May 19, 2020
On May 18, 2020, after President Trump revealed Guidelines for Opening Up America Again, the Centers for Medicare and Medicaid Services (CMS) announced new guidance for state and local officials to ensure the safe reopening of nursing homes across the country.
State leaders are encouraged to collaborate with the state survey agency and local health departments to develop a plan on how these criteria should be implemented.
CMS recommends that decisions on relaxing restrictions in nursing homes be made with careful review of the following facility-level, community, and state factors:
- Case status in community: State-based criteria to determine the level of community transmission guides progression from one phase to another. For example, a decline in the number of new cases, hospitalizations, or deaths (with exceptions for temporary outliers).
- Case status in the nursing home(s): Absence of any new nursing home onset of COVID-19 cases (resident or staff), such as a resident acquiring COVID-19 in the nursing home, for 28 days (through phases one and two).
- Adequate staffing: No staffing shortages and the facility is not under a contingency staffing plan.
- Access to adequate testing: The facility should have a testing plan in place based on contingencies informed by the Centers for Disease Control and Prevention (CDC). At minimum, the plan should consider the following components:
- The capacity for all nursing home residents to receive a single baseline COVID-19 test. Similarly, the capacity for all residents to be tested upon identification of an individual with symptoms consistent with COVID-19, or if a staff member tests positive for COVID-19. Capacity for continuance of weekly re-testing of all nursing home residents until all residents test negative;
- The capacity for all nursing home staff (including volunteers and vendors who are in the facility on a weekly basis) to receive a single baseline COVID-19 test, with re-testing of all staff continuing every week (note: State and local leaders may adjust the requirement for weekly testing of staff based on data about the circulation of the virus in their community);
- Written screening protocols for all staff (each shift), each resident (daily), and all persons entering the facility, including vendors, volunteers, and visitors;
- An arrangement with laboratories to process tests. The test used should be able to detect SARS-Cov-2 virus (e.g., polymerase chain reaction (PCR)) with greater than 95% sensitivity, greater than 90% specificity, with results obtained rapidly (e.g., within 48 hours). Antibody test results should not be used to diagnose someone with active SARS-Cov-2 infection.
- A procedure for addressing residents or staff that decline or are unable to be tested (e.g., symptomatic resident refusing testing in a facility with positive COVID-19 cases should be treated as positive).
- Universal source control: Residents and visitors should wear a cloth face covering or facemask. If a visitor is unable or unwilling to maintain these precautions (such as young children), consider restricting their ability to enter the facility. All visitors should continue social distancing and perform hand washing or sanitizing upon entry to the facility.
- Access to adequate Personal Protective Equipment (PPE) for staff: Contingency capacity strategy is allowable, such as CDC’s guidance at Strategies to Optimize the Supply of PPE and Equipment. All staff wears all appropriate PPE when indicated. Staff wears cloth face covering if facemask is not indicated, such as administrative staff.
- Local hospital capacity: Ability for the local hospital to accept transfers from nursing homes.
This policy is effective immediately.
The guidance can be accessed
The Frequently Asked Questions (FAQ) document can be accessed
For questions or concerns related to this memo, please email the
DNH Triage Team