Nursing Home Reopening Recommendations and Resumption of State Survey Agency Inspections

Nursing Home Reopening Recommendations and Resumption of State Survey Agency Inspections

As discussed today on the LeadingAge National call, LTC providers need to be aware of the schedule for reopening of nursing homes and resumption of state survey activity, which may not mirror the county your nursing home is in.  In QSO 20-30 NH pages 4-10, CMS outlines Recommended Nursing Home Phased Reopening for States, which follows along with the White House plan for Opening Up America Again.  CMS specifically calls out;

Due to the elevated risk COVID-19 poses to nursing home residents, we recommend additional criteria for advancing through phases of reopening nursing homes than is recommended in the broader Administration’s Opening Up America Again framework. For example:

  • Nursing homes should not advance through any phases of reopening or relax any restrictions until all residents and staff have received a base-line test, and the appropriate actions are taken based on the results;
  • States should survey those nursing homes that experienced a significant COVID-19 outbreak prior to reopening to ensure the facility is adequately preventing transmission of COVID=19; and
  • Nursing homes should remain in the current state of highest mitigation while the community is in Phase 1 of Opening Up America Again (in other words, a nursing home’s reopening should lag behind the general community’s reopening by 14 days).

As Washington State continues to grant counties the ability to progress to Phase 2 on June 1st, please remember that nursing homes do not begin to de-escalate or relax restrictions until their surrounding community satisfies gating criteria and enters phase 2 of Opening Up America Again, and;

  • A nursing home should spend a minimum of 14 days in a given phase, with no new nursing home onset of COVID-19 cases, prior to advancing to the next phase.
  • A nursing home may be in different phases than its surrounding community based on the status of COVID-19 inside the facility, and the availability of key elements including, but not limited to PPE2 , testing, and staffing. For example, if a facility identifies a new, nursing home onset COVID-19 case in the facility while in any phase, that facility goes back to the highest level of mitigation, and starts over (even if the community is in phase 3).
  • States may choose to have a longer waiting period (e.g., 28 days) before relaxing restrictions for facilities that have had a significant outbreak of COVID-19 cases, facilities with a history of noncompliance with infection control requirements, facilities with issues maintaining adequate staffing levels, or any other situations the state believes may warrant additional oversight or duration before being permitted to relax restrictions.

Washington is still working on our State plan for re-opening long term care and none of the details have been released. Ultimately nursing homes will need to follow the state guidance. 




Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804