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 Reopening Guidance by CMS Wins Praise for Aggressive Stance on Staff, Resident Testing

Amid the state-by-state reopening of the United States while the coronavirus (COVID-19) pandemic continues, the Centers for Medicare & Medicaid Services (CMS) on Monday issued new guidance for state and local officials to ensure the safe reopening of skilled nursing facilities (SNFs), which quickly won the support of the long term and post-acute care profession for its focus on extreme caution and the call for aggressive testing for staff and residents alike.

CMS Administrator Seema Verma, in discussing the new recommendations in a press call Monday evening, said the impact of COVID-19 on SNFs has been “heartbreaking” given the unrelenting nature of the virus on the elderly and those with pre-existing chronic conditions. At the same time, she said families and residents have been separated for months since CMS in March declared nursing centers closed to everyone except essential staff and medical personnel.

“We did what was necessary to protect the elderly,” Verma said. Now, the time has come to prepare for what eventually will the allowance of visitors to return to facilities, with precautions like mandatory face coverings for all entering a building as well as coverings for residents and thorough screenings of all visitors.

“The vulnerable nature of the nursing home population requires aggressive efforts to limit COVID-19 exposure and to prevent the spread within facilities,” CMS said. “The recommendations issued today would allow states to make sure nursing homes are continuing to take the appropriate and necessary steps to ensure resident safety and are opening their doors when the time is right. This also serves to help states and nursing homes reunite families with their loved ones in a safe, phased manner.”

Because COVID-19 poses an elevated threat to vulnerable elderly SNF residents, CMS recommends additional criteria for nursing centers advancing through phases of reopening, to complement the Trump administration’s broader Opening Up America Again framework.

To that end, Verma said CMS is recommending to states and localities that nursing centers do not advance through any phases of reopening or relax any restrictions until all residents and staff have received results from a baseline test. 

In addition, CMS recommends that state survey agencies inspect SNFs that experienced a significant COVID-19 outbreak prior to reopening.  Lastly, CMS recommends that nursing centers remain in the current state of highest restriction even when a community begins to relax restrictions for other businesses and should be among the last to reopen within the community, to ensure safety of the residents.

Nursing centers may receive visitors during phase three, which is when there has been a sustained decrease in COVID-19 cases, the agency said. “A variety of factors must go into making this decision, including states not only relying on case count, but assessing the individual nursing home and other local factors. Visitors must be screened and wear a cloth face covering at all times,” CMS said.

AHCA/NCAL President and Chief Executive Officer Mark Parkinson said the long term/post-acute care profession strongly supports the new CMS guidance and its focus on caution in reopening SNFs.

“As CMS acknowledged, the pandemic has been a historic threat for long term care, and some of the steps we have taken to protect residents have been difficult as they have been physically distanced from loved ones,” he said.

“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. We are grateful to CMS for recognizing the importance of setting reasonable guidelines for reopening our nation’s long term care facilities.”  

Parkinson said AHCA/NCAL is particularly appreciative of the focus CMS puts on staff and resident testing. “As we have said repeatedly, before we can open our doors again, the ability to test residents and staff in every long term care facility is essential given the impact of this deadly virus on our vulnerable residents,” he said.

The new guidelines from CMS will help residents and staff in long term care facilities get access to testing across the country and ensure other key checkpoints are reached before long term care facilities fully reopen to visitors.

“Moving forward, it is vital that all long term care facilities receive additional support and funding from state governments to conduct expanded testing. We encourage governors to use the $11 billion that has been allocated to states for expanding testing in our nursing homes, assisted living communities, and other long term care facilities,” Parkinson said.

States can also assist with logistical support in implementing such a large endeavor, with help from the National Guard or the state’s health department, he added.

“The only way for our health care sector to curb the outbreak of this deadly virus is for prioritized, expedited, and continuous testing,” Parkinson said.

He stressed that long term care providers need to test all of their residents and staff, identify current positive cases, and take swift action to prevent further spread. “We then need to test staff on a regular basis and all visitors to prevent the virus from coming into the buildings. For our more than 2 million current residents and another 2 million staff members, this requires a collective effort from the public and private sectors to ensure both the availability and collection of testing kits with rapid results.” 

Parkinson said the association and its members appreciate CMS taking this important step with the guidelines issued today, and “we look forward to working with them to ensure we safely reopen for the sake of our residents and heroic staff.” 

During her press call, Verma also stressed that the CMS guidance is not a mandate to states, as states and localities will have to make the final decision on how and when facilities reopen. And, she said, it may even be the case that if individual facilities have a COVID-19 infection problem, that they would remain off-limits to reopening protocols until the situation is resolved.

“The guidance released today encourages state leaders to collaborate with the state survey agency and local health departments to decide how these criteria should be implemented,” CMS said. Given the critical importance in limiting COVID-19 exposure in nursing centers, CMS recommends that decisions on relaxing restrictions be made with careful review of the following facility-level, community, and state factors:

--Status of COVID-19 cases in the local community;

--Status of COVID-19 cases in nursing centers;

--Adequate staffing;

--Baseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control for residents and visitors (for example, face coverings);

--Access to adequate personal protective equipment; and

--Local hospital capacity

Verma also said by the end of the month new data culled from SHFs reporting COVID-19 infections, deaths, and other infection information will be made available and posted to the Nursing Home Compare website for public consumption. The new reporting requirements went into effect on May 18.

The CMS guidance is here:

And, the CMS FAQs are here:

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