The Centers for Medicare & Medicaid Services on Monday issued new guidance on when nursing homes should be open to visitors. Among the criteria: testing residents and staff to make sure COVID-19 is not present; and inspections for those facilities that have had outbreaks.
CMS also said restrictions can be relaxed based on the following factors:
- Status of COVID-19 cases in the local community
- Status of COVID-19 cases in nursing homes
- Adequate staffing
- Baseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control for residents and visitors (e.g., face coverings)
- Access to adequate personal protective equipment (PPE)
- Local hospital capacity
The Trump administration handed a detailed prescription for nursing homes. The question remains: Can nursing homes fill it?
While CMS Administrator Seema Verma stated during a press briefing that states have enough tests, some governors and state nursing home chapters are saying otherwise. Ohio’s governor, Mike DeWine (R), for example, said on Monday, the day the federal guidance was released, that his state will not be testing all nursing home residents. Why? There simply are not enough testing supplies.
This follows a “not so fast” reaction by nursing home providers in New York to a mandate to test workers twice a week.
“The state must ensure that enough tests will be available in a timely manner and that it will fully cover the costs of these tests,” said Stephen Hanse, president and CEO of the New York State Health Facilities Association and New York State Center for Assisted Living. “Providers are seeing costs of $150 per test — resulting in a potential $60 million a week cost that is unsustainable and is an existential threat to the economic viability of skilled nursing and assisted living providers throughout New York.”
Those who follow nursing home news closely are aware that LeadingAge has been particularly critical of the government’s plans. At every turn, the organization of nonprofit providers has questioned how the administration is backing up its recommendations and guidance. In staccato-like fashion, following a government action, LeadingAge fires off questions such as, who is going to provide the funds for testing and PPE? What exactly are federal authorities doing to facilitate this?
“The guidance from CMS is not grounded in these everyday realities of our members,” LeadingAge President and CEO Katie Smith Sloan said following Monday’s guidance. “We need a plan for testing. We need access to adequate testing supplies and PPE. And we need funding to make both of those possible for the brave people who care for vulnerable older adults day in and day out. Our members pay between $200,000 and $250,000 per week to test staff just twice a week. That’s $1 million dollars a month. Nursing homes need help from federal or state governments to cover these necessary costs. Today’s guidance delivers none of that.”
No question, CMS has been thinking about nursing homes and the plight of residents and staff during the pandemic. That is apparent from its many waivers, additional guidance and establishment of a nursing home commission. But to fully feel safe, nursing homes need to know that the government is attuned to what is happening on the ground. Until that happens, it will be hard for anyone to feel secure enough to take the next step.