As Nursing Homes with Cases Reach 400, AHCA Advises Operators to Assume All Untested Patients Positive for COVID-19

One of the country’s major nursing home trade groups is advising its members to assume that unless a person has tested negative for COVID-19 prior to admission, that patient has the virus.

This is regardless of whether or not they have symptoms, according to guidance from the American Health Care Association (AHCA) released on Monday.

The updated recommendations came after a March 27 report from the Centers for Disease Control and Prevention (CDC) found that of 23 COVID-19-positive tests at a nursing home in King County, Wash., 57% came from residents who had no symptoms of the disease before the test.


The total number of nursing homes nationwide with reported cases topped 400 this week, according to a CDC statistic cited in a Monday report from NBC News. That’s significantly higher than the 150 figure that Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma cited in a Monday night phone call with reporters — during which she also announced a plan to begin reimbursing labs for COVID-19 tests performed in nursing homes.

“We hope that this will encourage more testing of our nursing home residents who are amongst the most vulnerable,” Verma said. “We know that over 150 nursing homes have been affected. By increasing testing we can isolate those patients that have been infected and keep other residents healthy.”

Because these residents were still shedding virus at a level infectious to others, AHCA revised its decision-making guidance on the process of admitting patients from the hospital, advising SNFs to assume that any patients coming into the facility are positive for COVID-19, even if they do not show any symptoms.


“The decision-making process to accept hospital admissions will vary depending on the ability of the LTC facility to manage residents who are COVID-19 positive or suspected to have COVID-19,” the guidance said. “Accepting residents from the hospital is also contingent on the LTC facility having adequate staffing levels and [personal protective equipment] to manage COVID positive residents.”

If that’s not possible, then the long-term care facility should halt all admissions until it regains staffing and PPE sufficient to manage residents, AHCA added.

The association reiterated its earlier recommendation that long-term care facilities should create separate wings, units or floors now, to prepare for admissions from the hospital, and to keep current residents separate, if it is possible to do so.

The federal government this week released a host of rule waivers that will allow operators to move residents into facilities exclusively dedicated to serving COVID-19 patients, or transfer them to specific units within a single facility.

Salmon Health & Retirement, a nursing home operator in Massachusetts, as of Monday was already in the process of transferring residents in order to clear out a property in Worcester, Mass. to make way for COVID-19 cases. Management expected the coronavirus-specific nursing home to be ready as soon as this Thursday.

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