The federal government late Friday formally issued new guidance prohibiting all non-essential visits to nursing homes, while also waiving the three-day hospital stay requirement for subsequent Medicare skilled nursing coverage, as officials look to blunt the effects of the novel coronavirus on elderly Americans.
The strict ban allows exceptions for families to visit loved ones nearing the end of their lives, but even those situations require close scrutiny, according to an updated memo on COVID-19 protocols from Centers for Medicare & Medicaid Services (CMS) official David Wright.
“Decisions about visitation during an end of life situation should be made on a case by case basis, which should include careful screening of the visitor (including clergy, bereavement counselors, etc.) for fever or respiratory symptoms,” CMS advised in the memo. “Those with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations).”
Those visitors must also be restricted to a single designated room, and will be required to wear protective equipment for the duration of their stay.
Health care workers, including third-party practitioners such as hospice staff and dialysis technicians, are exempt from the bans, though even those visitors will be subject to scrutiny.
“They should be permitted to come into the facility as long as they meet the CDC guidelines for health care workers,” Wright wrote. “Facilities should contact their local health department for questions, and frequently review the CDC website dedicated to COVID-19 for health care professionals.”
Surveyors can also continue to visit facilities, though a temporary moratorium on non-emergency inspections remains in place and officials continue to monitor their own health; surveyors exhibiting fevers will not be allowed to enter skilled nursing facilities.
In addition, CMS ordered the complete suspension of all group activities in nursing homes, and is also mandating screenings for all staff at the beginning of their shifts.
“Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat,” the agency advised. “If they are ill, have them put on a facemask and self-isolate at home.”
The updated memo came a few hours after CMS administrator Seema Verma, speaking at a press conference with President Trump and Vice President Pence, announced the stricter protocols as part of a wider emergency response to the spread of COVID-19.
CMS had previously only banned visits from people who displayed symptoms of respiratory illness, though the American Health Care Association, a variety of state governments, and many individual nursing home operators had already been advising people to generally stay away from skilled nursing facilities.
Should an individual state enact an even stricter ban through a governor’s executive order, such as a blanket halt on all visits, facilities should follow those guidelines; surveyors will not cite nursing homes for being out of federal compliance when obeying state orders.
There is no current timeline for how long the federal ban will last.
“We fully appreciate that this measure represents a severe trial for residents of nursing homes and those who love them, but we are doing what we must to protect our vulnerable elderly,” Verma said on a Friday press call. “Needless to say, the moment we believe these restrictions can be relaxed, we will do so.”
The emergency declaration also includes a waiver of the three-day stay rule for receiving Medicare coverage of skilled nursing care; under normal circumstances, Medicare beneficiaries must spend three days at a hospital on an inpatient basis in order to receive a subsequent 100 days of covered care at a SNF.
The waiver eliminates that rule “for those people who need to be transferred as a result of the effect of a disaster or emergency.” Additionally, some Medicare beneficiaries whose skilled nursing coverage recently lapsed will be able to renew that coverage without needing to start a new benefit period.
“Our actions allow hospitals to reserve beds for the most severely ill patients by discharging those who are less severely ill to skilled nursing facilities,” Verma said Friday.