With New Holiday Recommendations from CMS, the Year of Challenges for Nursing Home Residents Continues

In advance of the beginning of the holiday season, the Centers for Medicare and Medicaid Services (CMS) issued recommendations for keeping nursing home residents safe amidst the continuing Coronavirus pandemic while still allowing them to enjoy the holidays as much as possible. In a call with stakeholders on November 18, 2020, CMS stated that it would not be issuing new visitation guidance in light of a holiday season that coincides with a nationwide surge in COVID-19 infections. Instead, the agency advised facilities, residents, families, and visitors to continue to follow existing guidance for visitation and provided recommendations for celebrating the holidays safely for those residents who exercise their right to leave the facility.

As a threshold matter, CMS recommends that residents not leave the facility during the holidays or for the duration of the Public Health Emergency and urges facilities to educate residents and their families regarding the risks of leaving the facility. Nevertheless, the agency recognizes the right of residents to leave the facility if they choose and recommends the following:

• Maintain social distancing of six (6) feet or more, keep gatherings as small as possible, and use technology to engage with others remotely;
• Wear facemasks or a cloth face covering at all times (including in cars, homes, restaurants, etc.);
• Limit contact with commonly touched surfaces or shared items;
• Keep safe around food and drinks. Avoid communal serving utensils, passing of food, potluck or buffet style food service, and instead, opt for individually prepared plates by a single server;
• Perform hand hygiene often (e.g., wash hands with soap and water or alcohol-based hand sanitizer);
• Avoid large gatherings, crowded areas, and high-risk activities such as singing;
• For those attending a gathering, avoid contact with individuals outside of their household for 14 days prior to the gathering;
• Ask anyone who has signs or symptoms of COVID-19, or has been exposed to someone diagnosed with COVID-19, not to attend the gathering;
• If possible, conduct gatherings outdoors. Indoor gatherings should have good ventilation, and open windows and doors if possible;
• Verbally greet others instead of shaking hands or giving hugs. Think ahead about how you will manage to prevent physical interactions with loved ones of different ages such as young children; and
• Check local conditions and state requirements for precautions and restrictions, including positivity rates and quarantine requirements, before crossing state lines.

CMS also recommends that nursing home staff follow the same recommendations as residents when engaging in holiday activities.

When a resident returns to the facility, particularly after the resident has been away for 24 hours or more, CMS recommends that facilities screen and increase monitoring of the resident for signs and symptoms of illness, conduct testing of the resident¹, and place the resident on transmission-based precautions.

Out-of-facility holiday visits present significant practical challenges for providers, particularly if they choose to quarantine residents upon their return to the facility.  Too many residents leaving the facility and returning at the same time may exceed the capacity of the facility’s quarantine unit, and could, in turn, hinder the provider from accepting new admissions to the facility.  Also, facilities will need to stagger departure and arrival times in an effort to maintain social distancing in the pickup/drop off area and avoid diverting staff for long periods of time.

CMS’s holiday recommendations serve as a reminder of the immense challenges that the Coronavirus pandemic continues to present for nursing home residents and their families, as well as for nursing home providers and their staff who are tasked with ensuring their safety.  Only with the advent of a safe and effective vaccine and better treatment for those afflicted with COVID-19 will facilities be able to return to anything resembling routine operations.

[1] If the resident has been away from the facility for less than 24 hours and does not leave the facility frequently, CMS recommends testing only if the resident has/develops signs or symptoms or if the resident or a family member reports possible exposure to COVID-19.  If the resident has been away from the facility in excess of 24 hours or frequently leaves the facility, the facility may opt to test the resident even if he or she does not present with signs or symptoms of COVID-19 infection.