On Mar. 13, the Centers for Medicare and Medicaid Services (CMS) issued an updated memorandum titled “Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes.” This memo is based on guidance from the Centers for Disease Control and Prevention (CDC), and it recommends that nursing homes take the following measures to protect their residents:

Screening

• Implement active and frequent screening of residents and healthcare personnel for fever and respiratory symptoms.
  • Prompt detection, triage and isolation of potentially infectious residents are essential to prevent unnecessary exposures among residents, healthcare personnel and visitors.
  • Do not permit anyone with symptoms of respiratory infection (fever, cough, shortness of breath or sore throat) to enter the facility at any time (even in end-of-life situations).
  • Facilities experiencing an increased number of respiratory illnesses (regardless of suspected cause) among patients/residents or personnel should immediately contact their local or state health department for further guidance.

Maintaining Clean Environments

• Remind everyone to perform frequent hand hygiene.
• Place alcohol-based hand sanitizer with 60-95% alcohol in every resident room – both inside and outside the room if possible – and in every common area.
• Ensure sinks are well-stocked with soap and paper towels for handwashing.
• Make tissues and facemasks available for people who are coughing and make necessary personal protective equipment (PPE) available in areas where resident care is provided.
• Ensure hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident equipment.

Social Distancing

• Immediately restrict all visitors, with exceptions for compassionate care such as end-of-life situations.
  • In compassionate care cases, all visitors (including clergy and bereavement counselors) should be screened for fever and respiratory symptoms. Visitation decisions should be made on a case-by-case basis.
  • Visitors should be equipped with PPE while inside the facility. The visit should be limited to a single specific room, and visitors should be reminded to perform frequent hand hygiene.
  • Notify potential visitors to defer visitation until further notice through signage and other outreach, such as emails and phone calls.
• Restrict all volunteers and nonessential healthcare personnel and other personnel (e.g., barbers).
• Cancel all group activities and communal dining.
• Encourage residents, visitors and personnel to refrain from physical contact with others while inside the facility (no hand-shaking or hugging, and remain six feet apart).
• In lieu of visits, nursing homes are encouraged to facilitate increased virtual communication between residents and families.
  • CMS also encourages nursing homes to keep residents’ loved ones informed about their care. This could include assigning a staff member as a primary contact for families to facilitate inbound communications, as well as regular outbound communications.

Finally, CMS also recommends that nursing homes regularly monitor the CDC website for additional resources and updates.