Americans living and working in nursing homes and other long-term care facilities have been disproportionately affected by the coronavirus pandemic, accounting for roughly a quarter of all U.S. COVID-19 deaths. If you have a spouse, sibling, parent or other loved one in a nursing home, here are 10 key questions to consider asking the facility, as recommended by experts.
1. What is the status of COVID-19 vaccinations in the facility?
- What proportion of residents and staff are fully vaccinated and have received a booster shot? You can find vaccination and booster rates of both residents and staff at any Medicare-certified nursing home and compare them with state and national averages on Medicare.gov’s Care Compare website.
- Is the facility tracking when residents and staff are due for boosters?
- Is the facility having trouble accessing or administering vaccines or boosters as residents and staff ask for them? If so, what’s being done to resolve this?
- What is the facility doing to educate residents and staff on the vaccines’ effectiveness and safety?
2. Is the facility's screening and testing of residents and staff for COVID-19 in line with government recommendations and regulations?
- Are residents and staff, including temporary staff, being screened at least daily for COVID-19 symptoms, as recommended by the Centers for Disease Control and Prevention (CDC)?
- Is the facility testing residents and staff as specified by the Centers for Medicare & Medicaid Services (CMS)?
- If the facility is in a county with a moderate or higher level of COVID-19 community transmission, are unvaccinated staff being tested regularly, as required by the CMS?
- Read the CMS’s full testing requirements for nursing homes.
3. If COVID-19 is detected, is the facility ready to respond quickly to prevent further spread?
- Is there a dedicated person planning and managing the facility’s infection control program, as required by the CMS?
- Is the facility able and ready to implement the correct infection prevention and control protocols, as established by the CDC, to prevent COVID-19’s spread? For instance, is there a dedicated COVID-19 care unit that’s physically separated from other rooms or units housing residents without COVID-19? Is there staff assigned to work only in the COVID-19 care unit?
- Read the CDC’s full guidance on infection prevention in nursing homes.
4. Has a positive case been identified at the facility in the past two weeks?
- If so, is the facility performing an outbreak investigation, as required by the CMS?
- How many residents and/or staff have tested positive?
5. Is the facility's management of visits in line with government regulations?
- Is the facility allowing visits for all residents at all times, as required by the CMS? Note that visitors with COVID-19 or symptoms of COVID-19, or who meet the criteria for quarantine, should not be granted entry. There are some “very limited and rare exceptions” that call for visitation restrictions in CMS requirements.
- Are all visitors entering the facility being screened for COVID-19 symptoms, as the CMS says they should?
- Are the core principles of COVID-19 infection prevention being followed, such as frequent hand hygiene, masking and physical distancing?
- If the facility is in a county with a substantial or high level of community transmission, is it encouraging and/or offering testing for visitors?
- Is the facility encouraging vaccination and boosters for visitors?
- Are residents who leave and return to the facility being screened, tested or quarantined, as recommended by the CMS?
- Read the CMS’s full visitation requirements for nursing homes.
6. How is the facility helping residents stay connected with their loved ones virtually?
- Does the facility have tablets or other technologies to enable virtual calls/visits?
- Is the facility offering to schedule — and assist — residents in calling their loved ones?
7. Does the facility have sufficient levels of personal protective equipment (PPE) — masks, face shields, hand sanitizer, gowns and gloves?
- If not, what is the plan to obtain more and what safety measures are in place in the meantime?
- Are staff, residents and visitors trained on how to properly use PPE?
- Is PPE available for visitors or should they bring their own?
8. How is the facility communicating important COVID-19 information?
- How can family members and resident representatives stay informed on COVID-19 case rates, community transmission rates, vaccination rates, changes to visitation and other issues? Is the facility using phone calls, email, a website, a newsletter or another platform to provide regular updates? How often are the updates being issued?
- How are residents and staff staying informed on these issues?
- If a COVID-19 case within the facility is confirmed, how long will it take for resident representatives to be notified?
9. Is the nursing home currently at full staffing levels for nurses, aides and other workers?
- If not, how are the care needs of residents — bathing, feeding, medication management, exercise, social engagement, etc. — being met?
- If not, is there a plan to increase staffing levels?
- You can find staffing data — including staff turnover rates, average hours of care provided to residents by different types of nurses, and weekend staffing levels — for any Medicare-certified nursing home on Medicare.gov’s Care Compare website. You can also compare a facility’s rates to state and national averages.
10. Are healthy-living programs back up and running?
- How are communal activities like dining, exercising, socializing and entertainment being adapted in order to follow infection-control practices?
- Have any services been cut?
If you’re concerned about the safety and well-being of a loved one who lives in a nursing home, contact your state’s long-term care ombudsman.
Editor's note: This article, originally published on April 24, 2020, has been updated to reflect new information.