CMS Gives Guidance on Unlocking Nursing Homes

Henrietta Brewer
May 23, 2020

A California lawmaker whose district includes a nursing home that saw a deadly coronavirus outbreak is proposing a bill that compel more COVID-19 testing in assisted living facilities regardless of whether a resident is showing symptoms of the disease.

CMS on Monday issued new guidance meant to help states form plans to ease restrictions aimed at curbing the new coronavirus' spread in nursing homes-and urged governors to use "extreme caution" in doing so.

The abrupt change - which calls for testing only a small sample of residents in nursing homes that have not had an outbreak - is outlined in a letter county health officials sent to nursing homes last week, as the death toll continued to mount at facilities across the county.

In addition to virus testing, Matson said nursing homes have struggled to keep the facilities adequately staffed with personal protective equipment.

Currently, nursing homes are supposed to report their infection rates and deaths to their state health departments, but only 33 states require reporting of death rates in those facilities. For example, a commission it is forming to evaluate nursing homes' responses to coronavirus and give further guidance just started calling for nominations on May 14, and Harder has called on it to get a commission together and active more quickly.

Starting with March's tragic COVID-19 outbreak in a Seattle-area nursing home, about one-third of U.S. COVID-19 fatalities were residents of nursing homes or people who worked in them, and in some communities that share is greater than 50%.

The nation must mobilize so every state has the capacity to test all patients and workers in every nursing home across the country.

-A NY nursing home was in the throes of a respiratory infection outbreak that had sickened 38 residents. The GAO said it plans other reports to independently examine how CMS responded to the outbreak as well as the agency's oversight of infection control in nursing homes. Along with the names of facilities, the department is also releasing the number of residents and staff who have tested positive for COVID-19 and the number of residents who have died from the disease.

A key sixth point, however, apparently was missing from the plan: Do not allow nursing homes to admit patients that test positive for COVID-19. Data for that five-year period showed that 82% of nursing homes inspected, or 13,299, had at least one deficiency related to infection control and prevention. He noted that the CDC initially did not place nursing homes in its highest-priority tier for testing. That effort should answer a series of critical questions, including what tests should be deployed, how often asymptomatic workers and residents should be tested, and how long sick workers must be quarantined before they can return to work.

"COVID-19 is very much a real threat to the elderly and people who have multiple medical conditions", he said.

Still, he said he was not aware of a nursing home that accepted an infected resident despite being unprepared to do so. The transmission rate is now probably down to two, with some local variation, so we have made progress.

OH has about 72,000 people living in nursing facilities, and 94,000 staff members.

However, as states have begun reopening nonessential businesses and easing social distancing measures, some stakeholders have called for guidance on how to begin easing restrictions-such as bans on visitors-at nursing homes, as well. We need to do this in a way that generates solid scientific evidence about how testing should be undertaken in nursing homes.

For his part, Minnesota Gov. Walz has attempted to deflect criticism of the state's controversial policy that allows nursing homes to accept COVID-19 positive patients by allowing the officials he has appointed to run the Department of Health explain the policy to the public.

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