Long-term care facilities continue to be a top priority for Illinois’ public health officials during the COVID-19 pandemic. The State of Illinois has worked diligently to protect residents and staff in long-term care facilities providing guidance, recommendations, technical assistance, testing, and other support. The number of cases of COVID-19 in long-term care facilities has declined by 95% since the peak in mid-April, and now represents just 2% of all Illinois cases. The Illinois Department of Public Health (IDPH) issued guidance early on to limit residents leaving facilities except for essential visits, and prohibit visitors from entering facilities, communal dining, and group activities. Simultaneously, IDPH required long-term care facilities to implement additional, strict infection prevention and control measures with the support and assistance of IDPH and local health departments. The administration also put in place an emergency rule on May 28, 2020 requiring all skilled nursing facilities to develop and deploy comprehensive testing plans that meet the needs of their unique circumstances. • • • • • • Early in the pandemic the only testing available was directly from CDC and it required pre-authorization. Illinois was the first state in the country to offer COVID-19 testing in its state health department labs. IDPH’s proficiency in COVID-19 testing allowed for decreased turnaround times for testing specimens, including specimens collected at nursing homes. IDPH was onsite multiple days and at all hours of the day at the first long-term care facility in Illinois that reported an outbreak. This included collecting specimens for testing. Since assisting that first facility, IDPH has provided ongoing and significant support to long-term care facilities across the state. When PPE was in short supply, the State worked to get hundreds of thousands of pieces of PPE to every long-term care facility in the state. IDPH worked with an independent laboratory to assist with testing for longterm care facilities having difficulty providing their own. IDPH currently has mobile testing teams that can be deployed to facilities around the state. IDPH has made thousands of calls to long-term care facilities to consult on infection control practices, disease surveillance, PPE, and testing. IDPH has also been working with local health departments, infection prevention and control experts, the CDC, and federal CMS to identify facilities experiencing outbreaks and to provide technical assistance through contracted infection control specialists. Each facility is unique – in its population, size, level of acuity, staffing needs, etc. A testing plan appropriate for one facility may not fit the needs of another. Rapid antigen testing is now being deployed to more than 700 facilities across Illinois. As the saliva test at the University of Illinois is scaled up, use in settings like long term care facilities is being explored. Per Emergency Rule issued on May 28, 2020 all skilled nursing facilities are required to develop testing plans and conduct testing of all residents and staff when: (1) the facility is experiencing an outbreak; or (2) directed by IDPH or the certified local health department where the chance of transmission is high, including, but not limited to, regional outbreaks, pandemics, or epidemics. Per Federal CMS guidelines intended to reduce the risk of introducing the virus into longterm care facilities and exposure to a medically fragile population, as well as IDPH staff, IDPH limited certain types of surveys during the height of the pandemic. However, IDPH continued to monitor facilities through calls, video conferences, and meetings with • local health departments. IDPH has conducted 100% of the federally required infection control surveys and is now working on a second round of facility infection control surveys at Federal CMS direction. In addition to protecting the health and safety of long-term care residents and staff, IDPH takes the health and safety of its employees very seriously, particularly because they often interact with staff. IDPH nurse surveyors are all fitted and required to use N95 masks and are provided appropriate PPE to wear. Surveyors should not and are not allowed to work if they have any symptoms and are trained on recognizing COVID-19 symptoms in others and infection control practices to help keep all parties safe. It is important to note that close contact between residents and surveyors is infrequent, rather they observe from an appropriate distance to determine if the facility is in compliance with resident care requirements. There are more than 1,400 long-term care facilities in Illinois. IDPH is the regulator for each of these facilities. IDPH staff, particularly surveyors, are required to perform regulatory oversight and licensure work. IDPH does not have the resources or the authority to provide direct services to residents in regulated facilities, including the provision of nurse staffing at long-term care facilities. Long-term care facilities are reimbursed by residents, private insurance, or Medicare/Medicaid to provide appropriate care in all situations, including infection prevention. Facilities are required to have emergency preparedness plans and adequate staffing for all situations pursuant to state regulations. This can include working with a staffing agency or other facility operators, but it is incumbent upon the facility to provide the services for which they are paid. Nevertheless, at the beginning of this unprecedent pandemic, some facilities did not have adequate emergency staffing plans. In response, the State called for volunteers through Illinois Helps to assist with staffing and allowed certified nursing assistants who were inactive on the Health Care Worker Registry for less than five years and in good standing to return to work. Additionally, IDPH worked with the Illinois Department of Financial and Professional Regulation to enable inactive and out-of-state health care workers who were in good standing to come back to work in the State of Illinois. In addition to having weekly calls and webinars with long-term care facilities to provide guidance and technical assistance to align with CDC, federal CMS, and state guidance and policies, IDPH met twice a week in the first months of the pandemic, and continues to meet weekly with long-term care industry representatives and with a group of legislators focused on Medicare/Medicaid issues. IDPH also works with long-term care ombudsman at the Department on Aging to ensure the health and safety of longterm care residents. Additionally, IDPH receives advice from the Long-term Care Advisory Board, which is made up of a diverse group of stakeholders. IDPH continues to work at capacity to address long-term care issues related to COVID-19 and will respond to any requests made by the General Assembly.