States, counties and cities nationwide are currently at varying levels of reopening their economies after the coronavirus outbreak. Some states, such as Texas and Florida, have backtracked by closing off various businesses again after a surge of COVID-19 cases in those areas. Such instances have made governors wary of reopening too quickly, especially in the states that were hit the hardest at the onset of COVID-19’s entry to the U.S. – New York and New Jersey. Given the tragic loss experienced in nursing homes and the known impact that this virus has on seniors, long-term care facilities (including nursing homes and assisted living facilities) may be among the last business to undergo a “reopening.” Strict adherence to the federal, state and local precautions will be required, as well as close monitoring for outbreaks in the facility. This article discusses what “reopening” means for these facilities since they were not technically closed in the way that most other businesses were. Then, it will cover the recent CMS recommendations to state and local officials on reopening nursing homes as states progress through the phases of the White House Guidelines for Opening Up America Again.
Although long-term facilities never fully closed, COVID-19 caused such facilities to impose strict precautions to attempt to limit the spread of the virus among these vulnerable communities. The meaning of “reopening” for seniors housing involves relaxing some of the currently required restrictions, including the restoration of socialized activities, permitting communal dining, accepting referrals again, allowing visitors/non-employees back into the facility, and allowing residents to take non-medical trips outside of the facility.
On May 18, 2020, CMS issued guidelines for state and local officials on reopening nursing facilities. At the outset, CMS encourages the state leaders to coordinate with the health departments when deciding how to implement these CMS recommendations. CMS suggests that states may decide to initiate the reopening of nursing homes on a statewide phased approach, on a regional phased approach, or an individual facility phased approach based on specific metrics. CMS advises the state to continuously monitor the factors for opening and be prepared to make adjustments. The factors that should be monitored are: the case status in community (e.g. number of hospitalizations in state), the case status in the nursing home, adequate staffing, access to adequate testing (based on the CDC recommendations for a testing plan); universal source control (face covering, social distancing, hand washing of visitors), access to adequate PPE for staff, and local hospital capacity.
Ultimately, this CMS guidance is a recommendation to the states and the states will make different decisions about which components it plans to implement. At least one state, Kentucky, plans to begin allowing visitors into seniors housing in mid-July and some states are currently allowing outdoor-only visitation, but the vast majority of facilities remain locked-down. Recently, New York and Pennsylvania have issued guidance on how assisted living facilities may reopen their facilities, including the allowance of visitation, as long as the specific criteria is met.
The Department of Health and Human Services has committed $4.9 billion to nursing homes to help compensate the extra expenses incurred by the facility due to COVID-19. Each facility with six or more certified beds will receive $50,000, plus $2,500 per bed. However, assisted living facilities have yet to receive any government funding to respond to the virus, although they also house a similarly vulnerable population and, frequently, states have mandated that they follow the same coronavirus precautions as nursing homes.
If you have questions about how your long-term care facility can comply with the CMS recommendations and/or the state requirements, please contact us. Also, we can help with ensuring that your facility’s COVID-19 policies are aligned with the current legal requirements and propose methods for shielding your organization from liability.