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March 18, 2020

CMS and CDC Guidance on COVID-19 for Post-Acute and Long Term Care

This Bulletin is brought to you by AHLA’s Post-Acute and Long Term Services Practice Group.
  • March 18, 2020
  • Richard Cheng , DLA Piper LLP

As the coronavirus disease 2019 (COVID-19) has become a pandemic throughout the country, the elderly population remains one of the most vulnerable to the effects of COVID-19. In post-acute care facilities, residents are often in more confined areas with other residents around, along with visitors and staff. The post-acute care continuum also includes clinical care provided through home health agencies and hospices, both of which, along with nursing homes, have received guidance from the Centers for Medicare & Medicaid Services (CMS) on mitigation strategies in response to COVID-19. Additionally, the Centers for Disease Control and Prevention (CDC) has issued recommendations on how to prevent the spread of COVID-19 in long term care facilities.

Nursing Homes

On March 9, 2020, CMS issued guidance on the containment of COVID-19. In that guidance, CMS recommended that facilities in counties or counties adjacent to other counties where a COVID-19 case has occurred limit visitation, and all other facilities not in those counties discourage visitation. The guidance recommended that facilities create designated visiting space and direct visitors to the resident’s room they are visiting. Additionally, facilities should consider steps to limit who is entering the facility. On March 13, 2020, CMS issued a revised version of the guidance to provide a more aggressive stance, including:

  • Restrictions on all visitors, effective immediately, with exceptions for compassionate care, such as end-of-life situations;
  • Restricting all volunteers and non-essential health care personnel and other personnel (e.g., barbers);
  • Canceling all group activities and communal dining;
  • Implementing active screening of residents and health care personnel for fever and respiratory symptoms.
  • Communicating visitation restrictions to potential visitors utilizing different methods (e.g. signage at entrances/exits, letters, emails, etc.);
  • Identifying staff that work at multiple facilities (e.g., agency staff, regional or corporate staff, etc.) and actively screening and restricting them appropriately to minimize risk for the spread of COVID-19 at the facility; and
  • Advising visitors, and any other health care providers who entered the facility (e.g., hospice staff), to monitor for symptoms of respiratory infection for at least 14 days after exiting the facility, along with follow-up actions to mitigate the transmission of COVID-19.

CMS’ guidance is modeled after CDC recommendations, which state that seniors with multiple health conditions are at highest risk of complications. While it is critical for residents to see family members and connect with society, given the high-risk nature of COVID-19 and the importance of reducing transmission, CMS has recommended residents utilize virtual communications with family members, along with assigning specific staff members to serve as a liaison for inbound and outbound communications on behalf of the residents. (CMS Letter to State Survey Agency Directors, Ref: QSO-20-14-NH, March 13, 2020)

The CDC recommends that nursing homes use alcohol-based hand sanitizer with 60%-95% alcohol in every resident room and common areas. Moreover, the CDC recommends nursing homes provide ample soap and paper towels for hand washing, make personal protective equipment (e.g. masks) and tissues available for residents who are coughing, and ensure hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident equipment.

According to the CDC, nursing homes and other post-acute care facilities (e.g. assisted living communities) can take steps to assess and improve their preparedness for responding to COVID-19. As such, the CDC provided the following checklist to help develop a COVID-19 response plan:

  • Rapid identification and management of currently ill residents;
  • Risk considerations for visitors and consultant staff;
  • Supplies and resources;
  • Sick leave policies and other occupational health considerations;
  • Education and training; and
  • Surge capacity for staffing, equipment and supplies, and postmortem care.

During this time of crisis and national emergency, it will be vital for nursing homes and other post-acute care facilities to assess its preparedness and response plan to COVID-19.

As part of the post-acute care continuum, CMS has also issued guidance for hospices and home health agencies. CMS recommendations were issued on March 9, 2020 for hospices and March 10, 2020 for home health agencies. The following is a summary of those recommendations.

Hospice Care

Hospice patients should discuss care options to ensure patient goals are respected, meeting patient right requirements. Professionals should adhere to Standard Precautions and use a facemask or respirator, gown, gloves, and eye protection (CMS Letter to State Survey Agency Directors, Ref: QSO-20-16-Hospice, March 9, 2020).

Home Health Agencies

COVID-19 patients with symptoms may be managed at home if isolation is adhered to, but risks remain for household members. Patients should wear a facemask during transports. Providers should wear all recommended personal protective equipment, health care personnel should be limited to essential personnel, and all supplies must be disinfected. (CMS Letter to State Survey Agency Directors, Ref: QSO-20-18-HHA, March 10, 2020).