CDC Provides Updated Guidance as Nursing Homes Begin to Ease Restrictions

In recognition that some nursing homes in states that are not experiencing a resurgence of COVID-19 cases are beginning to loosen restrictions, the Centers for Disease Control and Prevention (“CDC”) has quietly updated its COVID-19 nursing home guidance to provide tiered recommendations to facilities in different phases of the reopening process.  The revised guidance also addresses other issues pertaining to COVID-19 response, including management of a facility’s infection prevention and control program, reporting to the National Health Safety Network, and testing plans for residents and staff.

In addition to the CDC’s core infection control practices for the pandemic, CDC addresses two categories of measures facilities should consider as they move through their reopening phases:

• Social Distancing
  • High Tier – CDC continues to recommend aggressive social distancing measures for both residents and staff. This includes six feet of separation and cancellation of communal dining and group activities.
  • Relaxed Tier – CDC advises facilities to consider allowing:
    • Communal dining and group activities for residents without COVID-19 and those who had COVID-19 but are fully recovered. Facilities should maintain social distancing, continue to implement source control measures such as face masks, and limit the number of participants.
    • Outdoor excursions for residents. Again, social distancing and source control measures should be maintained.  In addition, CDC recommends rotating schedules for such excursions and scheduling them so that families can plan accordingly, though the involvement of families would seem to present logistical as well as source control and social distancing challenges.

• Visitor Restrictions
  • High Tier – CDC calls for maintaining restrictions on all visitation (except for compassionate care situations), and the use of alternative methods of visitation where possible.
  • Relaxed Tier – For facilities progressing through the reopening phases, CDC suggests restricting the hours for visitation, limiting the number of visitors per resident, scheduling visitation in advance, and restricting visitation to a resident’s room or outside as many facilities have begun to do where environmental conditions permit.

The revised guidance also recommends the following:

• Facilities with more than 100 residents or that provide on-site ventilator or hemodialysis services should assign at least one individual with training in infection prevention and control to provide full-time¹   on-site management of COVID-19 prevention and response activities.
• Facilities should create a plan for testing residents and staff that aligns with state and federal requirements. Such plan should focus on viral testing as opposed to antibody testing and address triggers for testing, access to appropriate test kits, process and capacity for testing, and procedures for residents or staff who decline or are unable to be tested.  Also, the CDC on July 1st, updated its testing guidance for nursing homes splitting out recommendations for testing residents and recommendations for testing staff into two separate documents.

While the most recent updates to the CDC guidance for nursing homes are more incremental than previous updates, they are nevertheless critical in terms of establishing de facto standards of operation that facilities should address in their COVID-related response efforts and documentation processes.  For additional information or assistance, please contact Jennifer L. Hilliard.

[1] Centers for Medicare and Medicaid Services regulations at 42 C.F.R. § 483.80(b) require facilities to designate an Infection Preventionist with specialized training, but the position need only be part-time.