March 14, 2020

Today's COVID-19 Report:

CMS Total Visitor Restrictions, End-of-Life Care Exempted 

Here are the latest need-to-know updates for Saturday, March 14, 2020 regarding the COVID-19 pandemic.

CMS Announces New Visitor Restrictions

Last night, Centers for Medicare and Medicaid Services (CMS) issued a revised memorandum related to visitor restrictions in nursing homes - effective immediately as of 8:52 p.m. on Friday, March 13.  This was mentioned in yesterday’s national press conference, when CMS Administrator Verma joined President Trump at the podium to share that visitation would be restricted to “all visitors and non-essential personnel, with a few exceptions, such as end-of-life personnel.” 

In the new guidance, CMS directs all facilities nationwide to restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, such as an end-of-life situation. Facilities are expected to communicate through multiple means to inform individuals and nonessential health care personnel of the visitation restrictions, such as through signage at entrances/exits, letters, emails, phone calls, and recorded messages for receiving calls.  

LeadingAge has provided template letters for communicating the restrictions: Family Sample Letter, Resident Sample Letter, Visitor Sample Letter.

End-of-Life Care Exception

In cases of compassionate/end-of-life care, CMS specifies that visitors will be limited to a specific room only and shall be required to perform hand hygiene and use Personal Protective Equipment (PPE), such as facemasks. Decisions about visitation during an end-of-life situation should be made on a case by case basis, which should include careful screening of the visitor (including clergy, bereavement counselors, etc.) for fever or respiratory symptoms.

Those with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations). Those visitors that are permitted must wear a facemask while in the building and restrict their visit to the resident’s room or other location designated by the facility. They should also be reminded to frequently perform hand hygiene and suggest refraining from physical contact with residents and others while in the facility.

Healthcare Workers Permitted

Facilities should follow CDC guidelines for restricting access to health care workers which also applies to other health care workers, such as hospice workers, EMS personnel, or dialysis technicians, that provide care to residents. They should be permitted to come into the facility as long as they meet the CDC guidelines for health care workers. Note that the CMS revised visitation guidance seems to have been based on the new CDC guidance released.

CMS Suspends Non-Emergency Enforcement Actions/Waives 3-day Stay

Most notably for nursing facilities, CMS has announced it “will temporarily suspend non-emergency survey inspections, allowing providers to focus on the most current serious health and safety threats, like infectious diseases and abuse.” This action is well received and a true reflection on both the seriousness of the COVID-19 crisis and the need for our nation’s survey system to become more collaborative and less punitive.

In another significant move, CMS will be waiving the 3-day hospitalization requirement for persons to receive their skilled nursing facility benefit. The announcement notes, “waiving the requirement…for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who need to be transferred as a result of the effect of a disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period.”

Further, CMS is “waiving 42 CFR 483.20 to provides relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.”

More information on the CMS announcement can be accessed in the CMS press release. 

Other Key Directives from CMS for Nursing Homes

  • Cancel communal dining and all group activities. Includes internal and external group activities.  
  • Screen all staff at the beginning of their shift for fever and respiratory symptoms. Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and self-isolate at home. 
  • Implement active screening of residents and staff for fever and respiratory symptoms. Remind residents to practice social distancing and perform frequent hand hygiene.
  • Facilities should identify staff that work at multiple facilities (e.g., agency staff, regional or corporate staff, etc.). Actively screen and restrict them appropriately to ensure they do not place individuals in the facility at risk for COVID-19.
  • Residents still have the right to access the Ombudsman program. Ombudsman access should be restricted except in compassionate care situations, however, facilities may review this on a case by case basis. If in-person access is not available due to infection control concerns, facilities need to facilitate resident communication (by phone or other format) with the Ombudsman program or any other entity listed in 42 CFR § 483.10(f)(4)(i).
  • Advise visitors, and any individuals who entered the facility (e.g., hospice staff), to monitor for signs and symptoms of respiratory infection for at least 14 days after exiting the facility. If symptoms occur, advise them to self-isolate at home, contact their healthcare provider, and immediately notify the facility of the date they were in the facility, the individuals they were in contact with, and the locations within the facility they visited. Facilities should immediately screen the individuals of reported contact, and take all necessary actions based on findings.

Members are encouraged to review the revised memorandum and CDC added recommendations for infection control practices in nursing homes when planning to implement these changes. 

CDC Issues New Guidance for Infection Control

The CDC added recommendations for infection control practices in nursing homes to their website.  The guidance was clearly the basis for CMS’ new visitor restriction policy but also includes other useful information.  The CDC states that these recommendations are specific for nursing homes, including skilled nursing facilities, but that much of this information could also be applied in assisted living facilities. This information complements, but does not replace, the general infection prevention and control recommendations for COVID-19.  

LeadingAge Releases New Crisis Communication Tools

Understanding that your job is to care for people, LeadingAge has created some tips on working with the media in wake of COVID-19.  They have also provided a template for a media statement in case the virus makes it onto your campus. 

HUD Property Inspections Postponed

HUD announced that the Real Estate Assessment Center (REAC) will postpone property inspections on all HUD-assisted multifamily and public housing, including senior housing, until further notice. Read the LeadingAge press release now.

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Trusted Links & Information

For more information and daily updates, please visit the LeadingAge coronavirus website or the LeadingAge Ohio COVID-19 hub. 


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