Experts Offer Practical Guidelines for COVID-19 Prevention and Management in Post-Acute and Long-Term Care

May 12, 2020

For post-acute and long-term care (PALTC) providers, the rise of COVID-19 into a global outbreak has presented a serious crisis. This rapidly developing situation has not only resulted in disproportionately high resident illnesses and deaths from the virus, but also transmission of COVID-19 to health care workers. An article in the May issue of JAMDA offers guidance for long-term care facilities and their care teams to help protect this high-risk patient population.

In Long-Term Care Facilities and the Coronavirus Epidemic: Practical Guidelines for a Population at Highest Risk, the authors offer five key elements for appropriate coronavirus preparedness: (1) reduce morbidity and mortality among those infected, (2) minimize transmission, (3) ensure protection of health care workers, (4) maintain health care system functioning, and (5) maintain communication with worried residents and families.

The authors said, “Absent vaccination and antiviral prophylaxis, stringent and proactive infection prevention and control measures remain the best way to reduce the risk of staff and residents becoming ill.” This includes steps to reduce both the risk of introducing COVID-19 into nursing homes and transmission within the nursing home. The authors suggested activating airborne disease transmission protocols, including a respiratory outbreak preparedness checklist.

Once COVID-19 has begun to spread in a community, the authors recommended additional measures, including limiting visitors and screening staff on entry (for fever or respiratory symptoms). “Early suspicion and detection of a case will help identify which resources can be deployed to further prevent or reduce the spread of the disease.” The authors also stressed the importance of hand hygiene as among the most fundamental measures to prevent disease transmission.

Environmental services, the authors said, “should be engaged to perform at least daily cleaning with Environmental Protection Agency (EPA)-registered hospital grade disinfectants.” These will be key to containing the disease, especially in high-traffic areas such as dining halls and living spaces.

The authors suggested guidance on other issues such as ensuring protection of health care workers, maintaining health care infrastructure, and addressing COVID-19 in assisted living. They stressed, “Currently, the types of precautions recommended for people with suspected COVID-19 are still evolving.” There is also much to learn about potential treatments for this disease, and there a need for more and more accurate testing. In the meantime, the authors said, “Training staff and visitors on how to minimize their risk for picking up virus in the community and the facility and transmitting it to others will remain our most important tools.”

This study was conducted by researchers at the Center for Gerontology and Healthcare Research, Brown University, Providence, RI; Warrant Alpert School of Medicine, Brown University, Providence, RI; Providence VAMC Center of Innovation, Providence, RI; Geriatric Research Education and Clinical Center (GRECC) at the VA Northeast Ohio Healthcare System, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population & Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; and University of Rhode Island College of Pharmacy, Kingston, RI.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.