For at least the last eleven weeks, nursing home residents have been separated from their families. Some family members have gotten creative – visiting through windows, on ladders, via Zoom, and from parking lots. But many have had no way to reach their loved ones except by relying on staff to give them updates. Unfortunately, this isolation has increased depression and confusion in many residents. It has also led to heartbreaking scenes of seniors dying alone with families not finding out until it is too late. Clients have called me weeping that all they want is to hold their loved one’s hand in their final days. As the number of COVID-19 cases continues to decrease in New Jersey, Pennsylvania, and New York, nursing home residents and their families are wondering when visitation will resume.

CMS Nursing Home Recommendations

The Centers for Medicare & Medicaid Services (CMS) is recommending that nursing homes should ensure that all residents and staff have received results from a baseline test before restrictions are relaxed. Finally, the federal agency recommends that nursing homes should be among the last to reopen, not allowing the renewal of visitation (except for compassionate care exceptions) until phase three when there has been a sustained decrease in COVID-19 cases.

CMS outlines the phase three criteria that will need to be met:

• There are no new COVID-19 cases in the nursing home for 28 days

• The nursing home is not experiencing staff shortages

• The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents

• The nursing home has adequate access to testing for COVID-19

• Referral hospital(s) have bed capacity onwards and intensive care units

Another barrier to reopening is inspection. CMS is recommending that states inspect nursing homes that experienced a significant COVID-19 outbreak prior to allowing them to reopen. Obviously, this will take some time as the vast majority of the nursing homes in New Jersey had significant outbreaks.

COVID-19 Guidelines for Opening Up America Again

Other criteria are largely beyond the control of the nursing facilities as well. The federal Guidelines for Opening Up America Again call for increased testing and contact tracing, but facilities struggle to keep up. The guidelines direct states to deploy testing resources to nursing homes.

In addition, CMS recently issued rules on Medicare payment for rapid testing. State and federal guidelines currently require that nursing home staff should be tested weekly. CMS and the Centers for Disease Control and Prevention (CDC) have also recently directed that all residents should receive a baseline test and be re-tested when any resident shows symptoms or any staff member tests positive for COVID-19. This clearly has not been happening on a widespread basis. Clients advise that residents generally have only been tested when they show symptoms or come in close contact with someone who tests positive.

However, a May 20 New Jersey Executive Order was issued requiring facilities to implement a plan to meet the CDC testing criteria. Hopefully, as testing ramps up, facilities will be able to move into phase three and allow families to resume visiting their loved ones.