UPDATE, Saturday, March 14: CMS formally issued its guidance late Friday, enacting a ban on most non-essential visits to nursing homes and also waiving the three-day stay rule for Medicare skilled nursing coverage.
The federal government will soon issue guidance directing nursing home operators to ban the vast majority of visitors amid the spread of the novel coronavirus, marking the latest escalation in the fight to protect vulnerable seniors.
Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma announced the pending change during a Friday news conference with President Trump and Vice President Pence.
“Later, CMS is going to be issuing guidance directing nursing homes to temporarily restrict all visitors and non-essential personnel, with a few exceptions, such as end-of-life situations,” Verma said. “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.”
The federal government had previously recommended that operators restrict visits from people experiencing potential symptoms of COVID-19, though many local municipalities and individual companies had enacted stricter bans depending on the severity of the coronavirus risk.
The American Health Care Association, a trade group that represents nursing homes and assisted living communities, had also recommended that people generally stay away from nursing facilities unless absolutely necessary, given the significant mortality rate for the 84-and-above population that makes up the average census at a given property.
“The grim reality is that for the elderly, COVID-19 is almost a perfect killing machine,” Parkinson said on CNN earlier this week.
LeadingAge, which represents nonprofit senior housing and care providers, expressed support for the decision in a statement issued Friday.
“We recognize how difficult this will be for residents and their loved ones,” Katie Smith Sloan, president and CEO, said in the statement. “Yet limiting residents to potential exposure is a crucial element of containment. While this is a significant change to the operating practices of most nursing homes, our members are dedicated to making the adjustments needed to prioritize and protect the needs of older adults and the staff who care for them.”
Verma also thanked the president for formally declaring an emergency over the coronavirus, a move that she said will allow CMS to take sweeping action due to the temporary suspension of certain regulations.
“The flexibilities we’re offering will be a godsend to the providers, clinicians, and facilities on the front lines of this fight,” Verma said.
The move by the federal government comes after several states had implemented similar measures on their own; in the state of New York, where more than 400 cases were confirmed as of Friday, Gov. Andrew Cuomo directed nursing homes and assisted living facilities to limit visitors only to those ‘end-of-life’ circumstances,” New York State Health Facilities Association (NYSHFA) president and CEO Stephen Hanse told Skilled Nursing News.
“No nursing home or assisted living resident to my knowledge has tested positive for COVID-19,” he said. “That said, it’s not a matter of if; it’s a matter of when.”
On a daily basis, SNFs are screening every individual who enters the facility, with a mandatory temperature check and documentation that the person has no symptoms such as cough or fever and has not come into contact with an infected individual or been in an infected area, Hanse said.
While such a step is hard for both residents and their families, it ultimately boils down to infection prevention and control, he explained. And this state could last for quite some time, given the evolving situation with the coronavirus.
“As more testing facilities come online and are approved, more and more testing is going to occur show more instances of infection,” Hanse said when asked how long this might go on. “We’re really looking three months out.”
In Washington, where a nursing facility became the center of a major outbreak of the coronavirus, the move by CMS is welcome, Washington Health Care Association CEO Robin Dale told SNN via email.
“This will help skilled nursing workers in their efforts to prevent COVID-19 from entering their centers,” Dale wrote. “It is a tough decision, but friends and families of nursing center residents should know that our amazing workers are focused on doing everything they can to keep our residents safe. They are doing incredible work under very difficult circumstances.”
While the incoming federal guidance marks the most severe move yet to contain potentially deadly outbreaks in nursing homes, many providers have already taken steps to substantially reduce the number of non-essential personnel and visitors within their walls.
The exact wording of each company’s COVID-19 protocols varies, but several key themes had emerged by Friday: Nobody’s coming into a nursing home without a vital reason. Those who are allowed in will be required to limit their movements and sanitize their hands frequently. Housekeeping and dietary teams are ramping up their infection-control protocols, including repeated cleanings of high-touch surfaces throughout their buildings. Families should keep in constant contact with loved ones in nursing homes over the phone, social media, or video chats to prevent loneliness and the potential for confusion or panic.
“The goal of each facility is infection prevention, and limiting the consequences of any that could occur,” The Ensign Group (Nasdaq: ENSG) affirmed in its coronavirus update. “The local leaders and caregivers are ever aware of the trust that has been given to them, and are embracing the opportunity to keep their residents and team members safe.”
At the Ohio-based CommuniCare, staffers as early as the first week of March were taking the temperature of everyone entering the company’s skilled nursing facilities, from staff to vendors — and anyone whose temperature exceeds 100.4 degrees was immediately sent home.
Tim Fields, CEO of Ignite Medical Resorts, told SNN that his company specifically invested in special temporal-scanning thermometers to increase routine checks of employees and residents.
As of Wednesday, the Evangelical Lutheran Good Samaritan Society had already explicitly banned visits at its skilled nursing facilities from anyone who is “not end-of-life-visit related or medically or operationally necessary”; even those people who meet those definitions could still be denied entry if they display symptoms of COVID-19 infection — or any respiratory illness.
Many of the major public health steps taken in response to the coronavirus pandemic — including the widespread cancellation of any large gatherings — have been explicitly aimed at reducing the risk for vulnerable populations, such as the elderly and people with compromised immune systems. But nursing home staff must remain safe as well, in order to keep caring for residents around the clock, and operators are deploying a variety of strategies to mitigate the risk while keeping buildings staffed.
CommuniCare’s protocols, for instance, call on individual buildings to maintain consistent staffing schedules to prevent cross-contamination, while also developing contingency plans if workers become ill. The Norcross, Ga.-based PruittHealth, meanwhile, rolled out a type of bonus plan to encourage uninterrupted staffing coverage in the event of an outbreak.
“In the event that an active coronavirus case presents, the PruittHealth partners who work their assigned shifts and other shifts as requested, will be eligible for a bonus when their facility is deemed virus-free,” the company noted in its COVID-19 plan.
Maggie Flynn contributed reporting.