As outlined in the CMS guidance, all nursing home facilities nationwide should restrict visitation of ALL visitors and non-essential health care personnel, except for in certain end-of-life situations. In an end-of-life situation, visitors should be limited to a specific room only. The access restrictions include individuals serving as power of attorney for a resident. Most decisions, including medical decisions, can be made via phone or video conference. Because an in-person assessment of the resident is not required for a power-of-attorney decision to be legally and ethically valid, those visitors should also be restricted in accordance with the CMS guidance. Additionally, nursing homes should:

• Actively screen residents and staff for fever and respiratory symptoms;
  
  
• Cancel communal dining and all internal and external group activities;
  
  
• Actively screen all staff at the beginning of their shift for fever and respiratory symptoms, including taking their temperature and documenting any shortness of breath, new or change in cough, and sore throat;
  
  
• Require infected staff to self-isolate at home;
  
  
• Inform individuals of the access restrictions through signage at entrances/exits, letters, emails, phone calls, and recorded messages;
  
  
• Identify staff who work at multiple facilities and screen and restrict them appropriately;
  
  
• Restrict vendors from coming inside the facility if not necessary; and
  
  
• Implement procedures for receiving supplies, mail, etc.
  
  

In light of the visitor and access restrictions, nursing homes should consider offering alternative means of communication to family and friends who would like to check on their loved one, including video conference, if available. Moreover, facilities should have a primary contact to keep families up to date and field inbound calls regarding the restrictions. Necessary health care workers and federal and state agency surveyors are exempt from these restrictions and should still be allowed to enter . Additionally, residents still have the right to access the Ombudsman program. If in-person access is not available, nursing homes need to facilitate resident communication (by phone or other format) with the Ombudsman program.

The spread of COVID-19 is rapidly changing, and nursing homes should be constantly monitoring relevant sources for any updates or changes. If you have any questions or concerns, please contact your Dinsmore health care attorney.

[1] Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html.

[2] The Centers for Medicare & Medicaid Services, https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf.