Feds urge ‘extreme caution’ for reopening nursing homes

“We’re urging governors to proceed with extreme caution because these are the most vulnerable citizens," says Seema Verma, head of the Centers for Medicare and Medicaid Services.
(Associated Press)

Federal authorities are urging governors to use “extreme caution” in deciding when to allow visits to resume at nursing homes, saying such a move shouldn’t come before all residents and staff have tested negative for the novel coronavirus for at least 28 days.

The Centers for Medicare and Medicaid Services’ criteria for relaxing restrictions at nursing homes come more than two months after the agency ordered homes to ban visitors. Instead of firm dates, the agency lists a variety of factors that state and local officials should consider, such as adequate staffing levels at homes and the ability to regularly test all residents and workers.

“We’re urging governors to proceed with extreme caution because these are the most vulnerable citizens. We know that nursing homes have struggled,” Seema Verma, head of CMS, told the Associated Press.

Outbreaks in nursing homes and long-term care facilities have claimed more than 33,000 lives in the U.S., more than a third of all coronavirus deaths in the country, according to a count by the AP.


The recommendations bolster the Trump administration’s broader guidelines that say senior care facilities should be among the last in a community to reopen, given the vulnerability of their elderly residents. And they noted that some homes may have to wait even longer than 28 days from the last negative test if they have had problems with infection controls, staffing or other issues.

COVID-19 doesn’t play fair. It goes after the institutionalized, the poor and the elderly.

Once visits resume, family members and others should wear face coverings and practice social distancing, CMS said.

Although the ban on visitors is intended to keep residents safe, Toby Edelman, senior policy attorney of the Center for Medicare Advocacy, said prolonged isolation could have negative consequences, since family members often act as an extra set of eyes to ensure their loved ones are being properly cared for.

“It’s been necessary, but it takes its toll on residents and family members, psychologically, mentally, physically — in every conceivable way,” Edelman said.

Dr. Sharon Inouye, a professor of geriatrics at Harvard Medical School in Boston, said it has been distressing to watch her mother, who is at an assisted living facility in the San Francisco area, cope with the isolation.

New data analyzed by the Los Angeles Times show that nearly half of all COVID-19 deaths in the state are associated with elder care facilities.

“She got pretty depressed initially. She kept calling me, and sometimes she’d be crying, ‘I’m so lonely,’” said Inouye, who had to cancel plans to fly out and see her mother.

Inouye’s sister, who lives closer to the home, was able to see their mother from a distance twice. The in-person encounters between family members and residents by the home’s entrance are difficult for staff to coordinate frequently, Inouye said.

For weeks, nursing homes have been calling on local and federal officials for help accessing tests and personal protective equipment.

Mark Parkinson, president and chief executive of the American Health Care Assn., which represents nursing homes and assisted living facilities, said testing of residents and staff should be possible within a few weeks, with the federal government making access for the homes more of a priority.