DOH Issues Revised FAQs on Cohorting

On Aug. 6, 2021, the Department of Health (DOH) issued an Advisory updating the May 13, 2020 guidance on cohorting of nursing home residents as a result of COVID-19 infection. The new guidance, in the form of Frequently Asked Questions (FAQs), touches on issues such as vaccination status and cohorting during an outbreak, issues not addressed in the earlier guidance. Members should thoroughly review the Advisory and determine if their current policies and procedures, as well as their Pandemic Emergency Plan (PEP), align with the newly issued guidance. Particular attention should be given to the guidance provided in determining the appropriate cohort (Positive, Negative, and Unknown) during an outbreak. The highlights of the Advisory are as follows:

If a facility has only one or a few residents with COVID-19, does an entire unit need to be cleared and devoted exclusively to the care of residents with COVID-19?

No. When there are only one or a few residents with COVID-19 in a facility, they may be cohorted on part of a unit, such as at the end of a hallway. The area for residents with COVID-19 should be demarcated as a reminder for other residents and healthcare personnel. Other residents should be prevented from entering the cohort area. The residents with COVID-19 should not share a bathroom with residents outside the cohort.

If a facility has only one or a few residents with COVID-19, do separate staff need to be devoted exclusively to those residents?

Yes, if possible. The goal of separate staffing teams is to minimize the number of staff who care for both residents with COVID-19 and residents without COVID-19. For staff caring for residents in different cohorts, they should bundle care and plan the order of care to minimize the need to go back and forth between cohorts. Personal protective equipment (PPE) should always be changed before leaving the positive cohort.

Please define positive, negative, and unknown as they apply to forming resident cohorts.

Positive cohort

The positive cohort should only house residents with a confirmed COVID-19 infection who have tested positive for SARS-CoV-2 by a diagnostic test (e.g., a rapid antigen, rapid molecular test, or a lab based molecular test). ...

Negative cohort

The negative cohort should house residents who have tested negative for SARS-CoV-2 by a diagnostic test, (e.g., a rapid antigen, rapid molecular test, or a lab based molecular test), excluding residents who test negative before meeting the criteria to discontinue COVID-19 transmission-based precautions (who should remain in the positive cohort until they meet criteria to discontinue precautions). The negative cohort should house residents who have met criteria to discontinue COVID-19 transmission-based precautions after recovery from COVID-19. ...

Unknown cohort

The unknown cohort should only house residents who have not been tested (e.g., the resident refused testing).

Residents (who have not tested positive) should be moved to the unknown cohort whenever the resident is not tested during any round of serial outbreak testing as required by CMS. The unknown cohort should include single rooms whenever possible, so residents do not have roommates. Available single rooms should be prioritized for residents who have symptoms concerning for COVID-19 infection. Residents on the unknown cohort should be cared for using transmission-based precautions.

How should negative roommates of residents who test positive for COVID-19 be cohorted?

Roommates of a resident who tests positive for COVID-19, who themselves have a negative test, are at high risk of being infected and a having positive test within the next 14 days.

These residents should be considered exposed contacts and who require quarantine. They should immediately be separated from the resident who tests positive and they should be placed in a single room, regardless of vaccination status.

Contact: Elliott Frost, efrost@leadingageny.org, 518-441-8761