The federal Centers for Medicaid and Medicare Services laid out a series of guidelines Monday that urged “extreme caution” in reopening the nation’s nursing homes, including calling for facilities to ramp up their testing capacity for residents and staff before they relax any coronavirus-related restrictions.
The guidelines from CMS, which regulates nursing homes, recommend that state and local officials follow a phased approach to reopening nursing homes and similar facilities in their states. But before any restrictions are relaxed, facilities should have the capacity to test all residents and staff — including volunteers and vendors who enter the facility on a weekly basis for COVID-19 — and have the supplies to continue testing all staff weekly, according to the guidelines.
Additionally, facilities must ensure that they have enough personal protective equipment and essential cleaning and disinfection supplies and local hospitals have sufficient capacity in case COVID-19 cases begin to spike.
If a facility goes four weeks without a new COVID-19 case among staff or residents and meets several other staffing and community transmission criteria, some restrictions on visitations, communal dining and group activities can start to be lifted, the guidelines state.
“CMS recommends nursing homes do not advance through any of the stages of reopening or relax any restrictions until all residents and staff have received a baseline test to establish that there are no known cases of COVID-19 in the facility,” CMS administrator Seema Verma said on a conference call with reporters from across the nation on Monday night. “In addition to the baseline test, we are calling on nursing homes to screen all staff daily and test them weekly. Further testing of residents may be necessary upon identification of coronavirus symptoms.”
Nursing homes and other long-term care facilities across the country have been hit hard by the pandemic, with high rates of infection and tens of thousands of deaths, according to an analysis by the Kaiser Family Foundation.
In Indiana, there have been at least 3,625 confirmed cases of COVID-19 in long-term care facilities, including 732 deaths, according to the Indiana State Department of Health.
As of last week, roughly half of the then-27 coronavirus deaths in Bartholomew County were linked to long-term care facilities, and there have been “a number of deaths at several facilities in the county attributed to COVID-19,” said county health officer Dr. Brian Niedbalski.
Prior to the new CMS recommendations, some states—including Texas, New York, Arizona, New Jersey, Delaware, West Virginia, Pennsylvania and South Dakota — had previously announced plans to test residents and workers at long-term care facilities, according to the The Associated Press.
In Indiana, however, is it still unclear how the guidelines would be implemented.
The guidance offers state leaders some flexibility on how to implement the different phases of the guidelines. Some states can opt to have all facilities go through each phase of reopening at the same time or evaluate individual facilities on a case-by-case basis, the guidelines state.
On Monday, the Indiana State Department of Health sent nursing facilities a survey asking how they could test all staff for COVID-19 in a two-week period, ensure that all staff gets tested and whether the facility supports universal testing among staff, according to the Indiana Health Care Association/Indiana Center for Assisted Living, a trade association that represents skilled nursing facilities, assisted living communities and independent living.
Zach Cattell, president of the Indiana Health Care Association/Indiana Center for Assisted Livings, said in a statement that he is “encouraged” by the CMS guidelines, but cautioned that Indiana does not currently have the testing capacity to meet the new CMS guidance.
“Just focusing on nursing homes alone, weekly testing of all staff and residents nears 90,000 tests per week,” Cattell said. When you add assisted living community resident and staff, which are just as important, you quickly get to more than 120,000 tests per week. Indiana has completed a total of just more than 177,000 tests total since the beginning of March. Any mandate to require testing on a weekly or even bi-weekly basis is hollow in the face of inadequate supply of testing capacity and test materials.”
Cattell said it costs, on average, $100 to test an individual for COVID-19 and estimated that it would cost around $5 million per week to just test all staff at nursing homes and similar facilities in the state.
“Indiana must use its portion of the $11 billion that the White House has allocated to states for testing for expanding testing for long term care residents and staff,” Cattell said.
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The Centers for Medicaid and Medicare Services plans to publish data on the number of cases of COVID-19 and deaths at individual facilities by the end of this month, said CMS administrator Seema Verma on Monday.
The data is expected to be updated weekly and list each nursing home or related facility in the United States by name and include the number of cases at the facility and the number of deaths, federal officials said. It is also expected that the data can be aggregated so that regional and national trends can be analyzed.
Currently, nursing homes are required to report that information to the federal Centers for Disease Control.
Indiana Gov. Eric Holcomb and state health officials have resisted calls to make facility-level data public, but have been publishing aggregate data on the total number of cases of COVID-19 in long-term care facilities, total number of deaths and the number of facilities that have reported at least one case or one death.
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Visit www.cms.gov/files/document/nursing-home-reopening-recommendations-state-and-local-officials.pdf to learn more about the new guidance from CMS.
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