The Occupational Safety and Health Administration (OSHA) is advising nursing homes to regularly screen staff for symptoms of COVID-19, as long-term care has been hit by devastating outbreaks of COVID-19.1

The OSHA recommendations include:

  • Perform regular symptom screening for staff and residents;
  • Send sick workers home or to seek medical care;
  • Closely monitor staff and residents who may have been exposed to COVID-19;
  • Ask visitors to inform the facility if they develop a fever or COVID-19 symptoms within 14 days of a visit;
  • Maintain at least six feet between workers, residents, and visitors to the extent possible;
  • Stagger employee breaks to avoid break room crowding;
  • Consider alternatives to in-person group gatherings, meetings, and resident activities;
  • Closely monitor personal protective equipment (PPE) supplies, burn rate, and supply chains;
  • Create a process to decontaminate and reuse PPE, such as face shields and goggles, when possible;
  • Follow Centers for Disease Control and Prevention (CDC) recommendations to optimize PPE supplies;
  • Encourage workers to report any safety and health concerns.

The combination of a highly infectious virus and a frail resident population in a closed environment — where infection control has historically been difficult to implement — has resulted in devastating outbreaks of COVID-19 in U.S. nursing homes.

As of April 23, a report by the Kaiser Family Foundation revealed that more than 10,000 reported nursing home residents and staff have died of COVID-19 in the 23 states that publicly report mortality data.2

“Our data also finds that there have been over 50,000 reported cases, accounting for 11% of coronavirus cases in 29 states,” according to the report. “In six states reporting data, deaths in long-term care facilities account for over 50% of all COVID-19 deaths — Delaware, Massachusetts, Oregon, Pennsylvania, Colorado, and Utah.”

Although incomplete reporting undermines full accuracy, it is clear that nursing homes are bearing the brunt of the pandemic. There are more than 1 million residents in about 15,000 nursing homes nationally, Terry Fulmer, PhD, RN, FAAN, president of the John A. Hartford Foundation, said during a recent webinar.

“Our healthcare system has failed our nursing homes and all those who live and work there,” she lamented. “It is heart-wrenching to see the devastating toll this is having on our residents and staff in long-term care facilities. We have to act now to prevent further death and suffering.”

In one of the first reported nursing home outbreaks of COVID-19 in the United States, the CDC recently described transmission in a Washington state facility that resulted in 23 deaths in February and March. The novel coronavirus infected 81 residents, 34 staff, and 14 visitors. Overall, 57% of residents, 36% of visitors, and 6% of staff were hospitalized. All staff survived, but the mortality rate was 27% in infected residents and 7% in visitors, the CDC reported.3

“Limitations in effective infection control and prevention, and staff members working in multiple facilities, contributed to intra- and interfacility spread,” the CDC concluded. “Long-term care facilities should take proactive steps to protect the health of residents and preserve the healthcare workforce by identifying and excluding potentially infected staff members, restricting visitation except in compassionate care situations, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures.”


  1. Occupational Safety and Health Administration. U.S. Department of Labor issues alert to keep nursing home and long-term care facility workers safe during coronavirus pandemic, May 14, 2020.
  2. Chidambaram P. State reporting of cases and deaths due to COVID-19 in long-term care facilities. Kaiser Family Foundation, April 23, 2020.
  3. McMichael TM, Clark S, Pogosjans S, et al. COVID-19 in a long-term care facility – King County, Washington, February 27-March 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:339-342.