COVID-19 Strategic Action Framework: Supporting Congregate Living Facilities

Page updated on Aug 20, 2020 at 11:00 PM

This document is congruent with Alexandria Health Department’s (AHD) Strategic Action Framework and is one of a series of frameworks outlining AHD’s COVID-19 Pandemic Response


Save lives and improve quality of life for residents and staff of group homes, shelters, and detention centers


  • Reduce and eliminate deaths, hospitalizations, and infections due to COVID-19 in facilities’ residents and staff
  • Support Alexandria’s group homes, shelters, and detention centers in infection control and outbreak prevention and response
  • Improve quality of workplace support for facilities’ workers.

Key Context

This is a living document and changes will be made based on updates in public health’s understanding of COVID-19, updated CDC and VDH guidance, and AHD resources and prioritizations. 

This strategic action framework is applicable to 12 Department of Community and Health Services (DCHS) group homes that house residents who are developmentally disabled or have mental health needs, 12 additional group homes (some with multiple sites), two detention facilities, two permanent shelters, and any temporary shelters that are established in Alexandria.


1. Guidance and coaching on day-to-day infection prevention and control practices
  • Providing facilities with updates on Centers for Disease Control (CDC), Virginia Department of Health (VDH), and other relevant infection prevention and control guidance on an ongoing basis
  • Gathering basic information about each facility such as layout, staffing, capacity, number of current residents, routine facility operations
    • Done for existing congregate facilities. Will gather information on temporary winter shelter during planning process for its opening.
  • Completing Infection Control Assessment and Response (ICAR) surveys via phone for facilities
    • Completed for detention centers and existing shelters. Ongoing for group homes.
  • Completing virtual walk-through sessions with infection prevention coaching for select high-risk facilities
    • Ongoing for group homes and shelters.
  • Making infection prevention and control recommendations to facilities based on ICARs and virtual walk-throughs, including specific guidance on recommended resident capacity, resident cohorting, safeguarding medically-vulnerable residents/staff, and staffing considerations based on layout and operations of the facility
    • Recommendations emailed to each facility after ICAR completed.
  • Ensuring facilities have a plan for operating with reduced numbers of staff 
    • Completed as a part of the ICAR 
  • Designing training manual and materials for training of Medical Reserve Corps (MRC) volunteers with appropriate KSAs and interest to become infection prevention coaches
    • Completed.
  • Deploying MRC infection prevention coaches to provide ongoing guidance to facilities
    • 12 volunteers trained and deployed
2. Resources and training to increase facilities’ self-efficacy in setting-specific infection prevention and response
  • Creating handbooks with setting-specific infection prevention and control guidance and COVID-19 case response protocols: one tailored to group homes and shelters; one tailored to detention centers. Contents include:
    • Administrative infection prevention and control checklist (recommended policies and procedures to support a healthy workforce and living environment)
    • Environmental infection prevention and control checklist (recommended actions for disinfecting and configuring the built environment)
    • Personal protective measures
    • Added precautions for medically-vulnerable staff and residents
    • Quarantine and isolation procedures
    • Guidelines for the facility to initiate contact tracing
    • Procedures for notifying or consulting Alexandria Health Department
    • Testing considerations
    • COVID-19 education and resource materials for staff
    • Completed for detention centers, group homes, and shelters, adapted for adult congregate day program use.
  • Distributing the handbook with detailed instructions through multiple conference calls with the facilities
    • Completed
  • Personal protective equipment (PPE) donning and doffing training for staff of facilities using PPE in conjunction with City EOC, and using a train the trainer model when feasible
    • Included in ICAR process
  • PPE fit testing for facilities that do not have fit testing capability in conjunction with City EOC
    • Fit testing needs fulfilled by EOC and other agencies.
  • Training DCHS clinical staff on how to collect nasopharyngeal (NP) test specimens
    • Completed. Also trained on using anterior nasal swabs.
3. Case identification, contact tracing, and outbreak response
  • Ensuring facilities are familiar with most recent testing guidelines and patient evaluation/testing resources
    • Included in handbooks, discussed at time of handbook distribution
  • Establishing processes between AHD and group home, shelter, and detention center liaisons for receiving notifications about cases, reviewing related exposures, and communicating applicable infection control recommendations
    • Included in handbooks, discussed at time of handbook distribution
  • Providing consultation on testing indications on a case by case basis
    • Ongoing
  • Working with facilities to accomplish thorough contact tracing
    • Ongoing
  • Coordinating public health testing and follow-up on test results
    • Ongoing
  • Monitoring for and tracking facility outbreaks
    • Ongoing
  • Surveilling for epidemiological links between facilities
    • Ongoing
  • Relaying information on outbreaks to Virginia Department of Health (VDH) via the Virginia Outbreak Surveillance System (VOSS)
    • Ongoing
  • Establishing the above processes in a way that maintains confidentiality of individuals and facilities
    • Ongoing
  • Explore the implementation of testing for new admissions to detention centers and other congregate settings in which residents rarely leave the facility.
4. Point Prevalence Surveys
  • Initiating Point Prevalence Survey (PPS) planning upon case notification in congregate settings
    • Completed two and facilitated two, all of the below steps were included.
  • Providing guidance to facility directors on span and scope of participants in PPS
  • Assuring facilities have established resident cohort and staffing contingency plans prior to point prevalence surveys
  • Ordering and preparing test kits for PPS
  • Organizing staffing for PPS event
  • Coordinating reporting of test results
  • Making determinations on utility of follow-up PPSs depending on survey results, and organizing them as needed
5. Phased-reopening guidance
  • Developing setting-specific phased reopening guidance to ensure added protections for vulnerable communities in congregation during surrounding business reopenings, including:
    • Timing and detailing of phases for relaxing visitation, staffing, and activity restrictions
    • Promoting adherence to safe behavioral practices for infection prevention among staff and residents
    • Ensuring capacity changes align with safe physical distancing precautions
    • Completed for residential and non-residential (e.g. day program) congregate settings
  • Conducting meetings with facility directors to plan alternative option to reopening and to consider optimal facility capacity for residents during community wide transmission
    • Ongoing
  • Training and mobilizing MRC volunteer coaching teams to conduct site visits in preparation for reopenings, and to conduct subsequent, ongoing infection prevention trainings for facility staff
    • Ongoing
6. Communication with partners
  • Establishing a relationship with the point of contact for each facility
    • Completed
  • Ensuring each facility is familiar with AHD point of contact and contact procedures
    • Completed
  • Disseminating updated CDC, VDH, and other updated guidance via emails, conference calls, and tailored interpretation on an ongoing basis
    • Ongoing
  • Facilitating information sharing and practices amongst similar facilities via conference calls
    • Ongoing
  • Reporting case and outbreak data to VDH for dissemination in aggregate form on their public website 
    • Ongoing
  • Guiding facilities on appropriate methods for exposure notifications to residents and staff
    • Completed