The California Department of Health issued an All Facilities Letter (AFL) providing guidance on transferring COVID-19 positive patients to state-run alternate care sites to alleviate strain on hospitals and skilled nursing facilities (SNFs). These low-acuity sites primarily receive adult patients post-discharge from hospitals and, if needed, from emergency departments for ongoing monitoring. They may also accept patients directly from the 911 system and from licensed SNFs and congregate living facilities. Transfers to alternate care sites must be coordinated with the local public health department and the California Department of Public Health (CDPH). SNFs must hold a transferred patient's bed for at least 14 days and accept the return of a resident from the alternate care site unless CDPH determines otherwise. Facilities must coordinate with their Medical Health Operational Area Coordinator before initiating a transfer.

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