COVID-19 in Long-Term Care Facilities

Recent News & Resources:
* CMS Rescinds Emergency Waivers, including of Training and Certification Requirements for Nurse Aides
* New CMS Guidance on Visitation and Quarantine and Testing
* Consumer Voice Report: Inadequate Staffing During the COVID-19 Pandemic and Its Catastrophic Effects on Nursing Homes Residents
* Biden Administration announces most significant reforms to nursing homes in decades. Read Consumer Voice's summary of the reforms.

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Consumer Voice Resources for Advocacy & Families

• Consumer Voice Webinars
• Nursing Home Visitation and Quarantine: Advocacy Strategies for Families
• CMS COVID-19 Data for Nursing Homes including vaccination rates, COVID-19 cases, and deaths.  Watch a video walkthrough of how to find information on the CMS website. (August 2021)
• Reuniting Residents and Families: What to Look for and Questions to Ask as You Resume Visits in a Long-Term Care Facility
• Family Advocacy for Nursing Home Residents During COVID-19
• Family Councils and Advocacy During COVID-19

Part of being a good advocate is taking care of yourself, read our fact sheets for tips on how family caregivers and residents can take care of themselves during the COVID-19 pandemic:

• Taking Care of You: Tips for the Family Caregiver
• Taking Care of You: Tips for Residents of Long-Term Care Facilities

Resource Archive

CMS and CDC Guidance for Nursing Homes

Visitation

On March 10, 2022, the Centers for Medicare & Medicaid Services (CMS) updated their Nursing Home Visitation Guidance (QSO-20-39-NH Revised).  Residents, regardless of vaccination status, can choose not to wear face coverings or masks when other residents are not present and have close contact (including touch) with their visitor. The guidance states that visitors should wear face coverings or masks and physically distance when around other residents or healthcare personnel, regardless of vaccination status. 

The guidance was also updated to align with the CDC's use of the term "up-to-date" with all recommended COVID-19 vaccine doses rather than "fully vaccinated."  

Visitation policies from the November 12, 2021 update of this guidance remain. Visitation is allowed at all times for all residents, this includes indoor visitation. Read Consumer Voice's resource on the guidance: Nursing Home Visitation Guidance Points. Consumer Voice provided an updated overview of nursing home visitation in January 2021.

The November guidance states:

• Facilities can no longer limit frequency and length of visits, number of visitors, or require advanced scheduling of visits.
• Vaccinated and unvaccinated residents can have close contact, including touch.  Visitors should be advised of the risks of physical contact with unvaccinated residents before the visit.
• Communal activities and dining may occur while adhering to core principles of COVID-19 infection prevention.  The safest approach is for everyone, regardless of vaccination status to wear a mask while in communal areas.

FAQs about the Guidance from CMS (2/2/2022)

Consumer Voice Summary of the FAQs (1/6/2022) and the Updates to the FAQs (2/2/2022)

Core Principles of Infection Prevention

Testing

CMS has updated its testing guidance QSO-20-38-NH (3/10/2022) to state that long-term care residents and staff with COVID-19 symptoms or who have had close contact with someone in the facility who tested positive must be tested immediately, regardless of vaccination status.   The memo was also revised to align with the CDC's use of the term "up-to-date" with all recommended COVID-19 vaccine doses rather than "fully vaccinated."  Facility staff who are not up-to-date on their vaccines should be tested according to community transmission guidelines.

Quarantine

Whether a resident should be quarantined depends on factors such as vaccination status, exposure to someone with COVID-19, and length of time outside of the facility. CMS updated its guidance QSO-20-39-NH Revised (3/10/2022) regarding quarantine, and updated the guidance to align with the CDC's use of the term "up-to-date" with all recommended COVID-19 vaccine doses.

The Centers for Disease Control and Prevention (CDC)'s  guidance (2/2/2022) regarding infection prevention and control to prevent COVID-19 spread in nursing homes includes important information about when nursing home residents are required to quarantine. Read Consumer Voice's summary. 

In February 2022, the CDC updated its Infection Prevention and Control Recommendations for Healthcare Personnel and provided updated definitions for "fully vaccinated" and being "up-to-date" on your vaccinations.

Waivers Related to Nurse Aide Training

On April 7, 2022, CMS rescinded emergency waivers, including of training and certification requirements for nurse aides.  Read Consumer Voice's summary.

CMS rescinded emergency waivers related to notice prior to discharge/transfer, care planning, and submission of Minimum Data Set. Waivers related to nurse aide training remain. QSO-21-17-NH (4/8/2021) Read Consumer Voice's summary.

Reduced training puts residents and staff at risk.  Less training leaves workers less equipped with the skills and knowledge needed to provide quality care.  Workers with less training are more likely to be injured and to cause injury to residents. Furthermore, work experience as a TNA during the pandemic does not equate to training.  To ensure quality care for nursing home residents, temporary nurse aides must complete the full federally required training. Read the issue brief.

More Info on CMS & CDC Guidance

How Limitation on Visitation Affects Residents

Consumer Voice supports safe visitation including vaccination for all long-term care residents and visitors to long-term care facilities and adhering to the Core Principles of Infection Prevention including mask wearing.

Despite the efficacy of COVID-19 vaccinations, the precipitous decline of COVID-19 cases and deaths in nursing homes, and the relaxation of some visitation restrictions, residents and families continue to face limitations on visitation and daily activities.  In January 2021 and again in June 2021, Consumer Voice released reports detailing the devastating effects of limiting visitation on nursing home residents.

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