Nursing homes that require testing as a condition of visitation must provide the testing options to do so, Centers for Medicare and Medicaid Services (CMS) officials announced this week.
CMS addressed the issue after receiving a flurry of questions on the matter from state officials and operators across the country.
CMS also said COVID-19 tests will soon be on the way to nursing homes – provided by South Korean pharmaceutical company Celltrion.
The Biden administration’s 2.5 million tests a week have not been sufficient against the sheer amount of infections associated with the omicron winter surge, according to a Kaiser Health News article.
The American Health Care Association estimates the industry needs closer to 5 million tests per week, the article said; about 76% of nursing homes said they have adequate testing supplies, but restocking was becoming more difficult.
If a facility doesn’t have tests available then the visit must still occur, according to CMS Division of Nursing Homes Director Evan Shulman, despite some states requiring facilities to test visitors prior to entry.
As of Jan. 20, California, New York and Rhode Island have mandated testing prior to visitation, another KHN article said.
Shulman was one of a few CMS officials who answered questions from the nursing home industry in a Wednesday stakeholder call.
“CMS has communicated to states that they can have facilities test visitors prior to entry, however, they need to be provided by the facility and they need to be the 15-minute rapid test,” Shulman said. “We believe it’s reasonable for facilities to test visitors prior to entry.”
On visitation safety, Schulman said nursing homes can request to use civil monetary penalty (CMP) funds to purchase portable devices to improve airflow and air quality as another way to prevent viral transmission.
“It’s hand hygiene, it’s physical distancing, it’s masking and it’s also airflow. We’re just trying to layer on top all of the practices that can help,” Shulman said. “There has never been one single practice that reduces the transmission of COVID-19. It’s always been a multitude of practices.”
Visitation can occur with a nursing home resident’s roommate safely distanced 6-feet away, Shulman added, but emphasized it would be better to conduct a visit when the roommate is not there.
Shulman also clarified that the term “visitors” doesn’t just apply to friends and family, but to state ombudsmen as well.
The Centers for Disease Control and Prevention (CDC), which was also involved in the stakeholder call, said it updated its infection prevention guidance as it applies to nursing homes. For example, those with even mild symptoms of COVID must receive a viral test “as soon as possible,” Kara Jacobs Slifka, medical officer for the agency, said.
Slifka urged nursing home staff to follow up their negative rapid test with a nucleic acid amplification test, or NAAT – a PCR test is an example of such a test, the CDC representative said.
“CDC continues to recommend that asymptomatic residents with a close contact exposure should have a series of two viral tests for [COVID-19] immediately, although not less than 24 hours after their exposure, and then if that’s negative again at five to seven days,” Slifka said of resident testing.
Guidance was expanded on Wednesday to include newly admitted residents and residents who had left the facility for more than 24 hours, Slifka said on the call.
Slifka added that CDC updated its vaccine page to help nursing home management better understand quarantine and isolation requirements for health care personnel.
While the agency has said health care personnel can shorten their amount of time in isolation with a negative test, the same doesn’t apply to residents.
“We recommend a 10-day isolation after symptoms have first appeared for residents who are infected with [COVID-19] who are either asymptomatic or who have had a mild to moderate illness and are not moderately to severely immunocompromised,” Slifka clarified.
Residents not “up to date” with vaccine doses who have had a close contact exposure should be placed in quarantine and cared for by staff in full protective personal equipment (PPE), Slifka said, even if a viral test comes back negative.
Individuals are considered “up to date” if they have received their primary and booster doses.
The CDC’s definition of “fully vaccinated” still refers to an individual’s primary series of COVID-19 vaccine doses, according to Slifka.