Residential Care Facilities for the Elderly (RCFEs) are congregate living settings with a fragile, vulnerable population at high risk for COVID-19 mortality and morbidity. RCFE staffing are generally less equipped to implement the infection prevention control measures to successfully prevent and/or mitigate spread.

description

In San Francisco (SF), there are approximately 100 RCFEs which care for residents with needs, ranging from minimal board and care support to multi-faceted supervision of activities of daily living. In order to assess and educate, the SF Department of Public Health outbreak and community units developed a standardized assessment tool with bullet points to guide and inform discussions.

In total 85 RCFEs, risk-stratified by site characteristics, history of complaints, and priority location, were reached by phone and 24 site visits were conducted.

lessons learned

• Phone survey process allowed us to quickly gather information on facility characteristics, but not the most effective way for providing education and guidance
• Non-medical staff were often challenged by medical questions
• Behavior changes needed to implement guidelines require more than one site visit to reinforce protocols and processes
• None of the high-risk sites had outbreaks
• The size of the facility has a stronger correlation with COVID positivity

implications/recommendations

• Onsite visits are important for greater insight and support of RCFEs
• Approach must include a review and development of a realistic and practical infection control and surge/outbreak plan
• Tabletop training scenarios are necessary to facilitate planning and address implementation challenges