These guidelines have been informed by experience in China, Korea and Japan. 

1. Personal Behaviour

• Staff, older residents and all visitors to care homes, including independent contractors should take precautions to protect themselves and those in their care from contracting COVID-19. These precautions include: 
  1. Washing hands with soap and water for at least 20 seconds 
  2. Using alcohol-based hand rub 
  3. Sneezing or coughing into a tissue, and discarding it immediately, or into an elbow, and then washing hands 
  4. Keeping at least one metre (3 feet) from each other wherever possible 
• Care home staff looking after older residents who are unwell should wear masks. They should wash their hands after putting on their mask, if they touch their mask while wearing it and after they have taken their mask off and throw it away.
• Care home staff should remind and help older people to take these precautions  

2. Inside the care home 

• Care home staff should not go to work if they have symptoms, including a fever, a cough or shortness of breath. This applies to all staff members, from care providers who have direct contact with older residents, to clerical workers, transfer staff and volunteers 
• If possible, staff should measure the older residents’ body temperature every morning and evening 
• Door handles, handrails, tables, chairs and other surfaces should be cleaned with disinfectant regularly 
• Staff should regularly empty garbage bins in which tissues are disposed 
• Care home staff should be aware of older people’s mental health and wellbeing. Affectionate personal communication can relieve anxiety 
• Older residents and staff should be well nourished 
• Warm temperatures should be maintained in the care home, and spaces should be regularly ventilated 
• Staff should try to maintain older residents’ normal schedule and daily routine 
• If possible, care home staff should organise or facilitate regular online contact between older residents and their family members and friends (i.e. via Skype, WhatsApp, WeChat). This will help to relieve stress and isolation 
• Staff with symptoms who cannot work should not face any employment-related disadvantages or penalties such as reduced wages or loss of their job 

3. Interaction with the outside environment 

• Decisions on whether visitors should be allowed to attend care homes should be based on advice from government or other relevant authorities. Visits should be discouraged where possible 
• All visitors should consider any potential contact they may have had with infected people before making a decision to visit. If they think this contact may have occurred, they should not visit a care home 
• People should not visit a care home if they have symptoms, including a fever, cough or shortness of breath 
• Care home staff should ask all visitors if they have symptoms before allowing them to enter the home 
• All visitors should take basic precautions when visiting. This includes hand washing, sneezing or coughing into a tissue or elbow, maintaining one metre distance from residents and avoiding personal contact 
• In a widespread outbreak or high-risk situation, visits should be limited to emergency needs only, for example, for medical professionals if a resident is ill 
• Delivery of goods should be restricted to a single entrance. If a contractor or vendor needs to enter the care home, staff should ask if they have symptoms such as fever, a cough or shortness of breath. If any of these symptoms are present, they should not be allowed to enter the care home • Care homes should establish links with their nearest health facility providing COVID-19 testing and care 

4. Management responsibilities 

• Care homes should establish links with their nearest health facility providing COVID-19 testing and care 
• Care homes should discuss with the health authority and their nearest facility, what they should do if a resident has symptoms 
• Care home managers should regularly refresh basic health education for staff. This should include knowledge of the virus and training in basic precautions. Posters and leaflets should be used as reminders 
• Care home managers should prepare and manage prevention and control items such as thermometers, masks, gloves, soap, alcohol-based hand rub, tissues and paper towels 
• The psychosocial support needs and wellbeing of staff should be supported through regular communication 

5. Governance 

• Care home staff should maintain close contact with related institutions and local administrations or health authorities. They should respond promptly to changes in their local situation or advice provided 
• Care home staff should keep families regularly informed of the situation, including prevention arrangements. This can be done through telephone calls, text messages and emails 

6. If someone is suspected of being infected 

• If an older resident or a member of staff feels unwell and has symptoms, they should be isolated from other residents, in a separate room. Symptoms include a fever of 37.5°or above, a cough or shortness of breath 
• Care home staff should immediately contact relevant health authorities or facilities and follow their instructions 
• Anyone isolated because of suspected COVID-19 infection should wear a mask Any staff looking after someone suspected to have COVID-19 should wear a mask 
• The room where someone is isolated should be in a relatively separate, well-ventilated area. It should have a door that can be closed and an independent toilet if possible 
• If health authorities require an older person to go to a designated facility for testing or treatment, care home staff should follow their instructions immediately. Public transport should not be used. The older person and accompanying staff should wear a mask 
• An isolated older resident should be given quality care and should be provided with support to maintain their mental health and wellbeing 
• Any older residents who have come into contact with someone known or suspected to have COVID-19 should be isolated from other residents 
• After an older resident or staff member with symptoms has been transferred to a health institution, care home staff should thoroughly clean and disinfect any areas the person has been in 
• Staff should be divided – as much as possible – between those providing care for older residents suspected to have COVID-19 or who have been in contact with those who have COVID-19, and those providing care for other older residents 
• Older people whose symptoms have ended and who return to the facility should be observed in a separate room for 14 days 

Please remember: COVID-19 is a serious illness, but there are things we can all do to protect ourselves and others. Taking sensible precautions is important but there is no need to panic. 

 ADVISORY FOR PHYSIOTHERAPISTS & CLINICS AS PREVENTIVE MEASURES FROM ONGOING COVID-19 

1. Attain patients without panic and negligence: 1.1. Keep minimum distance of 3 meters between two consecutive treatment couches 

1.2. Follow Red flags and Yellow flags strictly while collecting subjective data of the patient 

1.3. A clear color coded chart of Red & Yellow flags must be displayed properly to be noticed by the public 

1.4. Any kind of fever, common cold, flu take travel history from last 3 weeks and correlate them with WHO guidelines for COVID19 

2. Stick to the appointments: 2.1. Ensure that patients are coming on their allotted appointment time positively 

2.2. Try to complete treatment protocols with in stipulated time period (may be 45min – 01 hr) to avoid unnecessary crowding inside the premises. 

3. Hygienic habits of keeping premises disinfected: 3.1. Keep foot wares outside the premises 

3.2. Provide hand sanitizer who ever entering into the premises 

3.3. Frequently clean and disinfect objects used by multiple persons like water taps, door handles, switches, railings, weighing scales, assessment tools, exercise equipments, chairs, stools etc 

3.4. Floor cleaning with disinfectant solution frequently 

3.5. Keep the washroom clean and dry 

3.6. Use disposable bed sheets and pillow covers separately for each patient in every session 

3.7. Never allow patients to bring bed sheets & pillow covers from their home to use 

3.8. Use hand wash and tissue paper instead of soap and towels 

4. Professional attire to prevent & spread of infection: 4.1. Use doctor’s coat/ apron (preferably full sleeves) with buttons’ on 

4.2. Use disposable hand gloves during clinical examination and treatment 

4.3. Change gloves from patient to patient 

4.4. Use N-95 (used by health professionals) Mask while on duty 

4.5. Properly comb & tie long hair 

4.6. No extra nails 

4.7. Use clinic slippers inside and avoid taking them out 

5. Take on measures during Manual therapy treatment or any other Hands on skills: 5.1. Maintain all kind of professional attire without fail 

5.2. Provide mask to the patient if required 

5.3. Hand sanitizer to be used by the treating therapist and patient both before and after hands on session 

6. Etiquette of using Electro therapy: 6.1. All machines and accessories must be dust free 

6.2. Use gel and micropore tape instead of lint pads and straps 

6.3. Disinfect all the accessories which are used directly on patients like electrodes, US transducer head etc with saline water/ detol water/ sanitizer immediately before and after using them 

6.4. Use cottons or tissue paper instead of cloths/ towels to wipe up gel from the patient body part 

6.5. Avoid using of Hydro collateral packs and Wax bath 

6.6. Infra red radiation can be used instead with moisturizing gel on place 

7. Take on measures during Exercise therapy treatment: 7.1. Keep all exercise therapy equipments at certain height rather than on plain ground 

7.2. Advice maximum self exercise without any equipment or accessories 

7.3. Advise maximum home advice with proper demonstration, sufficient explanation and handout with clear diagrams (at least line diagram) 

7.4. In case exercise equipments are to be used then clean them with disinfectants immediately before and after use positively 

7.5. Provide hand sanitizer to the patient before and after using these exercise objects 

Introduction

The General Guidelines against the spread of  the virus COVID-19 that has become pandemic the world over, are based on the guidelines evolved and adopted by the members of ASLI, after studying various accredited international & national agencies recommendations. ASLI members are involved in senior care inclusive of living in India. These Guidelines may need necessary changes to suit the different models of senior care provided by members of ASLI

For ease of understanding, these guidelines are divided into three parts as follows:

• Part 1 – General precautions to be adopted by all
• Part 2 – Suggested precautions to be taken in senior living or retirement communities
• Part 3 – Suggested precautions to be taken by Home Care providers

Part 1: General Information and Suggested Precautions to all:

What is COVID-19-as per WHO

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.

Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.

The best way to prevent and slow down transmission is to protect yourself and others from infection by washing your hands or using an alcohol based rub frequently and not touching your face. 

The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, so it’s important that you also practice respiratory etiquette (for example, by coughing into a flexed elbow).

At this time, there are no specific vaccines or treatments for COVID-19. However, there are many ongoing clinical trials evaluating potential treatments. WHO will continue to provide updated information as soon as clinical findings become available.

General Protection/Prevention Measures:

You can reduce your chances of being infected or spreading COVID-19 by taking some simple precautions:

• Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water. Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.
• Maintain at least 1 metre (3 feet) distance between yourself and anyone else, especially the person who is coughing or sneezing.
• Avoid touching your MEN (Mouth, eyes, ears and nose). If you have to touch your face, wash hands before that. If you cannot wash hands, use an alcohol based hand sanitisers, which you must carry with you.
• Follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
• Stay home if you feel unwell. If you have a fever, cough and difficulty in breathing, seek medical attention and call your doctor or nurse and follow their instructions.
•  Avoid traveling to places,  especially if you are an older person or have diabetes, heart or lung disease
• Clean your mobile phones and laptops at least twice a day (depending upon usage) with alcohol-based sanitisers (a few drops in the front and rear and wipe it with a soft cloth
• Clean your spectacles with a soft cloth after washing your hands
• Try and use Blue Tooth based earphones which would avoid bringing your mobile phone close to your face.
• Avoid using your mobiles in public places or place it on any surface outside your home.

The Mantra:

• Sanitise, wash, sanitise, wash (Repeat).
• Use 75% Alcohol based hand sanitizers
• Self-isolate/quarantine, if any of the symptoms are observed.
• Call for your doctor or nurse in the retirement community or care centre
• Follow instructions as given by medical professionals
• Do NOT panic – Not all symptoms are due to COVID -19
• Avoid public spaces and contact

Stay Home, Stay Safe, Stay Positive, Stay Connected

 Background 

On 30 January 2020, WHO announced that the COVID-19 outbreak was a Public Health Emergency of International Concern. Initially, most cases were reported from China and among individuals with travel history to China. Please refer to the latest situation reports for COVID-19. 

COVID-19 is an acute respiratory illness caused by a novel human coronavirus (SARS-CoV-2, called COVID-19 virus), which causes higher mortality in people aged ≥60 years and in people with underling medical conditions such as cardiovascular disease, chronic respiratory disease, diabetes and cancer. 

Long-term care facilities (LTCFs), such as nursing homes and rehabilitative centers, are facilities that care for people who suffer from physical or mental disability, some of who are of advanced age. The people living in LTCF are vulnerable populations who are at a higher risk for adverse outcome and for infection due to living in close proximity to others. Thus, LTCFs must take special precautions to protect their residents, employees, and visitors. Note that infection prevention and control (IPC) activities may affect the mental health and well-being of residents and staff, especially the use of PPE and restriction of visitors and group activities. For further information on resilience during the time of COVID, see Mental health and psychosocial considerations during COVID-19 outbreak. 

This interim guidance is for LTCF managers and corresponding IPC focal persons in LTCF. The objective of this document is to provide guidance on IPC in LTCFs in the context of COVID-19 to 1) prevent COVID-19-virus from entering the facility, 2) prevent COVID-19 from spreading within the facility, and 3) prevent COVID-19 from spreading to outside the facility. WHO will update these recommendations as new information becomes available. All technical guidance for COVID-19 is available online. 

System and service coordination to provide long-term care 

• Coordinate with relevant authorities (e.g. Ministry of Health, Ministry of Social Welfare, Ministry of Social Justice, etc.) should be in place to provide continuous care in LTCFs. 

• Activate the local health and social care network to facilitate continuous care (clinic, acute-care hospital, day-care center, volunteer group, etc.) 
• Facilitate additional support (resources, health care providers) if any older person in LTCFs is confirmed with COVID19. 

Prevention 

IPC focal point and activities 

LTCFs should ensure that there is an IPC focal point at the facility to lead and coordinate IPC activities, ideally supported by an IPC team with delegated responsibilities and advised by a multidisciplinary committee. WHO guiding principles for IPC can be found online. 

At a minimum, the IPC focal point should:

• Provide COVID-19 IPC training 1to all employees, including: 
  – an overview of COVID-19: https://openwho.org; 
  – hand hygiene and respiratory etiquette; 
  – standard precautions; and 
  – COVID-19 transmission-based precautions.2 
• Provide information sessions for residents on COVID-19 to inform them about the virus, the disease it causes and how to protect themselves from infection 
• Regularly audit IPC practices (hand hygiene compliance) and provide feedback to employees. 
• Increase emphasis on hand hygiene and respiratory etiquette: 
  – Ensure adequate supplies of alcohol-based hand rub (ABHR) (containing at least 60% alcohol) and availability of soap and clean water. Place them at all entrances, exits and points of care 
  – Post reminders, posters, flyers around the facility, targeting employees, residents, and visitors to regularly use ABHR or wash hands. 
  – Encourage hand washing with soap and water for a minimum of 40 seconds or with ABHR for a minimum of 20 seconds.3 
  – Require employees to perform hand hygiene frequently, in particular at the beginning of the workday, before and after touching residents, after using the toilet, before and after preparing food, and before eating.
  – Encourage and support residents and visitors to perform hand hygiene frequently, in particular when hands are soiled, before and after touching other people (although this should be avoided as much as possible), after using the toilet, before eating, and after coughing or sneezing. 
  – Ensure adequate supplies of tissues and appropriate waste disposal (in a bin with a lid). 
  – Post reminders, posters, flyers around the facility, targeting employees, residents, and visitors to sneeze or cough into the elbow or to use a tissue and dispose of the tissue immediately in a bin with a lid. 
• A guide to local production of WHO-recommended ABHR is available 
• Maintain high standards of hygiene and sanitation practice. Guidance on water, sanitation, laundry, and waste management for COVID-19 is available.
• Provide annual influenza vaccination and pneumococcal conjugate vaccines to employees and staff, according to local policies, as these infections are important contributors to respiratory mortality in older people. 

Physical distancing in the facility 

Physical distancing in the facility should be instituted to reduce the spread of COVID-19: 

• Restrict the number of visitors (see below) 
• For group activities ensure physical distancing, if not feasible cancel group activities 
• Stagger meals to ensure physical distance maintained between residents or if not feasible, close dining halls and serve residents individual meals in their rooms 
• Enforce a minimum of 1 meter distance between residents 
• Require residents and employees to avoid touching (e.g., shaking hands, hugging, or kissing). 

Visitors 

In areas where COVID-19 transmission has been documented, access to visitors in the LTCFs should be restricted and avoided as much as possible. Alternatives to in-person visiting should be explored, including the use of telephones or video, or the use of plastic or glass barriers between residents and visitors. 

All visitors should be screened for signs and symptoms of acute respiratory infection or significant risk for COVID-19 (see screening, above), and no one with signs or symptoms should be allowed to enter the premises. 

A limited number of visitors who pass screening should be allowed entry to long-term care only on compassionate grounds, specifically if the resident of the facility is gravely 

ill and the visitor is their next-of-kin or other person required for emotional care. Visitors should be limited to one at a time to preserve physical distancing. Visitors should be instructed in respiratory and hand hygiene and to keep at least 1 meter distance from residents. They should visit the resident directly upon arrival and leave immediately after the visit. 

Direct contact by visitors with residents with confirmed or suspected COVID-19 should be prohibited. 

Note that in some settings, complete closure to visitors is under the jurisdiction of local health authorities.