CMS Coronavirus Guidance for Nursing Facilities

On March 4, CMS issued guidance for State Survey Agencies to limit the spread of Novel Coronavirus 2019 (COVID-19.)  This includes suspending non-emergency inspections of all healthcare facilities across the country and conducting screening of visitors and staff.

Prioritizing Survey Activity

Survey activity is now limited to the following activity, and is prioritized in the following order:

• Immediate jeopardy complaints and allegations of abuse and neglect; 
• Complaints about infection control concerns; 
• Statutorily required recertification surveys; 
• Any necessary re-visits to resolve current enforcement actions; 
• Initial certifications; 
• Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years; 
• Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy.

When COVID-19 is suspected or active in a facility, on-site surveys will be conducted only for immediate jeopardy or infection control concerns. Otherwise, surveys will be limited to desk audits until all active or suspected cases of COVID-19 have been cleared from the facility.  Onsite surveys will be abbreviated with a minimal survey team.

Nursing facilities are instructed to maintain a person-centered approach to care while preventing unnecessary exposure to COVID-19 through prompt detection, triage, and isolation of potentially infections patients.

Screening of Visitors and Staff

Nursing facilities are to screen both visitors and healthcare staff for:

1. International travel within the last 14 days to restricted countries; 
2. Signs or symptoms of respiratory infection (fever, cough, sore throat;) 
3. Contact with someone with or under investigation for COVID-19.

If a visitor falls into one of the above categories, the facility may restrict them from entering the facility.  A resident’s risk factors for infection and current health status should be considered prior to restricting visitors.

The guidance recommends that staff who have symptoms of a respiratory infection should not report to work.  Staff that develop symptoms of a respiratory infection while on-the-job should take immediate precautions to stop work, self-isolate, and notify the infection preventionist and local health department.

Facility Admissions and Hospital Transfers:

Residents with mild symptoms may not require transfer to a hospital, as long as the nursing facility can implement infection prevention and control practices recommended by the CDC.  More severe symptoms may require transfer to a hospital for a higher level of care.

Individuals with COVID-19 can be admitted to a nursing facility so long as it can implement CDC transmission precautions. CMS notes that facilities should continue admitting any individual they would normally admit, including those from hospitals where COVID-19 is or was present. ALL necessary medical information must be provided to any post-acute service provider prior to the discharge/transfer and to the healthcare transport personnel.

Recommendations from the Consumer Voice

This new guidance is intended to prevent and contain the spread of COVID-19 and protect residents and staff from infection. CMS actions include suspension of investigations for all but the priority areas listed above, and as the situation evolves, may result in decreased visitation by families and other community members. Consumer Voice offers the following recommendations to residents and families:

• Talk to facility staff and administration about infection control practices, status of COVID-19 (or not) in the facility, and how open and frequent communication can best be facilitated. 
• Encourage the facility to employ alternate methods of communication between residents and families if visits are limited due to COVID-19. Examples can include phone calls, video chat, or other creative solutions. 
• Raise concerns about care and rights violations with facility administration and with the long-term care ombudsman program. Complaints can also be filed with the state Department of Health, although due to the new guidance discussed above, follow up will likely be delayed if not in one of the priority areas for survey. 
• Visit our website at www.theconsumervoice.org for additional information and ideas.

Links to Guidance:

(QSO-20-12-ALL) Suspension of Survey Activities
(QSO-20_14-NH) Guidance for Infection Control and Prevention of COVID-19 in Nursing Homes
(QSO-20-13-HOSPITALS) Guidance for Infection Control and Prevention Concerning COVID-19: FAQs and Considerations for Patient Triage, Placement, and Hospital Discharge

For more information on COVID-19:  https://theconsumervoice.org/issues/other-issues-and-resources/covid-19
For more on infection prevention:  https://theconsumervoice.org/issues/other-issues-and-resources/infection-prevention