COVID-19 in Long-Term Care Facilities: Information for Advocates

Consumer Voice Resources   Consumer Voice Webinars   COVID-19 Vaccine

State COVID-19 Nursing Home Policies   CMS, ACL Resources & Action   Tips to Stay Connected

For Residents and Families   Visitation in Long-Term Care Facilities   Additional Resources

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Consumer Voice Resources

Voices from the Inside - What It's Like to Live in a Long-Term Care Facility During the COVID-19 Pandemic

Making the Case for Compassionate Care (January 2021)

Oppose Immunity for Long-Term Care Facilities During the COVID-19 Pandemic - Issue Brief and Statement from The Coalition for the Protection of Residents of Long-Term Care Facilities

Should I take my loved one home during the COVID-19 crisis?

COVID-19 and Nursing Homes: What Residents and Families Need to Know

COVID-19 Frequently Asked Questions

Recommendations for Protecting Residents and Staff of Long-Term Care Facilities

Summary of CMS Waivers for Nursing Homes

The Resident Advocate Newsletter (April 2020)

Letter to Congressional Leaders Opposing the Safe to Work Act Which Would Grant Immunity to Nursing Homes (7/31/20)

Letter to House Speaker Pelosi and Minority Leader McCarthy Opposing H.R. 7059 Which Would Grant Immunity to Nursing Homes (7/20/20)

Consumer Voice Statement in Response to CMS Guidance to Reopen (6/2/2020)

Consumer Voice Statement - The Nursing Home COVID-19 Crisis: More is Needed to Protect Residents and Staff (5/4/2020)

Letter to House Ways and Means Committee Opposing Granting Immunity to Nursing Homes (6/24/2020)

Letter to Senate Judiciary Committee Opposing Granting Immunity to Nursing Homes (5/11/20)

Letter from National and State Organizations to CMS Regarding Better Protections for Nursing Home Residents(4/28/20)

Letter to Faith Community Leaders to Increase Efforts to Connect with and Support Older Survivors of Abuse (4/23/20)

Letter from Organizations that Advocate for Older Adults (3/17/20)

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Consumer Voice COVID-Related Webinars

Strengthening Families as They Reunite During Uncertain Times (10/13/2020) - On this webinar hosted by Consumer Voice and the Maine Long-Term Care Ombudsman Program and featuring speaker Dr. Susan Wehry, we discussed the principles and interventions of moving forward while supporting ourselves and our families. We talked specifically about visitation in long-term care; as facilities transition to in-person visitation, reconnection with loved ones may present challenges.

Understanding Trauma and Ensuring Person-Centered Care During the COVID-19 Pandemic Training Series (September 2020) - The National Ombudsman Resource Center (NORC) released four training topics for three audiences: facility administrators, direct care staff, and family members of individuals living in long-term care facilities.  Dr. Sheri Gibson provided training on the following topics: person-centered care, trauma-informed care, compassion fatigue, and anxiety and grief in a time of COVID-19.

Nursing Home Staffing: Research Highlights Relationship Between COVID-19 and Staffing (7/17/20) - Researchers Dr. Charlene Harrington and Dr. Yue Li look carefully at the relationship between staffing and COVID-19 spread. 

• Webinar Slides
• Webinar Materials:
  • Dr. Charlene Harrington, et al., Nurse Staffing and Coronavirus Infections in California Nursing Homes
  • Dr. Yue Li, et al., COVID-19 infections and deaths among Connecticut nursing home residents: facility correlates

Family Advocacy for Residents During COVID-19 (6/18/2020) - Families are facing many new issues as they support and care for their loved ones in long-term care facilities during the COVID-19 pandemic. Watch the webinar to gain information and tips on how to advocate individually and through family councils for quality care. 

• Recording; Slides

COVID-19: Advocating for Nursing Home Residents Webinar Series - Joint webinars with Consumer Voice, Center for Medicare Advocacy, Long Term Care Community Coalition, and Justice in Aging.

Webinar Materials

Impact of Coronavirus on Advance Care Planning - Materials are available from the webinars entitled "The Impact of the Coronavirus Crisis and Pandemic on Advance Care Planning and Re-setting Goals of Care in Nursing Homes" from the Center for Practical Bioethics, AD Vault, and the National Nursing Home Social Work Network.

•  Part I - Recording; Slides (April 2, 2020)

• Part II - Recording; Slides (April 3, 2020)

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What are your state's COVID-19 nursing home policies?

Consumer Voice is tracking various policies and practices regarding each state's response to the COVID-19 crisis in nursing homes and assisted living facilities. Currently, we are tracking: what information a state is providing to the public regarding COVID-19 cases and deaths in long-term care facilities; what a state's policy is on testing residents and staff in those facilities; whether the state has taken action to grant civil and/or criminal immunity to facilities for substandard care that resulted in the harm or death of a resident in a facility; and state's reopening and visitation policies.

Find your state's information.

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Centers for Medicare & Medicaid Services (CMS), Administration for Community Living (ACL)
Resources & Action

• On January 4, 2021, CMS revised a June 1, 2020 memo to State Survey Agency Directors regarding survey activities and issued a set of Frequently Asked Questions (FAQs) about the resumption of survey activities (QSO-20-31-ALL). Read Consumer Voice's summary of the revision.

• CMS published Nursing Home COVID-19 Testing FAQs (December 2020)

• CMS published a memo, QSO-21-06 (12/4/2020), on updates to the Nursing Home Compare website and Five Star Quality Rating System.

• CMS issued an alert (November 2020) with Holiday Leave Recommendations for residents, their families, and representatives in the nursing home.

  • See Consumer Voice's fact sheet summarizing the recommendations.

• CMS updated its Nursing Home Reopening Recommendations for State and Local Officials, QSO-20-30-NH (9/28/20).

  • The 9/28/20 guidance revises the original guidance from 5/18/20 - CMS Guidance, QSO-20-30-NH and Frequently Asked Questions. See Consumer Voice's Statement in Response.

• CMS released a memo (9/17/2020) significantly easing visitation restrictions in nursing homes.  CMS notes that this guidance replaces all previous guidance. See Consumer Voice's summary. Prior to the release of this memo, Consumer Voice and other advocates provided recommendations:

  • Recommendations to Allow Nursing Home Residents to Have Increased In-Person Contact with Family and Friends During the COVID-19 Pandemic (9/4/20)

  • Initial Recommendations to Address Resident Isolation and Decline by Allowing Residents to Have Increased In-Person Contact with Family Members and Friends (8/20/20)

• CMS Interim Final Rule (8/25/20) on COVID-19 testing requirements for nursing home residents and staff and accompanying guidance. See Consumer Voice's summary.

  • Consumer Voice submitted comments to CMS regarding this rule.  Read Consumer Voice's comments.

• CMS Frequently Asked Questions on Nursing Home Visitation (6/23/2020)

• CMS COVID-19 Nursing Home Data includes data reported by nursing homes to the Centers for Disease Control and Prevention (CDC). 

  • Nusing Home COVID-19 Data Release FAQs (6/4/2020)

• CMS Memo - Posting of Nursing Home Inspections, QSO-20-33-NH (6/4/2020) Download the infection control survey reports from the Nursing Home Compare website.

• State Nursing Home COVID-19 Data (6/1/2020), chart that provides facility-reported information for each State under CMS’s new reporting requirements. 

• Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes (June 2020)

• CMS Memo - COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes, QSO-20-31-All (6/1/2020) See Consumer Voice's summary of the memo, data, and letter to Governors.

• Letter to Governors from CMS and CDC (5/31/2020), summarizing the information in the memo (QSO-20-31-All), describing the data chart, and calling on Governors to submit a comprehensive plan for testing and submit it to HHS. 

• CMS Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes (May 2020)

• CMS Interim Rule (5/8/2020) mandating that nursing homes report COVID-19 related data to CDC as well as residents and families.  See Consumer Voice’s summary (5/5/2020) and Consumer Voice's summary with comments (6/2/2020).

• Press Briefing (4/30/20) at which President Trump made a number of announcements regarding steps the federal government is taking related to nursing homes and COVID-19.  See Consumer Voice’s Summary and Statement in Response.

• CMS Waivers for Health Care Providers (3/30/20, revised 4/21/20), including waivers of select Nursing Home Requirements of Participation.  See Consumer Voice’s Summary.

• Civil Money Penalty (CMP) Application for Communicative Technology Requests - April 24, 2020 application template, and application approval letter, CMP Application for Communicative Technology Requests Frequently Asked Questions (FAQs) for State Medicaid Agencies.

• CMS Guidance, QSO-20-28-NH (4/24/20) – updates to Nursing Home Compare, nursing home staff counts, and frequently asked questions.  See Consumer Voice’s Summary.

• CMS Guidance, QSO-20-26-NH (4/19/20) – nursing homes will be required to report COVID related information to CDC, residents, and families.  See Consumer Voice’s Summary.

• CMS Guidance, QSO-20-25-NH (4/13/20) – supplemental information for transferring or discharging residents between facilities based on their COVID-19 status.  See Consumer Voice’s Summary.

• CMS Guidance (4/2/20) - CMS & CDC Recommendations to mitigate the spread of COVID-19. See Consumer Voice’s Summary.

• CMS ‘Flexibilities’ for Long Term Care Facilities (3/28/20, revised 4/29/20) –regulatory waivers and new rules. See Consumer Voice’s Summary.

• HHS Secretary Azar letter to Governors calling to expand capacity of healthcare workforce (3/24/2020)

• CMS Guidance, QSO-20-20-ALL (3/23/20) – limiting activities of the survey agencies. See Consumer Voice’s Summary.

• CMS Guidance, QSO-20-14-NH (3/4/20, revised 3/9/20 and 3/13/20) – suspended non-emergency inspections, restricts visitation and entry to facilities, suspends communal activities.  See Consumer Voice’s Summaries of the March 4th version, March 9th revision, March 13th revision. *Note that this guidance has been replaced as of the memo dated 9/17/2020.*

• The Administration for Community Living published FAQs for long-term care ombudsman programs regarding COVID-19 (3/16/2020).

• Administration for Community Living COVID-19 Information Page

• The Centers for Disease Control and Prevention (CDC) has issued specific guidance to long-term care facilities for strategies for preventing the spread of COVID-19.

• CMS COVID-19 Partner Toolkit

• CDC: Coronavirus Disease 2019 (COVID-19) Preparedness Checklist for Nursing Homes and other Long-Term Care Settings

• CDC: Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities

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Coronavirus Commission Report

The Centers for Medicare and Medicaid Services (CMS) and The MITRE Corporation (MITRE) released the final report of the Coronavirus Commission on Safety and Quality in Nursing Homes (Commission). CMS tasked MITRE with organizing the Commission to advise the federal government on how to address the impact of the coronavirus in nursing homes and to provide recommendations for actions that CMS could take to protect residents and staff during the pandemic. The final report includes 27 recommendations and more than 100 action steps. Of the 25 Commission members, 13 endorsed the final report without reservation, 11 endorsed with reservations, and one member did not endorse.

Read the full report.  Consumer Voice Executive Director Lori Smetanka endorsed the report with reservations.  Read her statement.

• Statement sent to CMS on the need for accountability, sent by five Commission members including Consumer Voice's Lori Smetanka
• CMS's response to the report

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Staying Connected with Family and Friends Living in Long-Term Care Facilities

With new directives placing strict limits on visitors to nursing homes and many assisted living facilities taking similar precautions, friends and families of residents living in long-term care facilities are using creative ways to stay in touch with their loved ones.  

Creative Ideas and Practices for Staying Connected While Social Distancing and Visitation is Limited

Show us how you are sharing #LoveFromADistance!

Residents, family members and friends are invited to post photos and share tips on how they're staying connected to their loved ones during the pandemic.

Use #LoveFromADistance and tag us on Facebook: @theconsumervoice and Twitter: @ConsumerVoices