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CMS Issues More Restrictive Guidance

March 16, 2020

The most recent CMS guidance on nursing home infection control and prevention of COVID-19, released late on March 13, further restricts visitation and entry to facilities, and suspends communal activities.
 
Summary of Major Revisions
 
All visitors except those in compassionate care situations, such as end of life care, and non-essential health care personnel are restricted. The decisions about visitation during a compassionate situation are to be made on a case by case basis. Note: visitation may be further limited by state action (e.g. Governor’s Executive Order).

Exceptions are:

  • Health care personnel who meet CDC guidelines for health care workers (facility staff, but also others who provide care, such as hospice workers and dialysis technicians); access guidelines here and here.
  • Surveyors who have no COVID-19 symptoms.

Communal dining and all group activities, both internal and external, must be suspended.
 
Visitors allowed to enter must be screened, and facility staff must instruct them on hand hygiene, limiting surfaces touched, and use of personal protective equipment (PPE) according to current facility policy. They will not be permitted to visit if they have a fever or other symptoms of COVID-19 or are unable to demonstrate proper infection control techniques.  Visitors must wear a facemask and only visit in the resident’s room or other place designated by the facility. Facilities should suggest visitors refrain from physical contact.

Residents should be actively screened for fever and respiratory symptoms. Staff are to remind residents to practice social distancing and to perform frequent hand hygiene.
 
Staff should be actively screened at the beginning of their shift for fever and respiratory symptoms.  Their temperature must be actively taken, and the facility must document the absence of shortness of breath, new or change in cough, and sore throat.  Any staff person who is ill must put on a facemask and self-isolate at home.   Staff that work at multiple facilities (e.g. regional or corporate staff) should also be actively screened and restricted appropriately.
 
Non-health care providers (e.g. food delivery, transportation providers, etc.) can be permitted to enter if needed, but must follow CDC guidelines for Transmission-Based Precautions.

Ombudsmen are subject to the same restrictions as visitors, but this may be reviewed on a case by case basis.

Visitors and anyone other than facility staff who entered the facility should monitor themselves for at least 14 days after leaving.  If signs of respiratory symptoms appear, they should 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 then immediately screen the individuals of reported contact, and take all necessary actions.

Stay tuned: Consumer Voice will be issuing recommendations/suggestions for ways to promote resident-family communication, keep families informed about their loved ones, and more.

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