Toolkit for assisted living, group homes, and other residential care settings (excluding nursing homes)
The purpose of this site is to provide you with the information necessary to respond to COVID-19 transmission at your facility. This guidance applies if one or more cases are identified at your facility, regardless of your outbreak status. See outbreak definitions below.
This toolkit is intended for all facility which follow the Community Congregate Living Settings (including assisted living, adult family homes, inpatient behavioral health facilities, supported living, and independent living) with COVID-19 cases. For skilled nursing facilities, please refer to the Skilled nursing facilities (nursing home) toolkit.
COVID-19 guidance is changing all the time, please bookmark the following sites and review them often:
- For healthcare and homeless service providers, Public Health – Seattle & King County
- How to Protect Yourself and Others, CDC
- Additional Information for Community Congregate Living Settings (e.g., Group Homes, Assisted Living), CDC
- What to do if you were exposed to COVID-19, CDC
- Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, CDC
The current definition of a COVID‑19 outbreak at an assisted living facility or adult family home is:
- One facility-acquired COVID 19 positive infection in a resident or client; OR
- Three or more suspect, probably, or confirmed COVID 19 cases in HCP WITH epi‑linkage AND no other more likely sources of exposure for at least one of the cases.
The current definition of a COVID‑19 outbreak at a supported living agency is:
- Three or more probable or confirmed COVID-19 cases in clients WITH epi-linkage AND no other more likely sources of exposure for at least two of the cases OR
- Three or more suspect, probable, or confirmed COVID-19 cases in healthcare workers WITH epi‑linkage AND no other more likely sources of exposure for at least two of the cases.
The current definition of a COVID‑19 outbreak at an inpatient behavioral health facility is:
- Two or more cases of confirmed COVID 19 infection in a patient four or more days after admission for a non COVID 19 condition WITH an epi‑linkage; OR
- Three or more suspect, probable, or confirmed cases of COVID‑19 infection in healthcare workers WITH epi‑linkage AND no other more likely sources of exposure for at least two of the cases.
The current definition of a COVID-19 outbreak at an independent living facility is when ALL of the following criteria is met:
- At least 5 confirmed cases OR at least 20% of individuals in a core group (i.e. people who regularly interact) AND
- The initial people who tested positive began to have symptoms within 7 days of each other AND
- Confirmed cases are epi-linked (connected by being close contacts or having a shared exposure) in the facility AND
- No more likely evidence that transmission occurred outside the facility.
Create and maintain a positive COVID-19 case list. Include all residents, clients, patients, students, employees, volunteers, and contractors at your facility who test positive for COVID-19. Example of this is found here: Download a COVID-19 Case List template (MS Excel). You will need to keep a complete case list for internal use to assist with contact tracing and internal management of your outbreak. However, you will not need to submit this case list to Public Health. Instead, you will use this list as a reference to submit weekly and end of outbreak cumulative case counts.
Report to Public Health – Seattle & King County
- Report positive COVID cases: If there is not an ongoing investigation associated with your facility, report any positive COVID cases (including residents/patients/staff/contractors) using the Public Health COVID-19 Intake Survey. You will receive a confirmatory email with additional information and guidance links.
- Investigation start: After your report has been processed, Public Health may open an investigation for your facility. You will receive an email with follow up instructions and a COVID-19 Investigator may contact you. An investigation is a non-punitive Public Health process for collecting information about how a disease is affecting our community and for providing guidance and resources.
- Submit weekly investigation updates: Every Monday while the investigation is open, you will receive an email prompting you to submit a weekly investigation update. Use the Investigation Update Form link provided to you to report a cumulative case count, most recent symptom onset date, and any hospitalizations or deaths associated with your facility.
- Investigation closure:
- If your facility meets outbreak criteria, your investigation will close when 15 days have passed since the last positive COVID-19 case was identified. Please submit an Investigation Update Form to indicate that your outbreak is over and report your cumulative case counts.
- If your facility does not meet outbreak criteria, your investigation will close when 8 days have passed since the last positive COVID case was identified.
- Report subsequent cases: After the investigation is closed, subsequent cases should be reported using thee Public Health COVID-19 Intake Survey.
Notify all staff, residents, and applicable resident families
Notify all staff, residents, and applicable resident families of COVID-19 in your facility while maintaining confidentiality of the positive case(s).
- Encourage residents and staff to self-monitor for COVID-19-like symptoms and review CDC’s COVID-19 Symptom List
- For healthcare staff who provide direct patient care: exclude COVID-19 positive staff (or visitors/contractors) from the facility
- Staff should not return to work until they meet CDC return to work guidelines
- For example, HCP with mild to moderate illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met*:
- At least 7 days have passed since symptoms first appeared if a negative viral test** is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7), AND
- At least 24 hours have passed since last fever without the use of fever-reducing medications, AND
- Symptoms (e.g., cough, shortness of breath) have improved.
- For non-healthcare staff who do not provide direct patient care, follow What to do if you test positive for COVID-19 (DOH)
- Isolate for a full 5 days after onset of symptoms or positive test if asymptomatic
- Can return to work after this isolation period if symptoms are improving and no fever for prior 24 hours
- Will need to wear source control (a well-fitting, high quality mask) while at work, indoors and around others for full 10 days
- For guidance on isolating COVID-19 postive residents, follow What to do if you test positive for COVID-19 (DOH)
- If resident tested positive for COVID-19:
- Isolate for a full 5 days after symptoms onset (or positive test if asymtomatic) if:
- Resident’s symptoms are improving AND
- Resident does not have a fever for 24 hours without the use of fever reducing medications
- NOTE: If resident develops symptoms after testing positive, their 5 day isolation time should start over
- Masking: Confirmed COVID-19 positive residents should wear a mask for a full 10 days while indoors with others. These residents should also not participate in group activities or communal dining during this time.
- If healthcare personnel/staff provide direct patient care to a COVID-19 positive resident, they should should practice transmission-based precautions while caring for this individual (fit-tested N95, gown, gloves, eye protection) for the full 10 day period
- Identify all facility close contacts (staff and residents) as well as affected unit(s):
- Review CDC’s close contact definition and follow What to do if you were potentially exposed to someone with COVID-19 (DOH)
- Wear a high-quality mask while indoors and around others for a full 10 days after last exposure to COVID-19 positive case
- This individual would also not be able to attend communal dining or group activities where masking is not able to be maintained
- Anyone potentially exposed and presenting new symptoms should isolate and test immediately.
*In individuals who have a more serious illness or are immunocompromised please refer directly to CDC guidance as isolation times vary in these instances.
**Either a NAAT (molecular) or antigen test may be used. If using an antigen test, HCP should have negative test obtained on day 5 and again 48 hours later.
NOTE: If a resident was cared for by an infectious healthcare worker (even if the caregiver was wearing a mask or N95), they are considered an exposed close contact
Facilities can consider pausing group dining until extent of transmission is known.
- If you need support acquiring COVID-19 treatment for residents, DOH’s Test to Treat Program may be able to assist.
- Immediately test and isolate symptomatic residents or furlough staff and follow COVID-19 Testing: What you need to know (When to test), CDC
- Post-exposure testing for those not showing symptoms is recommended at least 5 full days after last exposure, and ideally for a series of 3 antigen tests every 48 hours
- Facilities can also consider an additional test between day 3-5
- If additional cases are identified while completing post-exposure testing, you can consider implementing testing every 3-7 days until no new cases are identified after 14 days
Ordering testing and testing supplies
- Information on where staff can get testing if they cannot get tested at your facility.
- If you are a CLIA waived facility and wish to order BinaxNow Pro tests please speak with your assigned investigator or email firstname.lastname@example.org
- If you are a facility without a CLIA waiver and want information on how to obtain a CLIA waiver to use rapid antigen tests at your facility, email email@example.com
- Over the counter (OTC) BinaxNow tests are available for non-CLIA waived facilities. Order tests.
- PPE and source control may be indicated for wear. Please review and follow DOH Guidance on PPE Use.
- Ensure staff wear source control for full 10 days after exposure to a confirmed case of COVID-19.
- Healthcare workers will need to wear a fitted N95 mask when caring for residents with COVID-19
- Encourage residents and staff to stay up to date with COVID-19 vaccinations.
- For vaccine appointments, visit the DOH Vaccine Locator.
- If you need support with COVID-19 vaccines for your residents, please call 206-848-0243 or email firstname.lastname@example.org.
- Encourage staff and residents to get the annual influenza vaccination. Those who are 60 years and older are also eligible for the RSV vaccine.
Please notify your investigator if your facility is having difficulty providing critical services to residents due to isolation or quarantine of staff.
To request staffing support from DSHS Rapid Response Team, contact your DSHS Field Manager and use this request form.
- Note that local workplace safety and health requirements may differ slightly from federal guidance. Please review WA Dept. of Labor & Industries resources to ensure regulatory compliance.
- Improving indoor air, Public Health – Seattle & King County
- Ventilation and Air Quality for COVID-19, WA Dept. of Health
- Ventilation in Buildings, CDC
Cleaning and disinfection guidance
Link/share our site at kingcounty.gov/covid/ILFtoolkit