Nursing homes are being directed to restrict all visitor access from its facilities as the nation works to combat and limit the spread of COVID-19. The guidance received instant support from providers after it was announced by the Centers for Medicare & Medicaid Services on Friday evening.

Effectively immediately, providers should restrict visitation of all visitors and non-essential healthcare personnel, with the only exceptions being for compassionate care situations, like end-of-life. Healthcare workers and surveyors are also exceptions to restrictions, unless one of them would show questionable health signs that demand further investigation, according to the guidance. 

Providers also should cancel communal dining and all group activities; implement active screening of residents and staff for fever and respiratory symptoms; remind residents to practice social distancing and perform frequent hand hygiene; and screen all staff at the beginning for their shifts for fever and respiratory symptoms. 

CMS Administrator Seema Verma first announced the guidance early Friday afternoon as President Donald Trump declared a national emergency in response to the respiratory disease. The emergency declaration also allows CMS to waive the three-day prior hospitalization requirement for coverage. 

“We fully appreciate that this measure represents a severe trial for residents of nursing homes and those who love them, but we are doing what we must to protect our vulnerable elderly,” Verma said. 

Expands on previous visitor recommendations

Last Monday (3/9), the administration issued guidance that only recommended the halt of nursing home visits by individuals who might be showing coronavirus symptoms. That issuance came as the American Health Care Association / National Center for Assisted Living also called for “unprecedented” restriction of visitors at both nursing homes and assisted living communities. Many operators across the country quickly complied with the recommendation for visitor restrictions.

During a CNN television interview last week, AHCA/NCAL President and CEO Mark Parkinson said, “The grim reality is that, for the elderly, COVID-19 is almost a perfect killing machine.”

“It may be very hard for families and friends who cannot visit their loved ones at this time,” Parkinson noted in the original call for visitor restrictions. “But we know there is a risk that people who appear healthy will enter nursing homes and assisted living communities and still infect residents. 

“Working together with CDC, CMS and other partners, we agree that we need to do everything we can to minimize that risk. Those who work in long-term care facilities are committed to helping residents communicate with family members and friends through alternative means, so they can remain connected to their loved ones.”

LeadingAge, the nursing home association dedicated to nonprofit providers, also supported the fed’s move on Friday.

“We recognize how difficult this will be for residents and their loved ones. Yet limiting residents to potential exposure is a crucial element of containment,” said LeadingAge President and CEO Katie Smith Sloan. “While this is a significant change to the operating practices of most nursing homes, our members are dedicated to making the adjustments needed to prioritize and protect the needs of older adults and the staff who care for them.” 

Statistics out of China, where the current pandemic started, have shown that COVID-19 is many times more fatal for seniors than other age group, and up to 10 times more likely to kill than a regular flu strain.

Nursing home at epicenter

Friday’s actions indicate just how swiftly and severely the battle against further spread of COVID-19 has escalated. The nation’s first, and to date worst, outbreak of the dangerous bug took place at a nursing home in Kirkland, WA. The death toll hit 25 there as of Friday, when the nationwide death toll was at 41, according to the Centers for Disease Control and Prevention. Approximately 50 employees at the Kirkland facility had tested positive for coronavirus.

“It’s especially important now that we look after seniors with chronic, underlying health conditions,” Vice President Mike Pence said Friday. 

Earlier Friday, Trump also announced that the federal government will work with the private sector to expand COVID-19 testing. Long-term care providers have requested residents and staff receive top priority.

“Our most effective weapon right now is to limit the damage to our people and our country and slow the spread of the virus itself,” he said. “The choice[s] we make, the precautions we put into place are critical to overcoming the virus, reducing its spread and shortening the duration of the pandemic, which is what it is.”