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Increasing Infection Rates Trigger Implementation of Requirements in Some Counties

Unfortunately, we are seeing increases in COVID-19 infection rates across the state. Members are encouraged to monitor their community infection rates not only to inform general infection prevention measures, but also to ensure compliance with guidance.

CDC Guidance Regarding Community Transmission Rates and Implications for All Members

As a reminder, the Centers for Disease Control and Prevention (CDC) issued updated guidance as of July 27th in light of new evidence on the B.1.617.2 (Delta) variant currently circulating in the United States. Among the updates is the recommendation that fully vaccinated people wear a mask in public indoor settings in areas of substantial or high transmission. This website provides more information on those standards and provides a searchable tool to help you determine if you are in an area of substantial or high transmission. At the time of this writing, more than half of the counties in New York have met this threshold.

While the Department of Health (DOH) has not issued updated guidance specific to regulated entities such as nursing homes and adult care facilities (ACFs) regarding these changes, these are critical protective measures against this variant, particularly for vulnerable populations. Residents may not tolerate masks, however, or may object to wearing masks in the place they consider home.

The guidance also recommends that:

  • Fully vaccinated people might choose to wear a mask regardless of the level of transmission, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease, or not fully vaccinated.
  • Fully vaccinated people who have a known exposure to someone with suspected or confirmed COVID-19 should be tested three to five days after exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result.

Nursing homes and ACFs should also consider county positivity rates in determining whether to quarantine new admissions and residents who leave for extended periods to visit with family and loved ones.

County Positivity Rates and Nursing Home Staff Testing and Visitation

Nursing home members are also reminded of the community rates of infection and their implications for staff testing and visitation. ACFs should note, however, that the current ACF guidance does not condition staff testing or visitation on community transmission rates.

Under Centers for Medicare and Medicaid Services (CMS) testing guidance, nursing homes are required to test unvaccinated staff weekly if their county positivity rate is 5 percent or higher. If rates rise above 10 percent, nursing homes must test unvaccinated staff twice weekly.

Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency. However, if rates rise to 5 percent or more, triggering weekly testing, and then drop, they must remain below 5 percent for at least two weeks in order to permit a resumption of monthly testing. LeadingAge NY publishes the updated State and CMS positivity rates with the CMS color codes each week. This week’s update is available here. As of Aug. 10th, Schoharie County is the only county that has risen above 5 percent.

Positivity rates may also influence visitation in nursing homes. Under DOH and CMS guidance, indoor visitation must be suspended for unvaccinated residents if the nursing home’s county positivity rate is greater than 10 percent AND less than 70 percent of residents in the facility are fully vaccinated.

Nursing home members can click here for more information on this guidance.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828