COVID-19 Update May 4, 2020

To the Bloom Healthcare community,

Bloom Healthcare intends on being your trusted source of information concerning the coronavirus. We will be circulating this publication weekly and/or as we receive new information from the CDC, AMDA, White House, CO Department of Public Health, international medical journals and other sources.  Bloom understands that we are all supporting the same vulnerable population and we appreciate your dedication and a solid team approach. We encourage you to reach out to us at 303.993.1330 or directly to your Bloom provider should you have any questions or require clarification.

The Latest:

The CDPHE has begun following through on the recommendations from the governor’s office concerning assisted living and long-term care COVID-19 preparedness. Surveyors are visiting communities across the state to assess their readiness regarding monitoring resident & employee illness, social distancing, PPE for staff, resident movement, isolation precautions, and supply plans.

The state is also continuing to encourage active monitoring of resident symptoms on a daily basis.  Bloom feels that this is an appropriate measure. Where possible, consider incorporating vitals checks into routine care and resident interactions rather than conducting daily vital checks in a rounding format that may introduce opportunities for new exposure and cross contamination.

Bloom Recommendations on Conducting Safe Move-Ins During the COVID-19 Crisis

We understand that the prospect of moving new residents into independent, assisted, or memory care communities during the coronavirus outbreak can be daunting. Transitioning residents into the community with an uncertain COVID status or possible exposures presents tremendous risk to existing staff and residents. At the same time, the need for vulnerable seniors to find safe communal housing has not gone away during this crisis.

The Bloom team has developed recommendations on how to conduct safe move-ins based on frequent testing strategies, CDC guidance and infection control best practices to address this need. These recommendations are founded on a few key principles:

• Don’t jeopardize the health of many for benefit of few
• Conduct testing for each possible move-in
• Perform symptomatic and clinical assessments
• Track all possible exposures
• Deploy a conservative isolation & quarantine approach

For potential residents with known previous COVID positive status

A resident who previously tested COVID positive may move into a community:

1. After confirming documentation of positive status and
2. Proof of use of one of the CDC’s approved clearance strategies:
   1. Test Based: A patient who previously tested COVID positive may be cleared from precautions if all of the following are met (Bloom strongly recommends this Test Based approach):
      1. At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and
      2. Negative COVID-19 result from at least two consecutive specimens collected ≥24 hours apart (total of two negative specimens).
   2. Non-Test Based: A patient who previously tested COVID positive may be cleared from precautions if all of the following are met:
3. 1. 1. At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and
      2. At least 7 days have passed since symptoms first appeared

Note: If a Non-Test Based strategy is used, Bloom still recommends the resident undergo a single test and receive a negative result prior to move-in.

Potential residents with no known previous COVID positive test

1. A resident without known COVID history should have risk assessed for exposures, including:
   1. COVID-19 positive caregiver (family, hospice, home health) within last 14 days
   2. COVID-19 positive person living with patient who has not been cleared formally
   3. Persons with respiratory symptoms visiting or caregiving for the patient
   4. ER visit to a facility with known COVID cases in last 14 days
   5. Hospitalization in last 14 days
   6. SNF or Rehab visit in last 14 days
   7. Multiple caregivers necessary for routine care
2. Any patient with high risk exposure should be isolated for 14 days prior to move in
   1. Isolation is defined as having no high-risk exposures
   2. Have no visitors except for typical caregivers
3. All patients, regardless of high risk exposures, should be tested and receive a negative result prior to move in whenever possible.
4. When patients are unable to isolate for a full 14 days, the accepting community should utilize COVID Transmission Based precautions (Full PPE) for 14 days upon move-in.

Guidance upon move in

After move-in to the community, new residents should:

1. When able, have the resident wear a facemask at all times while in the community until 14 days after move-in.
2. Adhere to hand hygiene, respiratory hygiene, and cough etiquette in (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles).

Self-monitor for symptoms and seek evaluation of a medical provider if respiratory symptoms or fever develop.

For any communities needing assistance clearing residents for move-in, please contact Bloom.

Our previous COVID-19 communications and recommendations can be found at:

bloomhealthcare.com/news/

We appreciate your partnership and continued diligence.

Sincerely,

Thomas Lally, MD