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Assisted Living and Adult Day Care Centers: Standards of Practice Resources

Standards of practice help make sure residents receive the best care. There are many standards to consider. This page contains several resources to help understand these standards.

COVID-19 guidance, recommendations, and resources

Assisted living facilities (ALFs) care for residents who are elderly, who may also have chronic medical conditions that place them at higher risk of developing severe complications from COVID-19. ALFs typically provide some form of health care to their residents. This can range from passing medication to assistance with activities of daily living and more. ALFs should follow the CDC COVID-19 infection control guidance when providing health care to residents in order to improve their infection prevention and control practices and prevent the transmission of COVID-19.

Admissions

Facilities should admit any individuals that they would normally admit to their facility, including individuals from hospitals where a case of COVID-19 was or is present. Facilities should follow the CDC infection control guidance when COVID-19 is identified or suspected in a resident. Facilities may not require a negative COVID-19 test as a condition of admission.

Newly admitted or readmitted residents who are not up to date with all recommended COVID-19 vaccinations should be encouraged to remain up-to-date with all recommended COVID-19 vaccine doses.

Admissions during a COVID-19 outbreak

When a suspected or confirmed case of COVID-19 is identified in a facility, the facility may temporarily halt admissions to the facility, at least until the extent of transmission can be clarified and interventions can be implemented. See Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities for more information.

While COVID-19 remains a threat to long-term care residents, a facility may determine that they can safely admit a resident if certain considerations are taken into account. Facility leadership should carefully review CDC's Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic and consult with the local public health officer when possible.

Discharges and transfers

If a resident has been exposed and is being discharged, the discharging facility must inform the facility that is accepting the resident. This will allow the facility that is accepting the resident to ensure the resident uses source control and that any recommended testing is completed.

The strategies used to limit the spread of COVID-19 are especially difficult for residents with dementia due to their decreased cognitive ability. Residents with dementia may require additional assistance adhering to quarantine and isolation. In particular, residents with dementia may have an impaired ability to follow or remember the following instructions and may require additional assistance and reminders from staff:

  • Refraining from touching face
  • Handwashing
  • Wearing a mask
  • Refraining from placing things in their mouth
  • Social distancing - staying in a particular area
  • Other interventions requiring individual follow-through or accountability

Reporting requirements

Wisconsin has communicable diseases reporting requirements. Specific reporting requirements are described in Wis. Admin. Code ch. DHS 145 Control of Communicable Diseases. A list of reportable communicable diseases and other conditions is provided in Wis. Admin. Code ch. DHS 145 - Appendix A.

On September 29, 2023, DHS issued Changes to COVID-19 Reporting Requirements in Wisconsin, BCD 2023-05 (PDF) wherein the State Epidemiologist declared effective November 1, 2023, reporting of COVID-19 cases to public health is no longer required unless a confirmed or probable case is associated with a hospitalization or pediatric death.

Outbreak reporting requirements

In Wisconsin, confirmed or suspected outbreaks of any disease in health care facilities, including long-term care facilities, are a Category I Disease, meaning they shall be reported immediately by telephone to the patient's local health officer, or to the local health officer's designee, upon identification.

Suspected respiratory disease outbreak, including COVID-19

According to DHS guidance for Preventing and Controlling Respiratory Illness Outbreaks in Long-Term Care Facilities, a suspected respiratory disease outbreak in a long-term care facility is defined as three or more residents and/or staff from the same unit with illness onsets within 72 hours of each other and who have pneumonia, acute respiratory illness, or laboratory-confirmed viral or bacterial infection (including influenza and COVID-19).

CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic for infection prevention and control recommends staff who provide care for a resident with suspected or confirmed COVID-19 should adhere to standard precautions and use a fit tested N95, eye protection (goggles or face shield), gown, and gloves.

When an outbreak of acute respiratory illness, such as COVID-19 or another viral respiratory disease (e.g., influenza, RSV) is suspected, timely testing, reporting, and infection control is imperative. Until the cause of an acute respiratory illness outbreak is determined, facilities should initiate empiric precautions at the most protective level, a fit tested N95, eye protection (goggles or face shield), gown, and gloves.

CDC COVID-19 infection prevention and control guidance recommends ALFs should have a process to provide guidance ( e.g., posted signs at entrances with instructions) about screening everyone (to include but not limited to all staff, visitors, clergy, hospice, health care personnel, surveyors, vendors, volunteers) entering the facility and what actions they should take for anyone who meets any of the following three criteria:

  • Tested positive for SARS-CoV-2 with a viral test
  • Has symptoms of COVID-19, or
  • Had a known exposure to someone with COVID-19 (or a higher-risk exposure for health care personnel).

Visitors who have met community criteria to discontinue isolation or quarantine should not visit the facility until they have met the same healthcare criteria used to Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic for residents.

Staff who have a fever or any COVID-19 symptoms prior to or during their shift should be excluded from work. Decisions about when staff can return to work should be made using CDC Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection.

Infection control is recommended for individuals in healthcare settings who:

  • Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
  • Had close contact (residents and visitors) or a higher-risk exposure (health care personnel) with someone with SARS-CoV-2 infection, for 10 days after their exposure

Infection control is recommended more broadly as described in the CDC's Core Infection Prevention and Control Practice in the following circumstances:

  • By those residing or working on a unit or area of the facility experiencing a SARS-CoV-2 or other outbreak of respiratory infection; universal use of source control could be discontinued as a mitigation measure once the outbreak is over (e.g., no new cases of SARS-CoV-2 infection have been identified for 14 days); or
  • Facility-wide or, based on a facility risk assessment, targeted toward higher risk resident populations (e.g., when caring for residents with moderate to severe immunocompromise) during periods of higher levels of community SARS-CoV-2 or other respiratory virus transmission
  • Facility-wide when COVID-19 hospital admission levels are high

Staff with COVID-19 (regardless of whether the staff member is showing symptoms or not) and staff with acute respiratory infection (ARI) who are not tested for COVID-19 should be excluded from work until they have met the criteria set by the Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2.

Exceptions to this recommended practice will increase the risk of COVID-19 transmission to residents of long-term care facilities, but may be necessary in a crisis situation.

Admission testing is at the discretion of the facility.

Anyone with even mild symptoms of COVID-19 should receive a viral test for SARS-CoV-2 as soon as possible.

In the absence of testing, individuals providing care to symptomatic residents should adhere to standard precautions and wear a fit tested N95, eye protection (goggles or face shield), gown, and gloves.

Asymptomatic residents with close contact with someone with SARS-CoV-2 infection should have a series of three viral tests for SARS-CoV-2 infection. Testing is recommended immediately, but not earlier than 24 hours after the exposure. If the test is negative, the resident should be tested again in 48 hours. If the second test is negative, the resident should be tested again in 48 hours. If exposure is day 0, testing will typically be on day 1, day 3, and day 5. Source control is recommended for 10 days after their exposure. Source control is recommended for 10 days after their exposure.

Staff - Following a higher-risk exposure, staff should have a series of three viral tests for SARS-CoV-2 infection. Testing is recommended immediately, but not earlier than 24 hours after the exposure. If the test is negative, staff should be tested again in 48 hours. If the second test is negative, staff should be tested again in 48 hours. If exposure is day 0, testing will typically be on day 1, day 3, and day 5. Source control is recommended for 10 days after their exposure.

Staff should follow recommended infection prevention and control practices including wearing well-fitting source control, monitoring themselves for fever or symptoms consistent with COVID-19, and not reporting to work when ill or if testing positive for SARS-CoV-2 infection.

Staff who are unable to be tested or wear source control should be excluded from work.

CDC Testing and Management Considerations for Nursing Home Residents - While these considerations are specific to care of residents residing in nursing homes, some practices could be adapted for use in assisted living facilities.

While most people with COVID-19 have mild illness and recover at home, some people require medical care and treatment. Treatments for COVID-19 should always be prescribed by a doctor. If someone has COVID-19 symptoms, contact a doctor right away and do not delay treatment.

Additional resources

Improving ventilation in buildings:

  • To improve ventilation in your building, keep your system operating as designed. Aim for at least 5 air changes each hour and upgrade to MERV-13 filters if able to do so.
  • Good ventilation is essential to maintaining a healthy indoor environment and protecting building occupants from respiratory infections.
  • Improving ventilation in buildings can help reduce the number of viral particles in the air and lower occupants' risk of exposure to respiratory viruses.
  • Implementing multiple infection prevention and control strategies at the same time can increase the overall effectiveness of ventilation interventions.

Improving ventilation in your home:

Ventilate your home by getting fresh air into your home, filtering the air that is there, and improving air flow. Improving ventilation can help you reduce virus particles in your home and keep COVID-19 from spreading. You may or may not know if someone in your home or if a visitor to your home has COVID-19 or other respiratory viruses. Good ventilation, along with other preventive actions, can help prevent you and others from getting and spreading COVID-19 and other respiratory viruses.

Resources

Report Abuse, Neglect, or Misappropriation

Dementia Care Practice Recommendations

Bed bugs

CDC (Centers for Disease Control and Prevention)

Clostridioides Difficile (C. diff)

According to the CDC, Clostridioides difficile (C. diff) is a germ that causes severe diarrhea, which can be life-threatening. C. diff can affect anyone and is usually associated with recent antibiotic use. The CDC estimates that C. diff causes almost half a million infections in the United States each year.

The following resources are available to protect yourself, residents, families, and the facility from C. diff.

Hand hygiene

Injection safety

Measles

Tuberculosis

Use of leg bags

Use and Care of Leg Bags in Long-term Care

Imagine

Promoting emotional health and preventing suicide: A toolkit for senior living communities

Bathing Without a Battle

Root Cause Analysis Toolkit

For questions regarding this information or for technical assistance, providers should contact the Division of Quality Assurance (DQA), Bureau of Assisted Living (BAL) regional offices.

Glossary

 
Last revised March 3, 2025