On April 2, 2020, the Centers for Medicare & Medicaid Services (“CMS”) and the Centers for Disease Control and Prevention (“CDC”) issued new recommendations to long-term care facilities, also known as nursing homes, in response to the COVID-19 pandemic. This article summarizes these recommendations and provides additional commentary. 

Previously, the CDC and CMS provided guidance to the long-term care facilities regarding prohibiting visitors and implementing infection control and screening mechanisms. The CMS and CDC issued new recommendations to further explain this prior guidance.

First, long-term care facilities should ensure they are following all CMS and CDC infection control guidance, including guidance on hand hygiene and personal protective equipment (“PPE”). CMS provided a self-assessment checklist for long-term care facilities to review to review their infection control plan. Federal and state inspectors will be conducting targeted infection control inspections of at-risk, long-term care providers, so this checklist could be a tool for long-term care facilities in preparing for these inspections.

Second, long-term care facilities must immediately screen all individuals for symptoms. This includes individuals entering the facility, including employees, vendors, outside healthcare workers (e.g., attending physicians, hospice employees), and others. If an individual refuses to undergo screening, the facility should find a way to keep that person from entering the facility. For example, if the mail carrier refuses to undergo screening, the facility should request that the mail be held at the post office or designate an alternative delivery location. To aid in this screening, long-term care facilities should limit access points to the facility and ensure that each access point has a screening station. Emergency medical services personnel responding to an emergency call are the only exception to this screening requirement, as they should be separately screened. Additionally, long-term care facilities should screen residents daily, including temperature screening and reviewing residents for COVID-19 symptoms. To the extent COVID-19 testing kits are available, long-term care facilities should screen their residents and newly admitted residents. When conducted by a certified laboratory, COVID-19 testing is now a Medicare-covered benefit.

Third, employees of long-term care facilities should use PPE when providing care to residents to the extent it is available and in accordance with the CDC’s guidance on conservation of PPE. Facility staff should wear facemasks while in the facility and should wear full PPE when in the presence of any resident with, or suspected of having, COVID-19. Facility staff should wear full PPE if a COVID-19 transmission occurs in the facility. Facemasks should be worn by residents who regularly leave the facility, for example, dialysis patients, and by residents who test positive for or are assumed to be positive for COVID-19. All residents should attempt to limit the potential exposure of staff by covering their noses and mouths while staff are in their room, for example with a tissue or a cloth, non-medical mask. Fortunately for long-term care providers, CMS and CDC recommended to state and local leaders to consider long-term care facilities when planning for and distributing PPE and COVID-19 testing kits. Facilities having difficulty obtaining PPE should notify their local emergency management authority or local health department, which may be able to assist the facility with obtaining additional PPE.

Fourth, long-term care facilities should employ staffing methods to limit the transmission of COVID-19 between staff members. This could include consistent staffing assignments and avoiding scheduling staff on alternating units or floors. Long-term care facilities should separate COVID-19 positive residents, for example by relocating all COVID-19 positive residents to a dedicated unit. 

There are many resources for long-term care facilities with questions about complying with this guidance, including local membership organization calls and dedicated webpages, for example, the Florida Health Care Association, as well as state and national conference calls, including CMS calls to discuss best practices and answer questions about COVID-19.