On May 18, 2020, CMS released guidelines for State and local officials for phased nursing home reopenings. The guidelines include recommendations for (1) the criteria for relaxing certain restrictions and mitigating the risk of resurgence, (2) visitation and service considerations and (3) restoration of survey activities. The guidelines are non-binding recommendations and provide significant discretion to State and local leaders in making decisions specific to their communities.
One of the decisions that States are encouraged to make based on their specific communities is whether the phases should progress on a state-wide, region-wide, or individual facility level. The guidelines include various factors that should be used to inform relaxing restrictions in nursing homes. These factors include the case status in the community, the case status in the nursing home, the adequacy of staffing, access to adequate testing, universal source control, access to adequate personal protective equipment and local hospital capacity. CMS recommends that nursing homes have a testing plan based on CDC recommendations that includes, at a minimum, the capacity for all nursing home residents to receive a single baseline COVID-19 test and the capacity for all nursing home staff to receive both a single baseline COVID-19 test as well as re-testing of all staff every week.
The guidelines are structured in phases and crosswalk to the Opening Up America Again guidance for reopening State economies. However, the guidelines emphasize that additional criteria are recommended for advancing through the phases of reopening nursing homes due to the elevated risk COVID-19 poses to nursing home residents. The guidelines also recommend that a nursing home spend a minimum of 14 days in a given phase, with no new COVID-19 cases, prior to advancing to the next phase.
Phase 1, which reflects the current state, includes strict limitations on visitors to nursing homes and also limited survey activity. Specifically, in Phase I, surveying activity is limited to investigation of immediate jeopardy threats, revisit surveys to confirm the facility has removed any immediate jeopardy findings, focused infection control surveys, initial certification surveys, and State-based priority surveys (e.g., localized “hot spots,” “strike teams,” etc.).
Phases 2 and 3 include a gradual relaxation of restrictions. However, the guidelines recommend the general prohibition of all visitors except for compassionate care situations until Phase 3. Normal survey activity is not recommended to resume until Phase 3, although Phase 2 adds surveys investigating complaints of actual harm to residents to the Phase 1 survey activity identified above. Additionally, the recommendation that all staff are tested weekly continues through all three phases.
CMS’s guidelines are available here.
