Recommendations For Infection Control & Prevention Of COVID-19 In Facilities Serving Older Adults

Updated: Jul 8, 2020

According to the Centers for Disease Control and Prevention (“CDC”), older adults have higher risks related to the COVID-19 disease, commonly known as the coronavirus (“COVID-19”). The Maryland Department of Health (“MDH”) is publishing these recommendations to help deter the spread of COVID-19 among older adults.

These recommendations apply to skilled nursing facilities, assisted living facilities, adult medical daycare providers, hospice facilities, and rehabilitation facilities with older adult patients (“Senior Care Facilities”). Other facilities at which older adults reside, or that provide services to older adults, are strongly encouraged to review and, as reasonably appropriate, implement these recommendations.

To help deter the spread of COVID-19, MDH recommends that all Senior Care Facilities:

1. In all cases, comply with the more stringent of applicable CMS guidance or these


2. If visitors meet the criteria in #3 below, facilities may restrict their entry to the facility. Specifically, a facility may need to restrict or limit visitation rights for reasonable clinical

and safety reasons.

3. Facilities should actively screen and restrict visitation by those who meet the following


  • Signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath, or sore throat.

  • In the last 14 days, has had contact with someone with a confirmed diagnosis of COVID19, or under investigation for COVID-19, or are ill with respiratory illness.

  • International travel within the last 14 days to countries with sustained community transmission. For updated information on affected countries visit

  • Residing in a community where community-based spread of COVID-19 is occurring.

  • For those individuals that do not meet the above criteria, facilities can allow entry but may require visitors to use Personal Protective Equipment (PPE) such as facemasks.

4. Facility staff should be screened in the same manner as visitors. Specifically:

  • Health care providers (HCP) who have signs and symptoms of respiratory infection should not report to work.

  • Any staff that develops signs and symptoms of a respiratory infection while on-the-job, should:

- Immediately stop work, put on a facemask, and self-isolate at home.

- Contact and follow the local health department recommendations for the next steps.

- If applicable, inform the facility’s infection preventionist, and include information on individuals, equipment, and locations the person came in contact with.

Refer to the CDC guidance for exposures that might warrant restricting asymptomatic

healthcare personnel from reporting to work at:

5. Require all individuals entering the facility to wash their hands upon entry. If soap and

water are not available, alcohol-based hand sanitizers may be used.

6. Instruct all individuals entering the facility to limit their movement within the facility to

only those areas that are necessary for the purpose of their visit.

7. Establish processes to allow remote communication for residents and others.

8. Provide staff with training on infection control and prevention procedures.

9. Frequently disinfect equipment and workspaces, and limit sharing of equipment between

residents and areas of the facility.

10. Effectively communicate these recommendations to all individuals entering the facilities

and families of residents, using means such as:

  • Signage throughout the facility and at each point of entry, and

  • Proactive communication to residents, family members, visitors, vendors, and staff.

11. Follow the guidance of the Centers for Medicare and Medicaid Services (“CMS”) related


  • Transfers of residents with suspected or confirmed COVID-19 to a hospital, and

  • Acceptance of residents diagnosed with COVID-19 from a hospital.

12. Regularly review and, where applicable, implement all recommendations and guidance of MDH, CDC and CMS related to preventing the transmission of COVID-19.

Senior Care Facilities are strongly encouraged to regularly monitor MDH’s web site and social media accounts, as these recommendations may be updated from time to time.

MDH acknowledges that implementation of these regulations may cause regulated Senior Care Facilities to be in non-compliance with certain State regulatory requirements, including without limitation, regulations relating to visitation, resident activities, and staffing ratios.

MDH will not take enforcement action under State law or regulation against any regulated Senior Care Facility for regulatory non-compliance that arises solely from the good faith

implementation of these recommendations during the period in which the Governor has

proclaimed a state of emergency related to COVID-19.

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