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CMS Guideline for Safely Reopening Nursing Homes

The Centers for Medicare and Medicaid Services, on May 18, 2020, issued guidance for state and local officials to ensure the safe reopening of nursing homes nationwide.

The purpose of these guidelines per CMS is to give guidance for states to take appropriate and necessary steps to ensure resident’s safety. One main objective of CMS is to help states and nursing homes reunite families with their loved ones in a safe phase-in manner.

This policy is effective immediately.

Recommendations for States:

CMS has issued three examples on how a state may choose to implement these recommendations:

  • A State requiring all facilities to go through each phase at the same time (i.e., waiting until all facilities have met entrance criteria for a given phase).
  • A State allowing facilities in a certain region (e.g., counties) within a state to enter each phase at the same time.
  • A State permitting individual nursing homes to move through the phases based on each nursing home’s status for meeting the criteria for entering a phase.

Per CMS, states and local leaders should regularly monitor the factors for reopening and adjust their plans accordingly.  Factors CMS recommends that states should use for informed decision making in relaxing restrictions in nursing homes.

  • Cases status in the community: State-based criteria to determine the level of community transmission and 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 onset1 of COVID-19 cases (resident or staff), such as a resident acquiring COVID-19 in the nursing home.
  • Adequate staffing: No staffing shortages and the facility is not under a contingency staffing plan.
  • Access to adequate testing: see below website link
  • Universal source control: Residents and visitors 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 maintain 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 (facilities’ crisis capacity PPE strategy would not constitute adequate access to PPE). All staff wear all appropriate PPE when indicated. Staff wear 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

Recommended Nursing Home Phased Reopening for States:

  • Nursing homes should not advance through any phases of reopening or relax any restrictions until all residents and staff have received a base-line test, and the appropriate actions are taken based on the results;
  •  States should survey those nursing homes that experienced a significant COVID-19 outbreak prior to reopening to ensure the facility is adequately preventing transmission of COVID-19; and
  • Nursing homes should remain in the current state of highest mitigation while the community is in Phase 1 of Opening Up America Again (in other words, a nursing home’s reopening should lag behind the general community’s reopening by 14 days).
  • For additional criteria in the appendix click here.

Please continue to monitor our Coronavirus Resources and Information Page for updates.

CMS contact for questions or concerns: DNH_TriageTeam@cms.hhs.gov

Related CMS Website:

Nursing Home Reopening Recommendations for State and Local Officials

Trump Administration Issues Guidance to Ensure States Have a Plan in Place to Safely Reopen Nursing Homes

Nursing Home Reopening Recommendations Frequently Asked Questions

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