03/11/2020

CMS Memo Expanded to Include Guidance on Safe Visitation, PPE Use in Nursing Homes

Late on Monday night, the Centers for Medicare & Medicaid Services (CMS) released updates to a memo regarding steps nursing homes should take to limit transmission to and within their communities. The memo included guidance on visitation policies, noting that nursing homes should restrict, limit and/or discourage visitation. 

• Restricting means the individual should not be allowed in the facility at all, until they no longer meet criteria described in the memo. These criteria are:  
• Signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath, or sore throat.
• In the last 14 days, has had contact with someone with a confirmed diagnosis of COVID-19, or under investigation for COVID-19, or are ill with respiratory illness.
• International travel within the last 14 days to countries with sustained community transmission. 
• Residing in a community where community-based spread of COVID-19 is occurring.

• Limiting means the individual should not be allowed to come into the facility, except for certain situations, such as end-of-life situations or when a visitor is essential for the resident’s emotional well-being and care. CMS recommends limiting visitation for facilities that are in counties, or counties adjacent to other counties where a COVID-19 case has occurred. Right now, that pertains to only Cuyahoga County. 
  
  
• Discouraging means that the facility allows normal visitation practices (except for those individuals meeting the restricted criteria), however the facility advises individuals to defer visitation until further notice (through signage, calls, etc.). CMS recommends discouraging visitation for all other counties nationwide.

The memo also includes guidance on communicating with families, safe visitation, and how to revise their interactions with vendors, volunteers, and other groups to minimize the possibility of transmission.

Finally, the memo makes it clear that following the Food and Drug Administration’s emergency use authorization (EUA) expanding the use of certain industrial respirators to health care personnel is appropriate in Medicare/Medicaid certified providers and suppliers, and that surveyors should not cite a provider that has been unable to secure necessary personal protective equipment (PPE), despite its best efforts.

As of yet, there is not specific guidance on how the guidance related to visitation will impact hospice providers visiting patients in nursing homes.

During a call with long-term care providers on Tuesday afternoon, Director Amy Acton indicated that in the future, it may be important to limit non-essential visits from other agencies, including hospices, for individuals residing in nursing homes and assisted living. LeadingAge Ohio encourages hospices and nursing homes alike to be in close communication with one another as the situation unfolds.