Updated Residential Care Facilities Mitigation Guidance–July 2021

The last few weeks have again put our industry into a reactive posture.  First, the Western and Southern counties struck by Delta variant cases were suddenly placed under a more restrictive Enhanced Infection Prevention Recommendation.  And now, those counties have been brought back under the same Residential Care Facilities Mitigation Guidance as everyone else but it has been modified to incorporate much of the more restrictive measures.

They have added a requirement that newly diagnosed COVID positive patients be evaluated by a provider for use of monoclonal antibody treatment soon after the receipt of the positive diagnosis.  Please note:  Monoclonal antibodies are recommended for outpatients with mild to moderate Covid-19 symptoms who are at high risk of disease progression.  The 2 choices at this time that would be considered effective are:  Casirivimab plus imdevimab; or Sotrovimab.

Here is a summary of the new guidance.

Surveillance Testing

Unvaccinated** staff

Þ    POC Rapid test at beginning of each shift

Þ    1x/week PCR – <10% positivity in county

Þ    2x/week PCR – >10% positivity in county

Unvaccinated** residents who have left facility for 24+ hours within previous 14 days

Þ    Daily POC x14 days from return

Þ    1x/week PCR – <10% positivity in county

Þ    2x/week PCR – >10% positivity in county

Þ    Exclude those who tested PCR positive in the past 90 days and remain asymptomatic.


Outbreak Testing

Unvaccinated** staff  

Þ    POC test at beginning of each shift

Þ    2x/week PCR test

Unvaccinated** residents, regardless of whether they’ve left the facility

Þ    Daily POC test

Þ    2x/week PCR test

Vaccinated staff & residents

Þ    2x/week PCR



Þ    Outdoor always permitted, regardless of vaccination status

Þ    Unvaccinated** residents/visitors must wear mask

Þ    Compassionate care visits and visits required under federal disability rights law should be allowed at all times, for any resident, and regardless of vaccination status.


Þ    When a new case (residents or staff) is identified, begin outbreak testing and suspend all visitation.

Þ    If the first round reveals no additional cases in other areas of the facility, visitation can resume for units with no identified positive residents. Visitation should be suspended for all residents on the affected unit until the facility meets the criteria to discontinue outbreak testing.

Þ    If outbreak testing reveals one or more additional cases in other areas/units of the, then facilities should suspend visitation for all residents until the facility meets the criteria to discontinue outbreak testing.


14-day Quarantine for…

Þ    new unvaccinated** admissions or vaccinated admits who have had prolonged exposure to a positive case within the previous 14 days

Þ    Unvaccinated** residents who have been out of facility for 24+ hours



Þ    Unvaccinated** Staff must wear masks

Þ    Unvaccinated** Staff wear eye protection during outbreak or if in a county with >10% two-week average test positivity rate

Þ    6-foot social distancing whenever possible


Dining and Activities

Þ    Unvaccinated** residents must dine 6 feet apart – all in dining room with them must wear masks when not eating

Þ    Vaccinated residents may dine with other vaccinated residents; during outbreak 2 per table

Þ    Outings – unvaccinated** residents can only attend if 6′ distance can be assured

Þ    Vaccinated visitors may join dining, activities, and outings


**Unvaccinated and Partially Vaccinated Individuals: including persons who have never received a vaccine (unvaccinated) and persons who have received one or two doses but have not yet met the complete criteria for full vaccination (partially vaccinated). This includes individuals whose vaccination status is unknown.