CMS: Nursing Homes Should Separate Staff Into Teams, Develop Dedicated Wings and Buildings for COVID-19

Building on individual state actions, the federal government on Thursday night directed the nation’s nursing home operators to begin setting up separate wings — or entire facilities — for residents who have tested positive for COVID-19, while also encouraging operators to use separate teams of staff members to better monitor developing cases.

The Centers for Medicare & Medicaid Services (CMS) issued a new set of updated guidance for nursing homes, which largely formalized actions that many providers across the country have already taken — including screening all visitors for symptoms, ensuring buildings are actively complying with existing CMS and Centers for Disease Control & Prevention (CDC) protocols, and using personal protective equipment (PPE) when interacting with residents whenever possible.

But the mandate to use separate staffs and accelerate the development of segregated facilities took the federal guidance a step further, as CMS looked to states such as Massachusetts that have already implemented plans to create dedicated COVID-19 facilities for long-term and post-acute care.

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“Long-term care facilities should exercise as best as possible consistent assignment (meaning the assignment of staff to certain patients and residents) for all patients and residents regardless of symptoms or COVID-19 status,” CMS wrote. “This practice can enhance staff’s familiarity with their assigned patients and residents, helping them detect emerging condition changes that unfamiliar staff may not notice.”

The directive only requires nursing homes to perform these tasks “to the best of their ability,” while also encouraging operators to work with state and local authorities to achieve the goal of creating COVID-specific nursing homes.

“Long-term care facilities should separate patients and residents who have COVID-19 from patients and residents who do not, or have an unknown status,” CMS wrote. “To this end, long-term care facilities should work with state and local community leaders to identify and designate facilities dedicated to patients and residents with known COVID-19-positive and those with suspected COVID-19, ensuring they are separate from patients and residents who are COVID-19-negative.”

The late Thursday announcement also builds on waivers that CMS issued earlier this week, relaxing the rules around transferring long-term care patients and receiving reimbursements for care provided at alternate sites.

“The Trump administration is calling on the nursing home industry and state and local leaders to join us by taking action now to ensure the safety of their residents, who are among our most vulnerable citizens,” administrator Seema Verma said in a statement. “The administration urges them to carefully review our recommendations, and implement them immediately.”

CMS in particular lauded operators and officials in Massachusetts for the creation of a 142-bed facility for COVID-19 patients in Wilmington, Mass.

“Residents across the region who are infected with COVID-19 can be moved to this facility to receive appropriate care and avoid transmitting the virus within their facilities. This approach also eases the challenges of preventing transmission, like extensive PPE usage and isolation practices, for individual facilities,” CMS observed. “The Massachusetts arrangement, developed in coordination with the state’s government, is a prime example of the arrangements envisioned in the recommendations announced today.”

To help ease the strain on supplies of PPE — a major concern for nursing homes and other health care settings across the country — CMS urged state and local governments to “consider the needs of long-term care facilities with respect to supplies of PPE and COVID-19 tests.”

The updated rules also call on nursing home staffers to wear face masks for the entire time they are in a facility, as long as their state government has declared an emergency; at properties with confirmed transmission of COVID-19, employees should wear full PPE at all times, regardless of whether or not they are coming in contact with people exhibiting coronavirus symptoms.

CMS also warned that, as previously announced, state surveyors will continue to prioritize infection-control inspections. During the first round of surveys conducted the week of March 30, 36% of facilities did not follow proper hand-washing protocols, while 25% did not demonstrate proper use of PPE, CMS announced.

“Both of these are long-standing infection-control measures that all nursing homes are expected to follow per federal regulation,” CMS warned. “CMS is continuing to conduct targeted infection control inspections to ensure nursing homes are prepared to confront COVID-19 and keep their residents safe.”

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