CMS and ISDH GUIDANCE FOR COVID-19 FOR LONG TERM CARE FACILITIES

04.28.2020 Written by Norris Cunningham, Kathryn 'Katie' Cordell, Christina L. Essex

Nursing Homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.

  • In particular, facilities should focus on adherence to appropriate hand hygiene as set forth by CDC.
    • Increase the availability and accessibility of alcohol-based hand rubs (ABHRs), reinforce strong hand-hygiene practices, tissues, no touch receptacles for disposal, and facemasks at health care facility entrances, waiting rooms, resident check-ins, etc.
    • Ensure ABHR is accessible in all resident-care areas including inside and outside resident rooms.
    • Increase signage for vigilant infection prevention.
    • Properly clean, disinfect and limit sharing of medical equipment between residents and areas of the facility.
    • Provide additional work supplies to avoid sharing (e.g., pens, pads) and disinfect workplace areas (nurse’s stations, phones, internal radios, etc.).
  • CMS has issued a self-assessment checklist that long-term care facilities can use to determine compliance with infection control actions.
  • Ensure all staff are using appropriate PPE when they are interacting with patients and residents.
  • Facilities should use separate staffing teams for COVID-19-positive residents to the best of their ability, and work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19-negative residents from COVID-19-positive residents and individuals with unknown COVID-19 status.
  • Restrict visitation of all visitors and non-essential health care personnel except for certain compassionate care situations.
    • If a state implements actions that exceed CMS requirements, such as a ban on all visitation through a governor’s executive order, a facility would not be out of compliance with CMS’ requirements.
    • Decisions about visitation during an end of life situation should be made on a case-by- case basis and include careful screening of all visitors.

Screening

  • Every individual regardless of reason for entering a long-term care facility should be asked about COVID-19 symptoms and have their temperature checked. An exception to this is Emergency Medical Service (EMS) workers responding to an urgent medical need.
  • Facilities should limit access points and ensure all accessible entrances have a screening station.
  • Every resident should be assessed for symptoms and have their temperature checked every day.
  • Patients and residents who enter facilities should be screened for COVID-19 by testing, if available.
  • Facilities should implement active screening of residents and staff for fever and respiratory symptoms.
    • Screen all staff at the beginning of their shift for fever and respiratory symptoms. Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and self-isolate at home.

Acceptance of new residents

  • A nursing home can accept a resident diagnosed with COVID-19 and still under Transmission Based Precautions for COVID-19 as long as the facility can follow CDC guidance for Transmission-Based Precautions. If a nursing home cannot, it must wait until these precautions are discontinued.

Please note that ISDH has a team available to come into facilities to rapidly test residents and staff who are suspected of having COVID-19. If facilities have patients or providers who are symptomatic and need to be tested, an email should be sent to striketeamrequest@isdh.in.gov

Katz Korin Cunningham’s team of long-term care attorneys is available to assist you during these unprecedented times. Do not hesitate to contact us:

Norris Cunningham 317-396-2562

Katie Cordell 317-396-2549

Christina Essex 317-396-2571

The contents of this document are for general information purposes only. The information is not intended to, and does not, constitute legal counsel, advice, or opinion on any specific facts or circumstances. Information contained in this article is not a substitute for the professional judgment of an attorney and you are encouraged to consult your own attorney on any specific questions you might have concerning your specific situation. This article may constitute advertising materials in some jurisdictions. The information in this white paper is current at the time it was published but due to the rapidly changing situation, we recommend that you check with the agencies or our team of long-term care attorneys for the most up-to-date guidelines and information.

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