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Nursing Home Safety Amid COVID-19: CMS Publishes Infection Control Guidance and Toolkit 

by Thomas W. Hess, Timothy Cahill, Sydney N. Pahren

Published: June, 2020

Submission: June, 2020


As states are beginning to open back up amid the COVID-19 pandemic, nursing homes and other long-term care facilities are still at the highest risk of infection and should continue to be cautious. One-third of all COVID-19 deaths are attributed to long-term care residents and workers.[1] Facilities need to take steps to manage the spread of the disease and protect their residents and staff as states begin to allow more flexibility around long-term care quarantine practices.

Recently, CMS published guidance for safely reopening nursing homes and other long-term care facilities. CMS recommends opening in small phases that allow for certain restrictions to be relaxed on a trial basis before completely reopening. CMS is recommending that nursing homes do not advance through any phases of reopening or relax any restrictions until all residents and staff have received results from a baseline test. Additionally, CMS recommends that state survey agencies inspect nursing homes that experienced a significant COVID-19 outbreak prior to reopening.

Some of the phases allow for non-essential health care personnel to be allowed back into the building after proper screening, as well as allowing residents who tested negative for COVID-19 to eat in the same room at a social distance. Later phases also allow for limited group activities with fewer than 10 people at a social distance. However, all of these decisions should be made after careful and thoughtful review of the facilities’ ability to accommodate these changes in a safe way. Some factors to consider are:

  • Status of COVID-19 cases in the local community and nursing homes
  • Adequate staffing
  • Access to adequate personal protective equipment (PPE)
  • Baseline testing for all residents
  • Ability to social distance

Nursing homes should regularly monitor the factors for reopening and can adjust their plans accordingly. The entire CMS guidance and outline for reopening can be found here.

Additionally, CMS released a toolkit to provide guidance and resources for long-term care facilities. The entire toolkit can be found here. The toolkit is comprised of best practices from state COVID-19 resources and tasks forces, health care providers, and agencies to help combine resources into a useable document for nursing homes to address the various challenges related to COVID-19. The toolkit provides resources and outlines best practices for issues ranging from infection control to workforce and staffing. It also provides contact information for organizations that can help assist with those issues.

As nursing homes begin to consider reopening, they should be conscious of their infection-control practices. Recently, CMS also began enhanced enforcement for nursing homes with violations of longstanding infection-control practices in light of the COVID-19 pandemic. This builds on the previous CMS enforcement actions related to infection control. Now, CMS is increasing penalties for noncompliance with infection control to help prevent backsliding, improve accountability, and ensure prompt compliance.[2]

Nursing homes’ first priority should be protecting the safety of their residents and staff. The abovementioned guidance and tools can help nursing homes determine the best course of action for reopening their facilities and complying with regulations.

If you have any question regarding the CMS guidance, please contact your Dinsmore health care attorney.

[1] Karen Yourish, K.K. Rebecca Lai, Danielle Ivory and Mitch Smith, One-Third of All U.S. Coronavirus Deaths Are Nursing Home Residents or Workers, New York Times (May 11, 2020), https://www.nytimes.com/interactive/2020/05/09/us/coronavirus-cases-nursing-homes-us.html.

[2] Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results, Centers for Medicare & Medicaid Services, (June 1, 2020), https://www.cms.gov/newsroom/press-releases/trump-administration-unveils-enhanced-enforcement-actions-based-nursing-home-covid-19-data-and


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