $10,000 civil penalty against Carlton for what happened at its Fulton Avenue home some two years earlier. According to a facility evaluation report, Carlton Crown Plaza admitted a mobility-challenged male resident with Parkinson’s that it knew was a risk for falls. Yet the man fell approximately twenty-four times over a period of ten months, resulting in multiple head injuries and contributing to his death at a skilled nursing facility in October 2016.
The state found that Carlton Crown Plaza didn’t do an adequate job of protecting the resident.
All totaled, Carlton’s three Sacramento facilities have been cited forty-one times for violating state health and safety regulations, including twenty-three times for serious violations. More than half of the violations (twenty-one) were found at the Elk Grove home, where a state licensing evaluator last paid an unannounced visit in November 2019 to make sure that it had cut ties with three employees who were no longer cleared by fingerprints.
At the time, the evaluator’s census noted that 147 residents were staying at the facility, which has the capacity for 180.
Jessica Arnold, vice president of resident relations for Carlton Senior Living, didn’t return a voicemail asking about the company’s mitigation measures since the elderly woman’s death.
Prior to Newsom’s March 15 press conference, these facilities were being told to follow the recommendations of the U.S. Centers for Disease Control and Prevention at a time that the Trump administration was being criticized for downplaying the seriousness of the pandemic to better ensure the president’s reelection chances.
On March 3, the California Assisted Living Association, which represents the state’s residential care facilities for the elderly, hosted a coronavirus webinar for its members. Josh Allen, a registered nurse who works with Allen Flores Consulting Group, told those watching that the key was to prevent the disease from entering their facilities in the first place, and containing it if it did.
“Our residents are a frail population. They’re susceptible to a variety of illnesses, including this one,” Allen said.
But Allen also suggested that seasonal influenza preparation has been good practice for what senior homes must do during this outbreak, which illustrates just how quickly understanding of the respiratory illness has advanced in the weeks that it’s taken to cripple nations and overwhelm their health care systems.
“We know how to manage that,” Allen said of the flu two weeks ago. “And fortunately, a lot of the interventions we’re going to talk about to manage the risks of the coronavirus—they’re the same interventions you put in place every year for seasonal influenza. So you’re going to have some muscle memory.”
That is no longer the accepted wisdom.
Current modeling suggests as many as 100 million Americans could be infected by a ravaging respiratory illness for which they have no immunity and for which a vaccine is months away.
There are more than 250 assisted living facilities in Sacramento County, many just licensed for six beds. Of the roughly 1.5 million residents in Sacramento County, 14% are 65 or older, according to the U.S. Census Bureau.
The novel coronavirus and the disease it causes, COVID-19, is particularly dangerous to older people and those with preexisting health conditions. Known COVID-19 cases in California shot up 29% in just two days by Monday, with 160 of the 472 confirmed infections being in residents 65 or older.
Sacramento County saw infections more than double to forty, an exponential spike that health experts are warning could accelerate without an aggressive disruption to daily life.
With California standing at the precipice of what could be an unstoppable pandemic, Newsom tried to project calm while also issuing a plea for every person 65 or older to remain at home for now.
“We are calling for the home isolation of all seniors in California,” he said on March 15. “We are doing so with our eyes wide open.”
“California Issues Directive to Fight COVID-19.” Office of Governor Gavin Newsom, 16 Mar. 2020. State of California, www.gov.ca.gov/2020/03/16/california-issues-directive-to-fight-covid-19/.
“Coronavirus Disease 2019 (COVID-19) Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings.” CDC, 2020, www.cdc.gov/coronavirus/2019-ncov/downloads/novel-coronavirus-2019-Nursing-Homes-Preparedness-Checklist_3_13.pdf.
“Coronavirus Outbreak: U.S. Healthcare System Under Pressure After Spike in Cases.” YouTube, uploaded by Global News, 19 Mar. 2020, www.youtube.com/watch?v=5k2opVmOseo.
“Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19).” CDC, 14 mar. 2020, www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html.
“Executive Order N-27-20.” State of California Executive Department, 15 Mar. 2020, www.gov.ca.gov/wp-content/uploads/2020/03/3.15.2020-COVID-19-Facilities.pdf?_cldee=Y2RldmlAY2FsaG9zcGl0YWwub3Jn&recipientid=contact-fe5edad0afc9e911a842000d3a3b4cee-61372131750547f094977254eb6c7cd7&esid=74f85bce-0268-ea11-a811-000d3a375a4d.
Hosseini, Raheem F. “Assisted Living — Or Sitting Ducks?” Sacramento News and Review, 19 Mar. 2020, www.newsreview.com/sacramento/assisted-living-mdash-or-sitting-ducks/content?oid=29903755.
“Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19).” CDC, 7 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html.
“Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19).” CDC, 7 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.
“Nursing Homes, Senior Living Facilities Put Visitor Restrictions in Place.” YouTube, uploaded by KCCI, 11 Mar. 2020, www.youtube.com/watch?v=sbIihbZbM8g.
“Officials: Assisted Living Facility Resident First to Die from COVID-19 in Sacramento County.” YouTube, uploaded by Bridgette Bjorlo, 14 Mar. 2020, www.youtube.com/watch?v=VB_KHGrRHtQ.
“Preparing for COVID-19: Long-term Care Facilities, Nursing Homes.” CDC, 13 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html.
“Sick Staff Fueled Coronavirus Outbreak in Seattle-Area Care Centers, CDC Report Says.” YouTube, uploaded by Q13 Fox, 19 Mar. 2020, www.youtube.com/watch?v=Qq8Uj1soKQE.
“Steps Healthcare Facilities Can Take Now to Prepare for Coronavirus Disease 2019 (COVID-19).” CDC, 6 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/steps-to-prepare.html.