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New Covid-19 Testing Guidance to Protect Seniors and Those Living With Disabilities

Protocols significantly reduce the risk of Covid-19 transmission in America’s congregate care facilities

Washington, DC— With over two million seniors and Americans with disabilities currently living in nursing homes and other congregate care facilities (CCFs) across the United States, this at-risk group has been disproportionately impacted by the Covid-19 pandemic: 140,000 residents and 1,000 staff have died since March 2020. In response, a new report by the Duke-Margolis Center for Health Policy, with support from The Rockefeller Foundation, provides technical guidance to develop testing protocols to significantly reduce the risk of Covid-19 transmission and protect residents, staff, and visitors, as vaccination efforts scale up.

CCFs, which also encompass assisted living facilities, memory care units, and independent living communities, serve those who require support services but do not need the high level of consistent medical care provided in nursing homes. Although vaccinations can reduce the risk of Covid-19 transmission in these facilities, testing should continue to be prioritized as the consequences – death and severe morbidity – remain high in these communities.

“Even with the vaccine roll-out occurring for priority groups, testing will remain an important strategy for reducing risk in congregate care throughout 2021,” said report co-author Dr. Courtney Van Houtven, professor at Duke Population Health Sciences, Duke Margolis, and the Veterans Affairs Health Care System. “Screening and surveillance test protocols can help reduce the risk of infection and mortality in CCFs.”

While the federal government has released testing guidance for federally regulated nursing homes, there is no guidance for CCFs that take into consideration different risk factors in these settings. A distinguishing feature of many CCFs is that they provide residential and care services but are not inherently medicalized facilities. The culture and regulatory requirements de-emphasize the medical model, which often results in fewer infection control procedures and medical resources.  Furthermore, CCFs are lower on the vaccination prioritization list than nursing homes.

“We owe it to our seniors to do everything we can to protect them from this virus that is disproportionately deadly to them,” said Dr. Rajiv J. Shah, President of The Rockefeller Foundation. “The testing guidance outlined in this new report, combined with vaccinations and other mitigation measures like social distancing and mask wearing, will reduce community spread of Covid-19 in congregate care facilities and save lives.”

In December 2020, the U.S. Centers for Disease Control and Prevention released guidelines for infection control measures in congregate care settings. This report provides detailed guidance on how routine testing can be used as an added layer of protection to reduce risk of Covid-19 and better inform decision making during the pandemic and if an outbreak occurs. Building off the Covid-19 testing framework published in September 2020, the report recommends that testing protocols be customized for individual facilities based on a risk assessment and provides testing strategies based on low, moderate, higher, and highest risk. In addition, the report provides policy recommendations in four key areas:

  • Prioritize CCF settings for federal and state test distribution of rapid tests. As manufacturing capacity for antigen and other point-of-care tests increase, federal and state distributions should prioritize CCFs as highly at-risk communities.
  • Set a pathway for payment. A clear pathway for payment for this testing should be established, especially for testing required by federal or state authorities and for facilities that serve lower-income populations. States should consider putting support for regular testing in these communities high among their priorities, while Congress should consider if additional support may be required.
  • Ensure rapid turnaround and clear understanding of how to use results. Policymakers should encourage the adoption of antigen and other point-of-care tests by providing a straightforward regulatory path for testing and by providing training and technical assistance in administering point of care tests.
  • Support studies to better understand transmission among vaccinated individuals. Rapid studies are needed to develop evidence on transmission by vaccinated individuals, including residents at CCFs. If the evidence shows that vaccinated individuals are not likely to transmit, testing needs may decline substantially in CCFs, which would reduce costs and free up test capacity for other high-risk settings where vaccination may not yet be widely available.

About the Duke-Margolis Center for Health Policy

The Robert J. Margolis, MD, Center for Health Policy at Duke University is directed by Mark McClellan, MD, PhD, and brings together expertise from the Washington, DC, policy community, Duke University, and Duke Health to address the most pressing issues in health policy. The mission of Duke-Margolis is to improve health and the value of health care through practical, innovative, and evidence-based policy solutions. Duke-Margolis catalyzes Duke University’s leading capabilities, including interdisciplinary academic research and capacity for education and engagement, to inform policy making and implementation for better health and health care. For more information, visit and follow us on Twitter @dukemargolis.

About The Rockefeller Foundation

The Rockefeller Foundation advances new frontiers of science, data, and innovation to solve global challenges related to health, food, power, and economic mobility. As a science-driven philanthropy focused on building collaborative relationships with partners and grantees, The Rockefeller Foundation seeks to inspire and foster large-scale human impact that promotes the well-being of humanity throughout the world by identifying and accelerating breakthrough solutions, ideas, and conversations. For more information, sign up for our newsletter at and follow us on Twitter @RockefellerFdn.

Media Contacts:

Patricia Green, Duke-Margolis Center for Health Policy
(301) 520-6482

Ashley Chang, The Rockefeller Foundation
(212) 852-8451