Friday, April 03, 2020 New CMS Nursing Home Recommendations Stress Collaboration, Consistent Staffing Assignment The new recommendations underscore existing CDC and CMS guidance and call for extensive use of masks and other PPE. The U.S. Centers for Medicare & Medicaid Services issued new recommendations for nursing homes around the COVID-19 pandemic that urge states to attend to the personal protection equipment needs of long-term care facilities, and press nursing homes to establish separate staff teams for COVID-19-positive residents. The recommendations also include universal testing in the facilities and use of PPE "to the extent PPE is available." According to CMS, the recommendations were created after CDC and CMS experts working in nursing homes "emphasized that even more must be done" to underscore guidance already provided by CMS around response to the pandemic. The recommendations address five major areas: Compliance with existing CDC and CMS guidance. The recommendations stress the importance of following instructions from the CDC and CMS in areas such as hand hygiene, infection control, and conservation of PPE. Collaboration between states and nursing homes to meet PPE needs. CMS emphasizes the importance of state and local health departments to stay in close communication with long-term care facilities to "address … needs for PPE and/or COVID-19 tests." Symptom screening for all. The agency reiterates its position that every person entering a nursing home be asked about COVID-19 symptoms and have their temperature checked. Symptom assessment and temperature checks should also be performed on every resident. Appropriate PPE use. The recommendations urge the use of facemasks by all nursing home personnel on site, as well as donning of full PPE when caring for any resident known or suspected to have COVID-19. CMS also calls for all residents "to cover their noses and mouths when staff are in their rooms," and suggests that they could use tissues or non-medical masks to do this. Separate staff teams for residents with COVID-19, and consistent assignment. CMS recommends that facilities try to assign the same staff to the same residents to increase the chances of "detect[ing] emerging condition changes that unfamiliar staff may not notice" and to decrease the number of different staff interacting with residents. Residents diagnosed with COVID-19 should be separated from other patients, and have separate staff teams "when possible." CMS also recommends that state agencies, hospitals, and nursing home associations help to "ensure coordination among facilities to determine which facilities will have a designation [as a facility for COVID-19 patients] and provide adequate staff supplies and PPE."