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COVID-19 Nursing Home Guidance – Compliance Recommendations

March 13, 2020

As novel coronavirus (COVID-19) cases continue to rise in the United States, federal and state agencies have nearly daily communicated new, and at times confusing, guidelines and requirements for nursing home providers.  Navigating this guidance as a nursing home provider, while operating a facility, is certainly challenging, but absolutely necessary.  Below are some tips for how nursing home providers can stay compliant during this uncertain time:

Triage and implement federal and state guidance as quickly as possible. Given the volume of guidance, it can be hard for providers to identify what to do first.  CMS’s March 13, 2020 guidance (linked here) identified the following as immediate steps a nursing home should take:

    • End all visitation except for certain compassionate care situations, such as end of life.
    • End all volunteer activities and keep non-essential personnel (ex: beauticians) out of your facility.
    • Cancel all group activities and communal dining.
      • Given this prohibition, facilities should consider how to manage therapy sessions – how many residents can your therapy gym accommodate, keeping them six feet apart?
      • Group activities are prohibited, but the requirement to offer activities to all residents remains in effect. Do you need to increase your supply of in-room activities—books, games, puzzles, videos?
      • This prohibition also implicates smoke breaks. How will you change this procedure?
    • Implement frequent active monitoring of all residents for fever or respiratory symptoms.
      • While the term, “frequent,” is not defined, it probably means more often than daily.
      • We do not recommend documenting by exception to show compliance with this requirement. Consider Q-8 hour checks, and connecting these checks to med passes, and documenting these checks on the MARs..
    • Implement careful screening of anyone who enters the facility, be it a physician, other healthcare personnel, EMS personnel, or a surveyor.
      • Surveyors expect to be screened, and we have heard anecdotally that facilities who fail to screen surveyors receive an immediate IJ citation.
      • For individuals who enter in compassionate-care situations, the facility should screen the individual for fever and respiratory issues and not allow them to visit if they are symptomatic or have been exposed to someone diagnosed with COVID-19.
      • Permitted visitors should be required to wear a facemask and perform hand hygiene, and go straight to their resident’s room without stopping anywhere else. It may be prudent to escort them.

Designate a person within your organization to review and implement all federal and state guidance. CMS, CDC, state agencies, and local healthcare authorities are constantly releasing new information about COVID-19. It is vital to designate a person within your organization tasked with reviewing new guidance as it is released. If you are unable to keep up with the guidance or have questions, immediately reach out to your legal counsel or industry groups for assistance.

Document, document, document. Providers should memorialize in real time every step taken to comply with federal and state guidance.

  • For example, providers should make and keep screening logs of all those who enter the facility.

Please note that this brief memo is not intended to be, nor is it, an exhaustive list of all new federal requirements.  Please consult the actual guidance itself for additional information, or seek assistance from legal counsel or industry groups.

We are closely following the COVID-19 cases across the nation and the implications for  nursing home providers.  We anticipate the CDC may release new guidance today (March 17, 2020) on its mid-day call and we will send an updated bulletin if there is any new or updated guidance for nursing homes.

If you have any questions or need legal support in understanding and implementing the federal, state, or local guidance regarding COVID-19, please contact one of our attorneys and Click Here to view more COVID-19 Resources

Reed Bates at RBates@starneslaw.com

Rick Harris at RHarris@starneslaw.com

Alicia Harrison at AHarrison@starneslaw.com

Stephen Still at SStill@starneslaw.com

Kelly Thomas at KThomas@starneslaw.com

Will Davis at WDavis@starneslaw.com

Cat Kirkland at CKirkland@starneslaw.com

Weathers Bolt at WBolt@starneslaw.com


This information is not intended to provide legal advice, and no legal or business decision should be based on its content. No representation is made that the quality of legal services to be performed is greater than the quality of legal services performed by other lawyers. Read full disclaimer.

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