As nursing homes prepare to reopen, they should not relax restrictions until all residents and staff have received results from a baseline test indicating they do not have COVID-19, the Trump administration said in new guidance (PDF) released Monday.
Further, nursing homes should continue to restrict visitors to residents until later phases of reopening in their respective states, the Centers for Medicare & Medicaid Services (CMS) said in the guidelines.
Nursing homes "should be among the last to reopen within the community, to ensure safety of the residents," the agency said in an announcement.
In March, CMS temporarily shut down visits to nursing homes nationwide in an effort to stem cases that had begun spreading like wildfire among elderly residents in some facilities.
CMS Administrator Seema Verma said the guidance is aimed at helping direct nursing homes through safely reopening but keeping decisions about reopening up to state and local authorities on the ground.
"I think the guidelines and the recommendations are very clear where I think they [advise] nursing homes to use extreme caution because this is such a vulnerable population. I am confident that governors are going to do what's best for their nursing home residents and their families who really want to be reunited with them," Verma said in a call with reporters.
As part of the guidance, CMS also recommends:
- Nursing homes screen staff daily and test them weekly for COVID-19 cases in order to detect and respond rapidly to potential cases of the virus.
- Nursing homes ensure they have sufficient safety equipment and coverings for all staff and essential visitors.
- State survey agencies inspect nursing homes that experienced a significant COVID-19 outbreak prior to reopening.
- Nursing homes remain in the current state of highest restriction even when a community begins to relax restrictions for other businesses until there has been a sustained decrease in COVID-19 cases taken into consideration with an assessment of the individual nursing home and other local factors. Visitors must be screened and wear a cloth face covering at all times.
Last week, the agency released a toolkit of best practices to prevent the spread of the novel coronavirus.
"A shared responsibility is crucial because it's clear this virus will continue to pose a threat to nursing homes where elderly individuals with underlying health conditions live in close quarters," Verma said.
CMS is encouraging local and state leaders to take into consideration multiple factors when deciding when to reopen nursing homes including the status of COVID-19 cases in the local community, the status of COVID-19 cases in nursing homes, staffing levels, baseline testing, access to adequate personal protective equipment and local hospital capacity.
"It's not only looking at the case counts in the community. Is there a positivity level? But also what's gone on in each nursing home," Verma said. "If a nursing home had a significant outbreak, it's important that the state prioritize and do an inspection of that nursing home to ensure they are properly adhering to the guidelines and the recommendations and proper infection control practices. That's why it's important to look at all of these factors when reopening a nursing home."