• Confusion, Fear of Legal Liability Leads to Counties Creating, Rescinding Local "Safer-at-Home" Orders Nursing Home Visitation Restrictions Not Directly Affected by Supreme Court Decision; DHS Recommends all LTC Facilities Restrict Visitors
• DHS Publishes, Then Withdraws Scope Statement for Stay-at-Home Emergency Rule
• Gov Evers: Senate Rejecting DHS Secretary Would Be "Chaotic"
• CMS Issues New Guidance on "Reopening" Nursing Homes
• Questions Answered on COVID-19 Reporting Requirements
• Required Data Collection for COVID-19 Disease Testing; New Guidelines for COVID-19 Testing at Wisconsin Public Health Laboratories
• Wisconsin Assisted Living Forums: Regulatory Response to COVID-19
• COVID-19, Visitation and Long-Term Care Communities

• Template letter – notification to families that the CMS visitation restriction memo is still active
• Template door posting – notification that visitation restrictions remain in effect
• Template communication to staff encouraging the use of caution and social responsibility

1. Staffing less than your facility needs or internal policies for staffing ratios (despite efforts made by the facility to secure staff) 
2. Employing crisis strategies for staffing shortage 
3. Using any temporary positions per waiver allowances (such as temporary nurse aide or temporary feeding assistant) or agency staff, yet staffing ratios for facility needs and internal policies are still not met 

1. They have made a good faith effort to exhaust all other options; 
2. There are no skilled nursing facilities within the hospital’s catchment area that under normal circumstances would have accepted SNF transfers, but are currently not willing to accept or able to take patients because of the COVID-19 PHE; 
3. The hospital meets all waiver eligibility requirements; and 
4. They have a plan to discharge patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.  

• The next phase in Wisconsin’s COVID-19 pandemic response will require a massive scale up of testing (a health care activity) and contact tracing (a local public health activity). For these intensified activities to succeed, a new and stronger commitment to collecting and reporting patient-level data is needed.
• To enable collaboration between health care partners and state and local public health, DHS is requiring collection of a standard set of data elements for all patients at the time of testing, and will be supporting numerous strategies for submitting these data to public health.
• As more labs develop testing capacity, Wisconsin’s public health labs are able to accept a broader range of patients for fee-exempt testing. The expanded priority list for public health testing is available on the DHS website.

• Patient Demographics (Name, DOB, Gender, Race/Ethnicity, Preferred Language)
• Contact Information (Mobile Phone Number, Secondary Phone Number, Address)
• Reason For Testing (Symptoms, Pre-procedure Screening, Public Health Investigation)
• Hospitalization Status
• Occupation
• Link (if any) to outbreak investigation or community testing initiative
• Specimen type

• Public Health Investigations as directed by state or local public health
• Hospitalized patients with COVID-19 symptoms
• Patients with COVID-19 symptoms for whom rapid diagnosis is needed to inform infection control practices (e.g. labor and delivery, dialysis, aerosol-generating procedures, etc.)
• Resident of a long-term care facility with COVID-19 symptoms
• Resident in a jail, prison, or other congregate setting with COVID-19 symptoms
• Health care worker or first responders (e.g. fire, EMS, police) with COVID-19 symptoms
• Essential staff in high consequence congregate settings (e.g. prisons or jails) with COVID-19 symptoms
• Utility workers (water, sewer, gas, electric, power, distribution of raw materials, oil and biofuel refining) with COVID-19 symptoms
• Underserved populations with poor access to testing in other settings (e.g., underinsured, patients at Federally Qualified Health Centers, homeless patients, migrant workers, etc.) with COVID-19 symptoms
• Post-mortem testing for a person with COVID-19 symptoms prior to death who died of unknown causes AND where results would influence infection control interventions at a facility or inform a public health response

• Facilities should restrict all visitors and nonessential health care personnel, except for certain compassionate care situations, such as an end-of-life scenario. Facilities should notify potential visitors of the need to defer visitation until further notice (through signage, calls, letters, etc.).
• In compassionate care situations, visitors will be limited to a specific room only. Facilities should require visitors to perform hand hygiene and use personal protective equipment (PPE), such as face masks. Decisions about visitation during an end-of-life situation should be made on a case-by-case basis, which should include careful screening of the visitor (including clergy, bereavement counselors, etc.) for fever or respiratory symptoms.
• Individuals with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations).
• Visitors that are permitted to enter must wear a face mask while in the building and restrict their visit to the resident’s room or other location designated by the facility. Facilities should also remind visitors to frequently perform hand hygiene, especially after coughing or sneezing. 

• Other health care workers, such as hospice workers, EMS personnel, or dialysis technicians, who provide care to residents should be permitted to enter the facility as long as they meet the CDC guidelines for health care workers.
• Facilities should contact their local health department for questions, and frequently review the CDC COVID-19, website for health care professionals.

• Offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.).
• Creating and/or increasing listserv communication to update families, such as advising them to not visit.
• Assigning staff to serve as the primary contact to families for inbound calls, and conducting regular outbound calls to keep families up to date.
• Offering a phone line with a voice recording updated at set times (for example, daily) with the facility’s general operating status, such as when it is safe to resume visits.

• Use Facetime, Skype or other mobile media, if your resident has access to a device, or as arranged by the home.
• Send extra cards, notes, postcards, being sure to keep your message short and positive.
• Phone your resident often, but please try not to call during the busiest times of day if staff need to assist your resident with the phone.
• If your resident is unable to talk on the phone or use mobile media to stay in touch, ask the staff if someone can call you periodically to give you an update about how your resident is doing.