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Federal Guidelines Pave Way for Nursing Homes to Reopen (1)

May 18, 2020, 10:27 PMUpdated: May 19, 2020, 12:30 AM

The Trump administration has issued new guidance that would eventually allow nursing homes nationwide to re-open to visitors—on a phased-in basis.

The recommendations call for all nursing home staff and residents to be tested for the coronavirus, and for state or local infections to be declining, before restrictions on visitation are relaxed or facilities reopened.

The Centers for Medicare & Medicaid Services also wants all nursing home staff to be screened each day for respiratory symptoms and to be tested each week. The new guidance also calls for state officials to inspect nursing homes that had previous Covid-19 cases before visitations can resume.

“Our focus continues to be on the safety of residents and we are encouraging states and nursing homes to move very carefully,” CMS administrator Seema Verma said in a Monday press briefing with reporters.

The CMS guidance builds on the administration’s push to or re-open the economy in the aftermath of the Covid-19 pandemic. But as nursing homes continue to reel from coronavirus infections and deaths, industry stakeholders, resident advocates, and lawmakers could raise concerns over whether the facilities are safe enough to resume visitations.

Nursing homes account for at least one-third of U.S. Covid-19 deaths and more than half the total in 14 states, according to data compiled by the Kaiser Family Foundation. The facilities have struggled with measures like hand washing, proper use of personal protective equipment, and isolating residents by their infection status.

Assistance Needed

The industry says it needs more staffing, protective gear, and testing to combat the infection caused by the coronavirus. It has asked the government to establish a $10 billion fund to help pay for the needed services.

In a statement, Katie Smith Sloan, president and CEO of LeadingAge, the trade association representing nonprofit nursing homes, said the new guidance “raises many questions, but doesn’t answer the most important one: When will vulnerable older Americans and their caregivers get the support needed to protect them from the most dangerous pandemic in a century?”

Sloan’s statement said “we too want to have a plan to safely reopen nursing homes, and we agree that testing is essential.”

But, she added, “The reality is that too many nursing homes and other aging services providers are still desperately in need of testing and personal protective equipment, and we don’t know when or if it’s coming. We need these tools to make reopening possible.”

The Federal Emergency Management Agency is in the process of sending all U.S. nursing homes a one-week supply of protective gear. Sloan said previously that the shipment wasn’t enough to make a meaningful difference.

Mark Parkinson, president and CEO of American Health Care Association and the National Center for Assisted Living, said in a statement that both organizations support the new guidance. “Nursing homes and assisted living communities are eager for our residents to welcome their loved ones back into facilities, yet cautious about doing this safely,” he said.

Parkinson called on the nations’ governors “to use the $11 billion that has been allocated to states for expanding testing in our nursing homes, assisted living communities and other long term care facilities. States can also assist with logistical support in implementing such a large endeavor, with help from the National Guard or the state’s health department.”

Virtual Lockdown

The nation’s 15,000-plus nursing homes have been on virtual lockdown since March 13 when the CMS directed them to stop admitting most visitors and nonessential workers. The facilities were also forced to cancel group activities and communal dining and to begin screening residents and staff for high temperatures and respiratory symptoms.

In addition, the CMS required nursing homes to provide the Centers for Disease Control and Prevention with information each week on Covid-19 infections and deaths among staff and visitors. Facilities could face penalties of up to $1,000 per week for violating the directive.

Since visitations were stopped, the virus is entering facilities mainly through employees, new admissions from hospitals, and when residents return from essential outside medical appointments like dialysis, said Richard Feifer, chief medical officer at Genesis HealthCare, one of the nation’s largest nursing home operators.

About 20% of residents infected in nursing homes end up dying, while more than half are asymptomatic, Feifer said during a recent webinar sponsored by the Alliance for Health Policy.

The new guidance recommends that facilities remain in the “current state of highest restriction” even when the greater community relaxes restrictions for other businesses.

It calls for nursing homes “to be among the last to reopen within the community, to ensure safety of the residents.” Only nursing homes that are in Phase 3 of the Trump administration’s blueprint for re-opening the economy would be allowed to lift restrictions, Verma said.

The agency is recommending that nursing homes “not advance through any of the first three phases of reopening or relax any restrictions on visitations until all residents and staff have received a baseline test to establish there are no known cases of Covid-19 in the facility,” Verma said.

(Updates with additional reporting throughout.)

To contact the reporter on this story: Tony Pugh in Washington at

To contact the editors responsible for this story: Fawn Johnson at; Brent Bierman at