During the COVID 19 pandemic, long-term care facilities/skilled nursing facilities have received much attention, unfortunately due to the rapid spread of COVID 19 and a staggering number of infections and deaths that have occurred in these facilities since the outbreak. As a result, state and federal government agencies which regulate, monitor and evaluate these facilities have stepped up their attention and monitoring.
Providers and staff need to ensure that they are aware of regulations that were already in place as well as updated guidelines, regulations and requirements in force during the pandemic. The following resources discuss the challenges affecting long-term care facilities as well as provide guidance and recommendations to help reduce risk and keep residents safe.
Strategies to Prepare for COVID-19 in Long-term Care Facilities
- In a Johns Hopkins article, a geriatric nurse practitioner discusses challenges that COVID-19 poses for nursing homes.
- The CDC provides detailed strategies to prepare for COVID 19 in Long-term Care Facilities including:
- Keep COVID-19 from entering your facility
- Identify infections early
- Prevent spread of COVID-19
- Assess supply of personal protective equipment (PPE) and initiate measures to optimize current supply
- Identify and manage severe illness
- The CDC also issued guidance for infection prevention and control for patients with suspected or confirmed COVID-19 in nursing homes including things that facilities should do now.
- CMS has launched a national training program for frontline nursing home staff and their management to strengthen infection control practices. This training is accessible through the CMS Quality, Safety & Education Portal (QSEP). Instructions for access are included on this page.
- The CDC offers a checklist to be used as a tool in developing a comprehensive COVID-19 response plan.
Nursing Home Visitation Guidance
- The Center for Medicare and Medicaid Services (CMS) provides detailed guidance regarding restrictions on visitation of all visitors and non-essential healthcare personnel in nursing homes.
- The CDC provides a sample letter for communicating visitation restrictions to families, friends and volunteers to help keep patients safe.
Telemedicine for Long-term Care Facilities
- CMS developed a Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit
- Additional telemedicine and COVID 19 resources from NORCAL Group
COVID-19 Reporting and Notification Requirements
- CMS expanded reporting requirements for confirmed COVID-19 (or COVID-19 persons under investigation) among residents and staff in nursing homes.
CARES Act- Regulatory Waivers for Long Term Care Facilities
Pursuant to the federal CARES Act, CMS has implemented several waivers which are intended to provide flexibility in day-to-day operations while allowing for measures to slow the spread of COVID-19.
The waivers apply to certain limitations and restrictions and are intended to serve multiple purposes including leveraging telehealth, expanding facility workforce, creating COVID-only care centers, and reducing certain types of paperwork and reporting requirements.
Other Considerations for Long-term Care Facilities
- Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes
This document is a compilation of actions employed by organizations, including state governments, in the United States and outlying territories to assist nursing homes in meeting the needs of nursing home residents since the onset of the COVID-19 pandemic recognized in early 2020.
(This compendium is not intended as guidance from CMS. It does not replace or serve as a substitute for CMS requirements and policy. The actions outlined in this document have not been evaluated for effectiveness by CMS or any government agency. This compendium is solely an informational product offered by CMS to nursing homes as well as state and local officials during the National Public Health Emergency.
- Department of Justice Launches a National Nursing Home Initiative (prior to COVID 19 breakout the Justice Department was looking to take a heavier hand with substandard nursing homes, dated March 3, 2020)
- The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19)