Ventilation in Residential Care Environments: U.S. Department of Energy (DOE), Energy Efficiency & Renewable Energy (EERE)

The purpose of this study was to evaluate the effect of ventilation rate, directional airflow (e.g. pressure relationships) and airflow barriers on bioaerosol concentration and movement within assisted-living and residential care environments. Included within this report is a comprehensive literature review, field data collection test plan and, an evaluation of commercially available mitigation technologies related to the transmission of COVID-19 in LTC environments. Additionally, this report includes aerosol testing in an actual LTC facility using the test plan developed herein. Nearly 1.5 million people live in 16,000 nursing homes in the U.S. As of December 20, 2020 the Centers for Medicare and Medicaid Services (CMS) identified a total of 662,549 confirmed and suspected COVID-19 cases in these and other long-term care (LTC) facilities resulting in 92,373 deaths. At this time, COVID-19 cases in LTC facilities accounted for only 3% of the U.S. total of 21M confirmed cases yet nearly a third of the 350,000 total U.S. deaths. Preliminary studies have found little correlation between the quality of care and transmission of COVID-19 in these facilities, suggesting that even the best infection control practices may not be effective in containing the spread of this potentially airborne disease. As a result, many LTC facilities have implemented quarantine procedures and other measures to isolate infectious residents from the general population. Unfortunately, most LTC facilities were not designed for airborne infection control and guidance for retrofitting existing LTC spaces for airborne isolation is limited.