As Massachusetts begins Phase 4, this week the Executive Office of Health and Human Services and respective agencies released a series of new guidance documents for health care and human service providers that supports the safe reopening of programs and provider sites and protects workers, patients, families, and the public.

Additionally, the Executive Office of Health and Human Services, Department of Public Health (DPH), and Executive Office of Elder Affairs (EOEA) recently released updated guidance to long-term care facilities (nursing and rest homes), Assisted Living Residences (ALRs), and congregate care settings in response to the high rates of residents and staff that are now vaccinated against COVID-19 in these settings. These changes align with recent guidance published by the federal Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS).

Health Care Guidance

Beginning March 22, 2021, the Commonwealth moved into Phase 4: New Normal of the State’s reopening process, and the Department of Public Health issued guidance to all health care providers setting minimum standards for continued provision of services. The new guidance supports the reopening process without jeopardizing health system capacity or the public health standards that are essential to protecting health care workers, patients, families, and the general public.

DPH also issued updated Resurgence Planning and Response Guidance for Acute Care Hospitals to continue the Regional COVID-19 Hospital Preparation and Response Planning Process while aligning with Phase 4 of reopening.

Day Programs

In addition, EOHHS has published updated guidance for day programs as they move into Phase 4, Step 1. day programs are required to continue to adhere to federal and state guidance regarding PPE, workplace safety, and participant safety. The updated guidance removes square footage requirements that will allow day programs to expand capacity, while adhering to other social distancing and infection control requirements.

Human Services Transportation

EOHHS has also published updated Phase 4 guidance for Human Services Transportation brokers and drivers. These organizations provide transportation to certain EOHHS consumers, such as MassHealth members and individuals served by the Department of Developmental Services, Department of Mental Health, Department of Public Health, Massachusetts Rehabilitation Commission, and the Massachusetts Commission for the Blind so they can access medical and day services across the state. The updated guidance now takes into account whether a passenger is fully vaccinated, and allows ride sharing among individuals who are fully vaccinated if a single trip is not available. Drivers and passengers are required to continue to wear face masks during the trip.

Long Term Care, Assisted Living Residence, and Congregate Care Guidance

In long-term care facilities and ALRs, 86% of all residents are fully vaccinated, with 98% having received at least one dose. As such, Massachusetts is updating guidance to allow for expanded visitation and congregate activities, lifting quarantine requirements for vaccinated individuals, and updating surveillance testing guidance for vaccinated staff.

The Executive Office of Health and Human Services (EOHHS) and agencies that operate, fund, or license residential congregate care settings, including group homes, residential treatment programs, and clinical stabilization service programs, have released updated visitation guidance that aligns with updates made for long-term care settings, as congregate care setting surveillance testing data shows significantly reduced rates of COVID-19 transmission, with a less than 1% positivity rate among surveillance test results in the past month. Additionally, across these EOHHS congregate care settings, data collected for state- and provider-operated sites indicates that over 70% of residents eligible to be vaccinated have received at least one dose of vaccine, and nearly 60% are fully vaccinated.

These changes balance the important role visitation and congregate activities play in supporting resident quality of life, while keeping in place critical infection control practices such as mask wearing and good hygiene.

In long-term care facilities, the following changes are now in effect:

• Visits may now occur in resident rooms when both the resident and visitor are fully vaccinated, without social distancing. Masks should still be worn during visits.
• Visits no longer need to be scheduled in advance unless scheduling is requested by the facility.
• Congregate activities that require residents to be closer than six feet apart can resume, such as card games, dining, and watching movies, if residents are fully vaccinated.
• Residences cannot require visitors to show proof of vaccination or prevent un-vaccinated visitors from entering the residence. However, if visitors are not yet vaccinated, visits should occur in designated spaces with appropriate social distancing, with the exception of compassionate care visits.
• Residents who are fully vaccinated and return to the facility from another setting do not need to quarantine for 14 days.
• Facilities must continue to conduct staff surveillance testing in accordance with DPH guidance,  however, staff who are fully vaccinated may move from weekly testing to biweekly testing.

Updated Assisted Living Residence guidance largely mirrors the updated guidance for long-term care facilities above, with additional changes that allow for:

• Visits can continue to occur in resident rooms, and social distancing is not required if both the resident and visitor are fully vaccinated.
• Congregate activities can resume.  Settings such as dining rooms, movie theaters, and gyms within the ALR should follow state guidance for the respective setting (e.g., restaurant, gym, etc.).

For congregate care settings, the following changes are now in effect:

• Visits may now occur in resident rooms when both the resident and visitor are fully vaccinated, without social distancing. Masks should still be worn during visits.
• Residents, regardless of vaccination status, may participate in congregate activities in the setting so long as they are not currently isolated or quarantining due to infection, exposure, or new admission status.
  • Participating residents must remain at least six feet apart, if they are not fully vaccinated.
  • Small groups of residents who are fully vaccinated may dine together at a table without social distancing, while still following state guidance for these settings.
• Residents with child(ren) or sibling(s) who may be unvaccinated may visit without physical distance, if both are wearing face coverings, as able.
• Visits no longer need to be scheduled in advance unless scheduling is requested by a specific program based upon safety considerations.
• Programs may allow more than two visitors per resident at a time, if all visitors are of the same household.
• Programs cannot require visitors to show proof of vaccination or prevent un-vaccinated visitors from visiting. However, if visitors are not yet vaccinated, visits should occur in designated spaces with appropriate social distancing.

For the full list of guidance, go to:

• Health and Human Services Phase 4 Reopening guidance
• Long term care guidance
• Assisted Living Residence Guidance

Congregate care setting guidance