Closeup of man on crutches being helped to walk by a physical therapist

With no new masking guidance from federal health officials as COVID cases climb, nursing homes are carefully navigating when to require masking and other infection prevention steps to head off outbreaks.

A facility for veterans in Florida, for example, recently implemented mask requirements for all staff and visitors and also imposed a two-visitor limit per resident, according to WFLA-TV in west-central Florida. 

“We can see not only in Florida but nationally, we’re seeing a pretty dramatic uptick compared to six weeks ago,” University of Southern Florida epidemiologist Jason Salemi told the TV station. 

The Centers for Disease Prevention and Control reported 7,880 nursing home COVID cases as of Aug. 20, adding to an uptick that started in mid-July.

As that surge hit Bay Pines VA Community Living Center in Pinellas County, FL, leaders increased screening and testing protocols but not under any specific state or federal guidelines.

Concerns about when to kick in additional preventative measures come as vaccination coverage has waned. As of Aug. 13, the Centers for Medicare & Medicaid Services reported 62% of nursing home residents and 26% of facility staff were up-to-date on COVID vaccinations.

More than 1.6 million cases of COVID have been confirmed among nursing home residents since 2021 with more than 167,000 deaths attributed to the virus, according to CMS. The agency’s data also shows there have been 1.6 million cases confirmed among facility staff. 

In May, the agency pulled its requirement that staff members be vaccinated. Instead, it’s relying on value-based incentives and quality reporting to keep track of vaccine rates and encourage facilities to push people to vaccinate. 

The rate for staff “is a dismally low number,” Sam Brooks, director of public policy for Consumer Voice, told Inside Health Policy.

“We pressed CMS to issue a booster mandate,” he told the publication. “Instead, all mandates have been lifted. It is not surprising that you are seeing an upswing in cases. Unfortunately, things are just back to ‘normal,’ and you will see that reflected in COVID-19 cases and deaths.”

Jodi Eyigor, director of Nursing Home Quality and Policy for LeadingAge, told McKnight’s Long-Term Care News on Monday that booster rates among their members surpassed all nursing home residents, nationwide, and the over-age 65 population as a whole.

“Coordinated, deliberate initiatives make a difference in the ongoing fight against COVID, as our mission-driven, nonprofit nursing home members’ actions have shown,” Eyigor said. “As COVID cases rise, our members are focused on implementing Centers for Disease Control and Prevention (CDC) recommendations; we are urging them to prevent severe outcomes by implementing vaccination and infection control strategies to protect residents and staff during the respiratory virus season.”

A spokeswoman for the American Health Care Association/National Center for Assisted Living told McKnight’s on Monday that the organization encourages the LTC community to use common-sense infection control practices, such as staying home when sick and getting vaccinated.

“Long-term care providers continue to follow CDC guidance and CMS regulations on infection control and prevention, including testing and masking protocols,” the spokeswoman said in an email. “The good news is that we are better equipped to prevent and manage COVID-19 than ever before thanks to life-saving vaccines and treatments.”