The Centers for Medicare & Medicaid Services (CMS) is recommending that residents do not leave the nursing home, especially during the holiday season. The anticipated vaccine is on the immediate horizon; therefore, CMS recommends that extra precautions taken now are essential to protect nursing home residents until the COVID-19 vaccine is available. Nursing Facilities should educate residents and their families of the risks of leaving the facility, the steps they should take to reduce the risk of contracting COVID-19, and encourage residents to stay connected with loved ones through alternative means of communication, such as phone and video communications. In September 2020, CMS updated their memorandum discussing innovative ways to connect with residents. This memorandum can be accessed at: QSO-20-28-NH Revised (cms.gov).
CMS reminds all nursing facilities to follow the Core Principles of COVID-19 Infection Prevention at all times. The Core Principles include screening of all who enter the facility for signs and symptoms of COVID-19 with denial of entry of those with signs and symptoms, proper hand hygiene, social distancing, and other core principles of infection prevention. The memorandum can be accessed at https://www.cms.gov/files/document/qso-20-39-nh.pdf
CMS does recognize that some residents may still choose to leave the facility during the holidays. CMS recommends that residents and their families be educated on the following recommendations when a resident makes this choice:
- Limit close contact (maintain physical distancing of six feet or more), keep gatherings as small as possible, and use technology to engage with others remotely;
- Wear facemasks or 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, to not attend the gathering;
- If possible, conduct gatherings outdoors. Indoor gatherings should have good ventilation or 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.
Upon residents’ return to the facility, CMS recommends the following:
- Screen and increase monitoring for signs and symptoms;
- Test a resident for COVID-19 if signs or symptoms are present or if a resident or their family reports possible exposure to COVID-19 while out on leave. The facility may opt to test residents without signs or symptoms if they leave the facility frequently or for more than 24 hours. CMS testing guidelines can be accessed here: QSO-20-38-NH (cms.gov)
- Place the resident on transmission-based precautions (TBP) if the resident or family member reports possible exposure to COVID-19 while on leave, or if the resident has signs or symptoms upon return.
- Consider placing residents on TBP if they were away for more than 24 hours.
CMS reminds all facility staff to use extra caution during the holiday season and too follow the same recommendations as those that apply to residents and families regarding gathering with others outside of work in order to help protect the vulnerable resident population.
Issue
Nursing facilities educate residents and their families on the risks of leaving the facility and the steps that should be taken to reduce the transmission of COVID-19 during the holiday season. Staff should provide innovative alternatives to residents and families for holiday celebrations. In addition, staff should adhere to the Core Principles of COVID-19 Infection Prevention principles. Failure can result in fines and penalties for placing residents in immediate jeopardy.
Discussion
- Review policies and procedures to ensure implementation of the Core Principles of COVID-19 Infection Prevention and the effectiveness of the facility’s Infection Prevention and Control Plan.
- Initiate education with residents and their families on the CMS recommendations for the holiday season.
- Periodically audit to ensure that the Core Principles of COVID-19 Infection Principles are being followed by staff, residents, and visitors.
