Nursing home residents and staff members must receive baseline COVID-19 test results before relaxing any restrictions or advancing through phases of reopening under new federal guidance issued Monday by the Centers for Medicare & Medicaid Services. 

“CMS is recommending nursing homes do not advance to any phase until all residents and staff have received a baseline test to establish there are no known cases of coronavirus in the facility,” CMS Administrator Seema Verma said during a press briefing Monday night. She noted that robust testing is necessary to “properly cohort and isolate residents.”

Also, prior to reopening, state survey agencies are required to inspect nursing homes that have experienced a significant COVID-19 outbreak. And CMS recommends that nursing homes be among the last to reopen within the community, even as other businesses begin to reopen. 

If adhering to the guidance, facilities should open “as quickly as possible,” Verma said Monday. “There is a variety of different decisions and those decisions are going to be made at the state and local level.”   

The agency noted in its guidance that decisions to relax restrictions in nursing homes should factor in the following: the case status in the local community and the facility; if a provider has adequate staffing and access to testing; whether social distancing measures can be followed, including having face coverings for residents and visitors; local hospital capacity; and if the facility has enough personal protective equipment. 

CMS urged states and nursing homes to use “extreme caution” in making the decision to reopen nursing homes to visitors, Verma said Monday. 

In mid-March, the agency announced a ban on all visitors and communal dining at nursing homes as an effort to limit the spread of COVID-19. It said that visits to nursing homes would not be allowed until phase 3 under President Trump’s three-phase plan to reopen America. That timeline was echoed in Monday’s newly released guidance, which said that visits can happen during phase 3 when “there has been a sustained decrease in COVID-19 cases.”

“We do not recommend nursing homes relax visitation until all benchmarks are met, which takes them to phase 3,” Verma said Monday.

Providers are also encouraged to spend a minimum of 14 days in each phase of the administration’s reopening plan, with no new COVID-19 cases, prior to advancing to the next phase, according to the guidance.  

‘Sufficient testing’ 

Verma said the federal government believes there is sufficient testing capacity at the state level despite pushback by nursing homes surrounding the availability of tests. She noted that the country “is approaching 11 million tests that have been conducted.”

“We feel that there is sufficient testing capacity available in all states, so these recommendations and guidelines were put together with that in mind,” she said.

‘Heartbreaking’ impact 

The decision to ban non-essential visitors in March was “heartbreaking,” Verma said at the outset of Monday night’s call. 

There was a “terrible emotional pull of separation,” she said. “While restriction of visitation was necessary, it was also drastic and affected the quality of life for nursing home residents.”

The government wants to reunite families with residents “in a responsible way.”