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IDH Updates LTC COVID-19 Infection Control Guidance

Posted Nov 23, 20213 min Read

Regulatory & Clinical

On November 23, 2021, the Indiana Department of Health updated COVID-19 guidance and toolkit to complement the most recent CMS guidance related to visitation for Nursing Homes and Assisted Living.

The updates are noted below in red text.  It is critical that facilities read this guidance and compare it to current facility policies.  This new guidance has also been incorporated into the COVID-19 LTC Toolkit (a link for which can be found on the IHCA’s main COVID-19 page).


  • All persons that enter the facility must be screened.
  • Continue to limit confirmed or presumed COVID-19 positive resident contact to essential direct care providers and designated essential family care givers.
  • Deny entry to those with COVID-19 diagnosis, signs or symptoms, or those with contact with someone with COVID-19 infection in the prior 14 days (regardless of the visitors vaccination status).
  • Visitors who have a positive viral test for COVID-19, symptoms of COVID-19 or meet the criteria for quarantine, should not enter the facility.


  • All direct and indirect care staff, vaccinated and unvaccinated, must wear a medical procedure mask for the duration of their shift when indoors.
  • Fully vaccinated HCPs and residents may choose to not wear a mask outdoors if in small groups (if in medium or large crowds, mask is required and adhere to social distancing).
  • N95 respirator masks are required in Red and Yellow Zones.
  • Ensure a plan is in place to transition away from approved KN95 to N95 masks. KN95s are permitted for Green Zone use.
  • Cloth masks for visitors are acceptable.
  • Residents should mask (cloth is acceptable) when they leave their room and when receiving care within 6 feet of the HCP.

Eye Protection

  • Eye protection is required for all resident care in Green Zones when community transmission is substantial or high.
  • Eye protection is always required for residents in Transmission Based Precautions – Yellow and Red Zones

Social Distancing

  • All residents, visitors, and staff should maintain social distancing in all cases as much as possible.  This reduces changes of meeting close contact definition of being within 6 feet for more than 15 minutes over a 24 hour period.

Cohorting of Residents

  • Continuation of effective cohorting in separate areas that are clearly marked with signage to also ensure that appropriate PPE is worn upon entering the area.
  • Ensure a plan is in place to rapidly implement a yellow or red zone for a positive or presumed positive COVID-19 resident.
  • Facilities with a dedicated COVID-19 memory unit, residents may continue to socialize as long as there are no COVID-19 negative residents or residents with unknown COVID_19 status in the unit.

Institutional Signage

  • Remove older versions of the Visitation Requirements Guideline signage and replace with the new updated Visitation Requirements Guidelines.

Isolation and Removal Recommendations

  • Track and monitor resident with COVID-19 to ensure they remain on TBP until at least 10 days and up to 20 days (residents with severe to critical illness or are severely immunocompromised) after symptom onset and 24 hours after resolution of fever, without use of antipyretic medication, improvement in symptoms (e.g., cough, shortness of breath), whichever is longer.

About the Author

Lori Davenport, Director of Regulatory and Clinical Affairs, Indiana Health Care Association