New Direction on Masking Guidance: What Does It Mean for ACF and Assisted Living Providers?

On Feb. 10, 2023, the Department of Health (DOH) issued a Dear Administrator Letter (DAL) updating its guidance to providers regarding the State mask mandate. The Commissioner’s Determination on Masking in Certain Indoor Settings expired on Feb. 12, 2023, and this guidance was issued to provide direction with State-specific requirements going away. It is important to understand that this change does not mean that staff will simply be able to work unmasked. Rather, the Department points adult care facility (ACF), assisted living program (ALP), and assisted living residence (ALR) providers (hereafter referenced as ACFs) to develop policies and procedures based on Centers for Disease Control and Prevention (CDC) guidance.

The bulk of the DAL addresses “health care providers,” but does include a brief section for ACFs, directing them to follow CDC community guidance and CDC guidance for congregate living settings. The CDC community guidance includes basic information geared toward the general public, highlighting measures that ACFs have been taking throughout the pandemic. The CDC guidance for congregate settings provides more details that will inform your practices. Specifically, the CDC recommends that congregate living settings apply prevention strategies based on COVID-19 Community Levels (as opposed to Transmission Levels) for mask wearing. This data is provided by county, updated weekly, and is currently varied based on the part of the state. The guidance also recommends that providers assess the unique risks of their setting and the populations and identify what mitigation strategies should be utilized, including masking.

COVID-19 Community Levels

The Community Levels website provides recommendations based on the level in your county. When Low, it provides basic strategies that have consistently been deployed in ACFs, such as vaccination, ventilation, following recommendations when exposed or positive, and avoiding contact with those who have suspected or confirmed COVID-19.

Below are excerpts for Medium and High levels:

When the COVID-19 Community Level is Medium or High:

If you are at high risk of getting very sick, wear a high-quality mask or respirator (e.g., N95) when indoors in public
If you have household or social contact with someone at high risk for getting very sick, consider self-testing to detect infection before contact, and consider wearing a high-quality mask when indoors with them

When the COVID-19 Community Level is High:

Wear a high-quality mask or respirator.
If you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

Assessing and Mitigating Risk

In addition to monitoring COVID-19 Community Levels, facilities can consider factors that would indicate heightened risk, including if your population is a greater risk, and your own structural and operational characteristics that might accelerate spread, such as poor ventilation, shared rooms, or resident population’s ability to adhere to COVID-19 prevention strategies. Of course, active COVID-19 spread occurring is another key factor. The CDC outlines strategies to mitigate risk as well, outlining activities that ACFs have been undertaking throughout the pandemic. Of course, vaccination is a key tool in mitigating risk.

Health Care Services Provided in ACFs

The aforementioned CDC guidance also indicates that masking during the delivery of health care services in ACFs should be informed by the CDC's Infection Prevention and Control Recommendations. Guidance for Assisted Living, Group Homes and Other Residential Care Settings (excluding nursing homes) is found at the bottom of that page. In that section, the CDC makes the distinction between health care services and non-skilled personal care, which consists of activities like assistance with activities of daily living, assistance with medications, housekeeping, and food service. Staff providing those non-skilled services should follow the above recommendations based on Community Levels, risks, and mitigation strategies when it comes to masking.

Home care, hospice, and other outside health care providers coming in to provide services to residents of ACFs should follow the CDC's Infection Prevention and Control Recommendations. In addition, health care services delivered in those settings by staff, such as in the ALP and the Enhanced Assisted Living Residence (EALR), should follow the health care guidance for masking of staff providing those services.

So What Does This Mean for You?

To summarize, the CDC directs ACFs to consider the Community Levels, the risks of your population and your building, the COVID-19 spread in your building, and the steps taken to mitigate risk in developing your masking guidance for your staff, residents, and visitors. However, the CDC guidance also indicates that health care services delivered in these settings should be informed by the CDC's Infection Prevention and Control Recommendations.

Obviously, if staff are treating residents who are COVID-19-positive or suspected to have COVID-19, they should be following the recommended infection prevention and control practices that you are familiar with.

While this new approach could provide the opportunity to offer some relief from mask wearing for some staff when Community Levels are Low, bear in mind that it also comes with the responsibility of developing a policy and effectively communicating changes for successful and consistent implementation. Staff should also be reminded that conditions may change, and that strategies may adjust based on those conditions. Your local health department may also provide specific recommendations on conditions within your building.

Members are also reminded that this change in guidance relates to masking; other infection prevention and control requirements remain in place. This summary provides our best understanding of the guidance at this time. Please let us know what questions you have, and we will keep our members apprised of developments.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828