In addition, such facilities must ensure that they have enough protective gear and access to coronavirus tests, and that nearby hospitals have sufficient space in intensive care units and other wards in the event cases spike again. The guidance also says how much virus is circulating in the community should be taking into account.
The guidance is an aspect of the White House’s Opening Up America Again plan, but it sets a significantly higher bar for resuming normal operations in nursing homes filled with vulnerable, elderly residents than the guidelines for businesses, stores and other workplaces — all of which President Trump has been encouraging to turn the lights back on.
“[W]hile we are not at a point where nursing homes can safely open up, we want to make sure communities have a plan in place when they are ready to reopen.” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services, which issued the guidance.
Though it recommends a careful, gradual approach, the nursing home guidance nevertheless reflects a tendency in the Trump administration for policy decisions sometimes to run ahead of facts on the ground.
CMS, which regulates nursing homes, issued the guidelines late Monday afternoon, hours after the deadline for the nation’s nursing homes to report their number of coronavirus infections and deaths to the federal government — something watchdogs for the elderly had been urging. Nursing facilities also must report on staff shortages, access to protective gear and the availability of ventilators.
Federal officials said they will collect that information weekly and publish it online, along with the names of affected nursing homes, starting by the end of May. As a result, the administration’s guidance for slowly relaxing restrictions was written before health officials had a chance to study those data for patterns.
The massive data collection marks the U.S. government’s first attempt to assess the virus’s impact since an outbreak in a Seattle nursing home in February killed 45 people, according to the King County, Wash., public health department.
Monday’s recommendations are appearing slightly more than two months after CMS issued its last nursing home guidance, in which health officials said facilities should “restrict visitation of all visitors and non-essential health care personnel.” The only exceptions, it said in the March 13 guidance, are for “certain compassionate care situations,” such as when a patient is dying, and those decisions should be made case by case, with visitors required to wear protective gear, including face masks.
Even before the government provides a statistical round-up, it has been evident that long-term care facilities are among the settings the coronavirus has penetrated most deeply. One in 4 nursing homes nationwide have reported at least one case of covid-19, according to a Washington Post analysis of publicly available data for more than 15,000 skilled nursing facilities certified by Medicare and Medicaid, the public insurance programs for older Americans and for the poor.
And in the absence of a government tally of covid-related deaths in nursing homes, the Kaiser Family Foundation, a nonpartisan health-care policy organization, has estimated those facilities and other assisted-living facilities account for 41 percent of covid-19 deaths in the United States, based on publicly available state data. In some states, the proportion is as high as 70 percent or 80 percent of the total deaths, Kaiser has said.
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