CMS Issues Alert on How to Handle Holidays

Regulation | November 18, 2020 | by Jodi Eyigor

CMS issued recommendations for how nursing homes should address the holidays, including discouraging residents from leaving.

CMS has released an alert regarding nursing homes and the holidays. Short of guidance, this alert provides recommendations for how nursing home staff, residents, and families should consider the upcoming holidays. What follows below are the main points of the alert and tips for how to implement these recommendations.

Restrictions will not be relaxed for the holidays.

Visitation restrictions remain in place according to CMS memo QSO-20-39-NH released in September 2020. Nursing homes should continue to adhere to core infection control principles, including screening of all who enter, hand hygiene, masks, social distancing, and cleaning and disinfection. Nursing homes should continue to encourage outdoor visits whenever possible and indoor visits are restricted in cases of high community positivity rates or outbreaks within the nursing home. Indoor visits should take place in private rooms or designated visiting spaces and numbers of visitors should be limited. Nursing homes may also consider testing visitors or requesting proof of recent testing.

What you can do: Let residents and families know that CMS has not relaxed restrictions for the holidays. Host virtual parties or visits. Assist residents to participate in virtual celebrations with their families or faith communities. Schedule special holiday programming, such as movies or other activities (conducted safely and according to CMS guidance on group activities).

Residents are not recommended to go out on leave.

Due to increasing spread of COVID-19 and the elevated danger this virus poses to nursing home residents, CMS recommends residents do not leave the nursing home for family gatherings and other non-medically necessary outings at this time. Simply leaving the nursing home puts the resident at risk. Further activities, such as attending large gatherings or interacting with individuals outside the resident’s household (which, in this case, is the nursing home) put the resident at greater risk.

What you can do: Educate residents and families on the risks associated with the resident leaving the nursing home. Do so with empathy and without judgment. Offer alternatives for staying connected, like virtual visits and virtual family gatherings. Talk with the residents and families about what the nursing home will be doing to celebrate the holidays.

Residents and families must take steps to mitigate transmission.

If, after education on the risks of leaving, a resident or family still chooses for the resident to leave the nursing home, CMS recommends educating the resident and family on steps they can take during the leave of absence to mitigate transmission of the virus. Some of these recommendations include wearing a mask at all times, performing hand hygiene often, avoiding gatherings, avoiding contact with individuals who are sick or who may have been exposed to COVID-19, and avoiding physical contact (please refer to the CMS Alert for the complete list of recommendations).

What you can do: Educate residents and families on the mitigation strategies. Give residents and families language that they can use to communicate with other family members about the risks and mitigation strategies. Help residents and families create a plan for handling specific scenarios, like asking a loved one to please wear a mask, explaining why we would rather not hold hands during a prayer, or gracefully leaving a gathering if it feels too risky.

Residents may be subject to additional precautions upon return to the nursing home.

While mitigation strategies such as masking and social distancing greatly reduce the risk of transmission, nursing homes may consider additional precautions upon a resident’s return to the nursing home. All residents should be screened and CMS recommends increasing monitoring for symptoms of COVID-19 (check here for the most updated list of symptoms). Residents should be tested for COVID-19 if they show symptoms or if family report possible exposure to COVID-19 while on leave. These residents should also be placed on transmission-based precautions.

Nursing homes may also consider testing residents who leave frequently or who are gone for more than 24 hours. Additionally, the nursing home may consider placing a resident on transmission-based precautions if they are out of the nursing home longer than 24 hours.

What you can do: Discuss these precautions with residents and family before they choose to leave the nursing home. Communicate clearly about the precautions that will be put in place, including testing and transmission-based precautions, upon the resident’s return. Discuss the duration of transmission-based precautions, and what this means for the resident’s daily life, like participation in dining and activities. Keep the resident and family updated on any changes.

Recommendations apply to staff too.

Everything staff do, even in their personal lives, has the potential to impact the health and safety of the residents for whom they care. CMS urges staff to use extra caution, especially during the holidays, and to follow the recommendations for residents and families in order to protect the residents for whom they care. Staff should continue to practice hand hygiene often, wear a mask at all times, social distance, and avoid attending large gatherings or interacting with individuals outside their household. Staff should consider alternatives, such as a virtual meal or celebration.

What you can do: Educate staff on the importance of mitigation measures and the impact of their personal choices on the residents for whom they care. Remember that requirements for screening and testing remain in place, and plan for any work restrictions (and staff shortages) that may result from ill or potentially exposed staff.

LeadingAge recognizes how difficult these past 8 months have been on residents and families, and we know you do too. Staying apart at the holidays poses an additional hardship. This virus does not celebrate holidays, so we must remain steadfast to protect older adults and those most vulnerable to this virus.