A sweeping phase-out of early COVID-19 pandemic allowances, such as the nurse aide certification waiver, addresses concerns about residents’ physical, mental and psychosocial well-being, the Centers for Medicare & Medicare Services announced Thursday.

CMS has suspended many requirements that it originally instated to address staffing shortages and other constraints endured by the nursing home industry during the COVID-19 public health emergency. On Thursday, it restored training requirements for nurse aides who work in skilled nursing facilities, along with other provisions that affect doctors, discharge requirements and the special use of rooms and buildings.

The decision to scale back these provisions was inspired in part by “steadily increasing” COVID-19 vaccine coverage across facilities and improvements in nursing homes’ abilities to respond to COVID-19 outbreaks, CMS said. But the agency expressed continued concerns about the risk COVID-19 poses to residents.

Survey data reveals problems

Recent nursing home surveys have uncovered pandemic-related problems that are unrelated to infection control, such as increases in resident weight-loss, depression and pressure ulcers, CMS reported.

“The lack of certain minimum standards, such as training for nurse aides, may be contributing to these issues,” it stated. “By ending some of the temporary waivers, CMS is helping nursing homes to redirect efforts back to meeting the regulatory requirements aimed at ensuring each resident’s physical, mental and psychosocial needs are met,” it explained.

Vaccination requirements stand 

The changes do not affect transmission prevention and practices to control outbreaks, the agency added. Facilities must continue to adhere to vaccination regulations, for example. CMS will also retain flexibility to reinstate certain waivers when needed, as in the case of a single, severe facility outbreak, or during outbreaks that affect groups of facilities in one area, it said. 

“CMS can quickly grant waivers to support the facilities’ response to COVID-19. If there is a nationwide surge of nursing home COVID-19 cases in the future, CMS can quickly re-issue national blanket waivers during the public health emergency,” the agency said.

“Patient and resident health and safety are top priorities for CMS, and today’s actions are focused on ensuring every nursing home resident is cared for in a safe, high-quality environment,” CMS Administrator Chiquita Brooks-LaSure said.