With the nation’s most vulnerable population residing in nursing homes and long-term care facilities, OSHA on May 14, 2020, finally issued much-needed guidance for this industry. These facilities, deemed “ground zero” by former head of the Center for Disease Control, Dr. Tom Frieden, over two months ago, have been struggling to keep COVID-19 at bay.

Although the mandate of the Occupational Safety and Health Administration (OSHA) is to ensure employers are providing a safe and healthful work environment for employees, central to the ability to do so requires recognition of the unique challenges presented by these facilities’ patient populations, which are the most vulnerable to the corona virus (SARS-CoV-2) disease.  And, according to USA Today, 32 states and the District of Columbia have reported cases of coronavirus in approximately 4000 nursing homes across the nation, though this number is likely higher given the number of states which are not reporting such information.

Against this backdrop, OSHA has issued guidelines suggesting best practices to prevent the spread of COVID-19 at these facilities.  Some measures, which apply to all industries, include:

• Encourage workers to stay home if they are sick.
• Ask visitors to inform the facility if they develop a fever or symptoms consistent with COVID-19 within 14 days of their visit.
• Screen workers (and residents) regularly for signs and symptoms consistent with COVID-19. Send sick workers home or to seek medical care.
• Stagger break periods to avoid crowding in breakrooms.
• Consider alternatives to in-person large group gatherings (e.g., staff meetings, resident activities).
• Provide handwashing facilities and alcohol-based hand sanitizer with at least 60 percent alcohol throughout facilities.
• Regularly clean and disinfect shared equipment and frequently touched surfaces in resident rooms, staff work stations, and common areas.
• Use hospital-grade cleaning chemicals approved by the Environmental Protection Agency (EPA) from List N or EPA-approved, hospital grade cleaning chemicals that have label claims against the coronavirus.
• Ensure workers have and use any personal protective equipment (PPE) they need to perform their jobs safely.
• Train workers about how to protect themselves and residents during the pandemic.
• Encourage workers to report any safety and health concerns.

Some additional recommend measures, more tailored to nursing homes and long-term care facilities include:

• Follow CDC guidance on updating existing resident visitation policies.
• Maintain at least six feet between workers, residents, and visitors, to the extent possible, including while workers perform their duties and during breaks.
• Always follow good infection prevention and control practices. Consult OSHA’s COVID-19 guidance for healthcare workers and employers.
• Continually monitor PPE stocks, burn rate, and supply chains. Develop a process for decontamination and reuse of PPE, such as face shields and goggles, as appropriate. Follow CDC recommendations for optimization of PPE supplies.

OSHA seems to recognize that nursing homes and long-term care facilities may not always be able to maintain 6 feet of separation between workers, residents, and visitors, given the language of “to the extent feasible.” In that regard, as a best practice, employers should be prepared to explain any challenges they face in implementing such a measure such as identifying tasks which make compliance with that measure impossible, should OSHA come knocking. Employers should also document challenges in procuring required PPE and all efforts made to do so when they are unable to procure it.  Still unanswered is whether OSHA will apply this guidance to other types of residential facilities that are neither nursing homes nor long-term care facilities.