MRSA in the Elderly – Part 2: California Regulations

In Part 1 of this series, we explored what MRSA is, how it’s spread, who is more susceptible, and how it is treated. Part 2 outlines what California Regulations say about managing MRSA in the Elderly in Care Homes.

Under Title 22, the California law that governs Residential Care Facilities for the Elderly, Staph infections are listed under prohibited conditions. This means that someone with an active Staph infection cannot reside in a licensed care home or community.

Community Care Licensing through the Department of Social Services is responsible for monitoring RCFEs (Residential Care Facilities for the Elderly). The RCFE Evaluator Manual states, “Antibiotic resistant bacterial infections are most often contracted in hospitals and brought into facilities by patients upon hospital discharge. The elderly are at high risk because their health and immune systems are generally less robust than those of younger people.”

The manual further states that, “If a resident is diagnosed with a methicillin-resistant staphylococcus aureus or vancomycin-resistant enterococci infection, the resident must be relocated elsewhere, such as to an acute care hospital or a skilled nursing facility, until the infection is cleared unless the facility applies for and receives an exception.”

An RCFE can submit a written exception request to licensing to retain or admit any resident with a prohibited health condition. The intention of the law is always to protect the staff and/or residents from harm. Therefore, if the home can show a care plan that can meet the intent of the law, then licensing may make an exception.

In most cases, however, homes choose not to even apply for an exception in order to accept a resident with active MRSA or other active bacterial infections because of how contagious the infection is. So the question comes up as to when an elderly person with MRSA can be admitted into an RCFE. When the bacterium has colonized, meaning the bacterium is present, but there is no active infection, a patient can be admitted into an RCFE.

The same manual referenced earlier states, “Colonization without infection is not prohibited in facilities, and so no exception is required to retain a resident who is colonized without infection. However, colonized residents can transmit infection to others; therefore, universal precautions should be practiced with any resident who is known to be colonized with an antibiotic-resistant bacterium.”

For more information on this topic, feel free to contact Care Placement.