Nursing Homes Challenged to Comply with Varying State and Federal COVID-19 Guidelines
Indiana skilled nursing facilities (SNF) recently faced a conflict between state and federal COVID-19 guidelines. A county issued orders preventing the transfer of residents with COVID-19 between counties that were in opposition to waivers issued earlier from the Centers for Medicare & Medicaid Services (CMS). Those waivers were aimed at stopping the spread of the coronavirus by allowing nursing home operators to create dedicated facilities for COVID-19 residents. This waiver provided transfer flexibility to SNF owners, allowing them to shift residents to their other locations—some in other counties or states. These waivers were also quickly followed-up by CMS mandates requiring SNFs to create dedicated wings and buildings for COVID-19 residents and their care staff.
Nursing homes must also cope with the disconnect that exists with hospitals. The president of AMDA, the Society for Post-Acute and Long-Term Care Medicine, put it this way, “It’s been quite obvious that hospital systems really do not know that much about the nursing home environment.” He also said this in a recent interview, “Where hospitals kind of need to be educated and re-educated and seem to keep on forgetting is that nursing homes are not hospitals, and they’re not mini-hospitals. They’re homes.”
Companies with SNFs in multiple states face even greater challenges regarding transfers. For example, Indiana prefers to “cohort”—locate COVID-19 residents together to reduce the risk for other residents who might not have the coronavirus and to maximize measures for infection control and the use of personal protective equipment (PPE). However, states like Maryland, Virginia, and to some extent Pennsylvania prefer to minimize transfers and treat residents in place at the SNF.
Nursing homes must also deal with varying directives regarding accepting new admissions and readmitting current residents who have been hospitalized but are now stable—including some who have had COVID-19. Currently, most agree that a nursing home with no COVID-19 cases should not admit persons who have the coronavirus. However, New York and California have issued directives requiring SNFs to accept residents regardless of their COVID-19 status.
Compliance Perspective
Lack of awareness of the most current state and federal guidelines and directives may result in a nursing home being out of compliance with state or federal regulations. Potential issues include seeking to transfer residents with COVID-19 to a dedicated coronavirus facility, denying admission to potential residents who have tested positive for the virus, and/or denying admission of previous residents who were hospitalized due to the virus and ready for readmission. Non-compliance could result in citations, fines, or exclusion as a Medicare and Medicaid provider.
Discussion Points:
- Review policies and procedures and all state and federal directives regarding the COVID-19 crisis to ensure updated protocols are implemented.
- Train staff on the directives and policies as they are issued to ensure current adherence regarding transfers and admissions.
- Periodically audit to determine if the most current state and federal COVID-19 guidelines are being followed.
