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As States Consider Allowing Nursing Home Visitors, CMS Urges ‘Extreme Caution'

Federal officials say facilities should be coronavirus-free for 28 days before opening to visitors

spinner image Man visiting his mother in her nursing home sitting in the chair across the room from her and wearing a face mask
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As states begin to lift coronavirus stay-at-home orders, the federal government is asking governors to “proceed with extreme caution” before allowing visitors into the long-term care facilities that are home to the nation's most vulnerable citizens and have become ground zero for the pandemic.

Nursing homes should be “among the last to reopen” in a community where restrictions are being lifted for businesses and other activities, officials from the Centers for Medicare & Medicaid Services (CMS) said Monday in announcing recommendations to state and local governments. “The vulnerable nature of the nursing home population requires aggressive efforts to limit COVID-19 exposure and to prevent the spread within facilities."

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"The impact of the coronavirus on nursing homes has been heartbreaking,” CMS Administrator Seema Verma said on a teleconference with reporters on Monday. “And we mourn the lives we've lost and continue to fight to fiercely protect residents and facilities around the country, while delivering the best possible quality of life for our most vulnerable populations."

Nursing homes have been hit hard by the coronavirus and COVID-19, the illness it causes. More than 143,000 nursing home workers and residents in 7,400 facilities have been stricken by the virus, according to the latest New York Times analysis, and 25,600 nursing home residents and staff have succumbed to the illness.

"While we are not at a point where nursing homes can safely open up, we want to make sure communities have a plan in place when they are ready to reopen,” Verma said in the announcement.

The CMS guidance makes clear that a nursing home should not even begin down the path of allowing visitors until all residents and staff at a facility have had a baseline test for the coronavirus to make sure there are no known cases. Staff should also be tested weekly and all residents should be tested again if any resident has coronavirus-like symptoms or any employee or staff member tests positive for COVID-19.

The announcement lists other specific recommendations that should be followed before visits resume, including:

  • There should be no new cases for 28 days.
  • There are adequate supplies of personal protective equipment (PPE) and cleaning and disinfection materials.
  • The staff is adequate, with no shortages.
  • Local hospitals have enough beds to take care of any residents who need to be transferred there.

AARP has been advocating for more testing, increased access to PPE and more monitoring to ensure that staffing levels are adequate. AARP has also asked officials to require nursing homes and other residential care facilities to make virtual visits available so family members and caregivers can be in touch with their loved ones.

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"The situation in America's nursing homes is gut-wrenching and terrifying. Families cannot visit and have no idea what is going on with their loved ones, which is why it is so outrageous that virtual visitation is still not available in every nursing home,” said Bill Sweeney, AARP's senior vice president for government affairs. “The staff and residents in these facilities need PPE and testing, and there needs to be more transparency and daily reports on which facilities have confirmed cases.”

Asked during the call with reporters whether CMS would require such virtual visits, Verma said she has heard about nursing home staff providing iPads and other devices to help residents communicate with loved ones. But she stopped short of saying such visits would be required. Verma said the issue will be discussed by a federal nursing home commission to be appointed this month to make recommendations about the future quality and safety of such facilities. The focus of the commission, she said, “is not only protecting our patients in nursing homes and we also want to make sure that they have the highest and best quality of life."

The CMS announcement also provides recommendations for how nursing homes should handle visitors once they reopen. These include requiring visitors to follow social-distancing guidelines, wash their hands and use sanitizer, and wear a face covering throughout their visit. CMS also recommends that visitors be screened before they enter the nursing home and that those screenings include temperature checks and questions about possible symptoms.

Even as nursing homes slowly begin to re-open for visitors, the recommendations make it clear it shouldn’t be business as usual. For example, under the CMS guidelines, nursing homes are asked to have residents who were accustomed to eating in a dining room before the pandemic sit 6 feet apart when eating with others. And nursing homes are advised to limit group activities that are common in nursing homes unless there is social distancing.

“We strongly support the new CMS guidance that issues caution in reopening America’s nursing homes,” said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living. “Nursing homes and assisted living communities are eager for our residents to welcome their loved ones back into facilities, yet cautious about doing this safely.“

Before any nursing home eventually reopens, CMS also wants states, which are generally responsible for nursing home oversight, to inspect any facility that has had a significant COVID-19 outbreak.

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