CMS issues guidance regarding safe reopening of nursing homes

Kelly Reinke

INDIANAPOLIS — This week the Centers for Medicare & Medicaid Services (CMS) announced new guidance for state and local officials to ensure the safe reopening of nursing homes across the country.

It details steps nursing homes and communities should take prior to relaxing restrictions implemented to prevent the spread of COVID-19.

“Coronavirus has had a devastating impact on nursing homes, and as we reopen America, we want to make sure we are doing everything we can to protect our most vulnerable citizens,” said CMS Administrator Seema Verma.  “Our focus continues to be the safety and quality of life of nursing home residents and 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.”

The guidance released this week encourages state leaders to collaborate with the state survey agency and local health departments to decide how these criteria should be implemented.  

CMS recommends that decisions on relaxing restrictions be made with careful review of the following factors:

Status of COVID-19 cases in the local communityStatus of COVID-19 cases in nursing homesAdequate staffingBaseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control for residents and visitors (e.g., face coverings)Access to adequate personal protective equipment (PPE)Local hospital capacity

The memo breaks down the recommendations into three phases. Nursing homes may receive visitors during phase three, which is when there has been a sustained decrease in COVID-19 cases. Visitors must be screened and wear a cloth face covering at all times.  

Also, CMS says nursing homes can enter phase three when there have been no new COVID-19 cases in the facility for 28 days.

“The guidance appears to be very detailed and seems to be fair. It sets out a good standard with respect to how long a facility would need to be COVID-19 free,” said Zach Cattell, president of the Indiana Health Care Association.

IHCA is a trade association and advocate representing skilled nursing facilities and assisted living communities.

Roughly 45 percent of COVID-19 deaths across the state are linked to its long term care facilities. More than 200 campuses are reporting at least one case as of Monday.

Cattell is noticing some promising data.

“There are many many nursing facilities, 70-75 percent of nursing facilities that are COVID naive or COVID free and have remained so for the duration,” he said.

Cattell explained IHCA issued a letter to the Indiana State Department of Health a few weeks ago to ask for guidance about reopening long term care communities.

He applauded CMS for putting the thought in providing some clarify for states to operate from.

CMS is recommending that nursing homes do not advance through any phases of reopening or relax any restrictions until all residents and staff have received results from a baseline test. The guidelines also recommend weekly testing of staff.

On a nationwide press call on Monday, CMS Administrator Seema Verma said they felt there is sufficient testing capacity available in all states.

“These recommendations and guidelines were put together with that in mind,” she said.

Cattell called this piece of the recommendation a hurdle for Indiana. He believes it will be difficult to overcome in order to reopen nursing facilities anytime soon.

“I hope she is right that with respect to the national picture but we are not seeing that necessarily in Indiana,” he said.

State and local leaders are urged to regularly monitor the factors for reopening and can adjust their plans accordingly, depending on local data about the circulation of the virus in their community.   

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