10 COVID-19 Questions to Ask a Nursing Home
Guidance for caregivers during the COVID-19 pandemic
Residents and staff of nursing homes and other long-term care facilities have been disproportionately affected by the coronavirus pandemic, accounting for roughly a fifth 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?
- Is the facility tracking when residents and staff are due for additional COVID-19 vaccines or boosters?
- What is the facility doing to educate residents and staff on the vaccines’ effectiveness and safety, including the omicron-specific bivalent boosters?
- What proportion of residents and staff are up to date on their COVID-19 vaccines and boosters? You can find vaccination 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.
- What hurdles is the facility facing in keeping residents and staff up to date on COVID-19 vaccines and boosters? What’s being done to resolve this?
2. What is the status of COVID-19 in the facility?
- Is there a dedicated person planning and managing the facility’s infection control program, as outlined by the Centers for Disease Control and Prevention (CDC)?
- Is the facility routinely testing residents and staff with symptoms to swiftly detect cases, as required by the Centers for Medicare & Medicaid Services (CMS)?
- How many positive cases have been identified at the facility in the past two weeks?
- Are outbreak investigations occurring when a new case of COVID-19 occurs among residents or staff, in line with CMS requirements?
- If in outbreak status, are residents being placed in a single-person room or cohorted in line with CDC recommendations? For example, is there a designated COVID-19 unit with dedicated workers to care for residents with suspected or confirmed COVID-19? Are those residents in private rooms?
3. 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 and other issues? Is the facility using phone calls, email, a web page, a newsletter or another platform to provide regular updates?
- If a COVID-19 case within the facility is confirmed, how long will it take for resident representatives to be notified?
- How are residents and staff staying informed on these issues?
4. Are COVID-19 treatments and medications being offered?
- Are treatments such as Paxlovid readily available to be started as soon as possible after diagnosis? (Note that treatment must be started within days of when you first develop symptoms to be effective.)
- Are medications readily available to help reduce symptoms and manage illness?
- Are residents and staff being educated on the effectiveness and safety of COVID-19 treatments and medications?
- Is a health care provider or pharmacist readily available to help residents and staff decide which treatment, if any, may be right for them?
5. Are the facility’s masking requirements in line with government guidance?
- If your facility is in a county where COVID-19 community transmission is high, is everyone wearing masks or face coverings when in areas where they could encounter residents, as recommended by the CDC?
- Is everyone wearing masks or face coverings in areas of the facility in outbreak status?
- If a roommate is present during a visit, are visitors encouraged to wear a mask or face covering?
6. Does the facility have enough masks, hand sanitizer and other essential personal protective equipment (PPE) on hand?
- Is enough PPE readily available in case of a COVID-19 outbreak?
- Are staff, residents and visitors trained on how to properly use PPE?
- Are masks and other PPE available for visitors, or should they bring their own?
7. 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 nurse aides, 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.
8. Is the facility allowing visits for all residents at all times, as required by CMS?
- Note there are “extremely rare” situations — such as a severe outbreak warranting health department intervention — that call for pauses on visitation. However, CMS recommends visitors who’ve tested positive for COVID-19, have symptoms of COVID-19, or who’ve had close contact with someone with COVID-19 defer nonurgent in-person visitation until they meet CDC criteria for reentry.
- Are the core principles of COVID-19 infection prevention being followed during visits?
- If the facility is in a county with a high level of community transmission, is it encouraging or offering testing for visitors?
- Is the facility encouraging vaccination for visitors?
- Are residents who leave and return to the facility being screened, tested or quarantined in line with CMS guidance?
9. 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 or visits when in-person visits are not recommended or possible?
- Is the facility offering to schedule — and assist — residents in calling their loved ones?
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.