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April 2020

Tennessee’s COVID-19 Update: Long-Term Care Facilities and Stay-At-Home Order

April 3, 2020

The Tennessee Department of Health is closely following the Centers for Disease Control and Prevention (“CDC”) guidance during the Coronavirus Disease (COVID-19) outbreak. To date, there have been  over 2,845 confirmed cases of COVID-19 in Tennessee, with 263 hospitalizations and 32 deaths. A Gallatin, TN nursing home was recently afflicted with the COVID-19 outbreak. The facility has experienced over 100 positive cases of COVID-19, including residents and staff alike, and three deaths to date. The Tennessee National Guard has stepped in, conducting mass testing and sending nurses to help treat patients.

On March 12, 2020, Governor Lee declared a State of Emergency over concerns related to COVID-19 in TN, and on March 22, 2020, he signed Executive Order 17, which limited social gatherings to fewer than 10 people, closed fitness centers, restricted visitation to nursing homes, retirement homes, and long-term care facilities, and closed food service establishments to on-site service.  Since then, he has issued several more stringent Executive Orders, in a greater effort to limit the exposure and spread of COVID-19 to our most vulnerable populations.

Executive Order 21 closed businesses that perform close-contact personal services and entertainment and recreational gathering places to members and the public. Executive Order 22 further restricts essential businesses and essential activities, and urged Tennesseans to stay home, but was not a shelter in place order.

On April 2, 2020, Governor Lee issued Executive Order 23 that mandates Tennesseans stay home, unless they are carrying out essential activities, to help stop the spread of the COVID-19 virus. The mandate was issued after data from the Tennessee Department of Transportation showed an uptick in traffic and after mounting pressure from state lawmakers, doctors and national media to do so. “COVID-19 is an imminent threat and we need you to understand that staying home isn’t an option,"  Lee said. "It’s a requirement for the swift defeat of COVID-19 in Tennessee.”

On the same day, FEMA approved Tennessee’s COVID-19 major disaster declaration. This accelerates efforts to work with the U.S. Army Corps of Engineers and expand statewide capacity by an additional 7,000 beds. 

The Corps of Engineers is working for FEMA and in partnership with Tennessee in responding to this crisis.  Through Tennessee’s partnership with the Corps of Engineers, the state is assessing sites across Tennessee to build capacity and create Alternate Healthcare Facilities.

  • The Music City Center in downtown Nashville will be transformed into a COVID Positive Non-Acute Alternate Healthcare Facility.  It will serve COVID patients who need hospital care, but do not require critical care. The current plan for the Music City Center is to provide more than 1,600 patient care spaces.
  • In Memphis, the Corps will be constructing a COVID positive Non-Acute Alternate Healthcare facility at Gateway Shopping Center. Additional sites in Memphis are being actively assessed to ensure capacity in this hotspot is built up quickly and efficiently. 
  • Chattanooga Convention Center and the Knoxville Expo Center will also serve as a COVID positive Non-Acute Alternate Healthcare facility.

Given their congregate nature and residents served (e.g., older adults often with underlying chronic medical conditions), long-term care facilities continue to be at the highest risk of being affected by COVID-19. If infected with SARS-CoV-2, the virus that causes COVID-19, residents are at increased risk of serious illness.

Visitation to nursing homes, retirement homes, and long-term care or assisted-living facilities is limited to visits involving essential assistance or end-of-life care only, so long as such visits do not pose unreasonable risk to other residents.  Tennessee Department of Health also strongly recommends long-term care facilities  follow CDC guidance.

The general strategies CDC recommends to prevent the spread of COVID-19 in long-term care facilities are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza. The CDC has issued the following updated guidance to long-term care facilities:

  • Restrict all visitation except for certain compassionate care situations, such as end of life situations
  • Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers)
  • Cancel all group activities and communal dining
  • Implement active screening of residents and HCP for fever and respiratory symptoms

The CDC urges long-term care facilities concerned that a resident, visitor, or employee may be a COVID-19 patient under investigation to contact their local or state health department immediately for consultation and guidance.

Among the most urgent challenges facing facilities in Tennessee right now is the lack of personal protective equipment (PPE) for healthcare workers and staff, said Jesse Samples, executive director of the Tennessee Healthcare Association, which represents about 420 long-term care facilities. "The PPE is just simply very, very scarce, and it's not just scarce in nursing homes," Samples said. "We are encouraging long term care facilities to reach out to local businesses, whether it's veterinarians' offices or construction crews" for facemasks and other protective gear, he said.

Governor Lee has also established a website specific to COVID-19 updates which can be found here:

Tennessee Department of Health COVID-19 Webinars for Health Care Providers are held every Friday at noon. The link is here:

A preparedness checklist for hospitals, including long-term acute care hospitals is available here:

Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings:

Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (LTCF):

Additional helpful links are:

TDH COVID-19 information page:

CDC COVID-19 information page:

TDH COVID-19 Weekly Situation Summary:

CDC’s Guidance for People at Risk for Serious Illness:

CDC’s Information for long-term care facilities:

TN Coronavirus Hotline: 877-857-2945 Available 10 a.m. – 10 p.m. CST Daily


Visit our COVID-19 Hub for ongoing updates.

Health Care

Heather M. Gwinn

Health Care