Safety First: Guidelines For Reopening America’s Nursing Facilities

We’re all longing for life before coronavirus. In the span of just a few months, our country has been ravaged by a contagion that’s infected hundreds of thousands of people, wreaked havoc on our economy and brought on an epidemic of isolation and loneliness. We are all ready for a new normal that includes togetherness, hugs and life without masks. But unfortunately, we’re not there yet.

At Century Rehab, our primary focus is, and has always been, the safety of our patients, team members and partners and we’re committed to that now more than ever. This week, the Centers for Medicare & Medicaid Services (CMS) released new guidelines for reopening nursing facilities with parameters focused on testing requirements and visitation. Knowing the pandemic is a fluid situation, the CMS guidelines give each state flexibility on how they choose to implement the criteria within each guideline.

For instance, according to the guidelines:

  • A State could require all facilities to go through each phase at the same time (i.e., waiting until all facilities have met entrance criteria for a given phase).
  • A State could allow facilities in a certain region of the state (e.g., counties) to enter each phase at the same time.
  • A State could permit individual nursing homes to move through the phases based on each nursing home’s status for meeting the criteria for entering a phase.

As we wait for State Governors to unveil their plans for reopening, Century Rehab is doing everything we can to help our partners reopen as quickly and as safely as possible. Whether you need our nurse consultants to assist your facilities with CMS guidance, or have other questions about complying with reopening guidelines, we’re here to help you and your staff prepare to provide extraordinary care.

The following are sections from the CMS guidelines that will help determine when that time may be.

According to CMS, the guidelines for “Opening Up America Again” will be implemented in three distinct phases:

Phase 1: Criteria for relaxing certain restrictions and mitigating the risk of resurgence.

Phase 2: Visitation and service considerations.

Phase 3: Restoration of Survey Activities.

Because COVID-19 has affected every community differently, CMS recommends State and local leaders monitor the factors for reopening regularly and to adjust their plans accordingly. Before relaxing any restrictions on nursing facilities, CMS guidelines ask operators to consider the following indicators:

Case status in community: State-based criteria to determine the level of community transmission and guides progression from one phase to another. For example, a decline in the number of new cases, hospitalizations, or deaths (with exceptions for temporary outliers).

Case status in the nursing home(s): Absence of any new nursing home onset1 of COVID-19 cases (resident or staff), such as a resident acquiring COVID-19 in the nursing home.

Adequate staffing: No staffing shortages and the facility is not under a contingency staffing plan.

Access to adequate testing: The facility should have a testing plan in place based on contingencies informed by the Centers for Disease Control and Prevention (CDC). At minimum, the plan should consider the following components:

  • The capacity for all nursing home residents to receive a single baseline COVID-19 test. Similarly, the capacity for all residents to be tested upon identification of an individual with symptoms consistent with COVID-19, or if a staff member tests positive for COVID-19. Capacity for continuance of weekly re-testing of all nursing home residents until all residents test negative;
  • The capacity for all nursing home staff (including volunteers and vendors who are in the facility on a weekly basis) to receive a single baseline COVID-19 test, with re-testing of all staff continuing every week (note: State and local leaders may adjust the requirement for weekly testing of staff based on data about the circulation of the virus in their community);
  • Written screening protocols for all staff (each shift), each resident (daily), and all persons entering the facility, such as vendors, volunteers, and visitors;
  • An arrangement with laboratories to process tests. The test used should be able to detect SARS-CoV-2 virus (e.g., polymerase chain reaction (PCR)) with greater than 95% sensitivity, greater than 90% specificity, with results obtained rapidly (e.g., within 48 hours). Antibody test results should not be used to diagnose someone with an active SARS-CoV-2 infection.
  • A procedure for addressing residents or staff that decline or are unable to be tested (e.g., symptomatic resident refusing testing in a facility with positive COVID-19 cases should be treated as positive).

Universal source control: Residents and visitors wear a cloth face covering or facemask. If a visitor is unable or unwilling to maintain these precautions (such as young children), consider restricting their ability to enter the facility. All visitors should maintain social distancing and perform hand washing or sanitizing upon entry to the facility.

Access to adequate Personal Protective Equipment (PPE) for staff: Contingency capacity strategy is allowable, such as CDC’s guidance at Strategies to Optimize the Supply of PPE and Equipment (facilities’ crisis capacity PPE strategy would not constitute adequate access to PPE). All staff wear all appropriate PPE when indicated. Staff wear cloth face covering if facemask is not indicated, such as administrative staff.

Local hospital capacity: Ability for the local hospital to accept transfers from nursing homes.

For more than 20 years, Century Rehab has helped our partners endure and prosper through the best of times, and in times like now, the worst. But that’s when our nurses, therapists and team members shine the brightest. Century Rehab is here to help you and to keep you safe – medically and financially. America will reopen. And when it does, we’ll be ready.


CENTURY REHABILITATION provides therapy, staffing and consulting services for skilled nursing and outpatient facilities so they can focus on the quality care their patients deserve. Founded by healthcare veteran Richard K. Pellerin, Century Rehab was built on the principle of always “doing the right thing” for our facilities, patients and employees. Every day, our teams continually strive to build lasting partnerships based on the highest level of quality and ethics. We are here to help improve our clients’ financial, operational and clinical performance so they can be extraordinary leaders in compassionate care.


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