Detroit nursing homes were hit hard by COVID-19 infections, leaving friends and family unable to visit loved ones. The Centers for Medicaid and Medicare, the federal agency overseeing long-term care facilities, issued infection control recommendations then. Now they are issuing guidelines for states to safely reopen to the public. The three-phase plan addresses how management should determine when to relax restrictions, how to prevent cases from reoccurring, and how visits and vendor services should resume on these properties. The Michigan Long Term Care Task Force, consisting of state and local leaders, health department officials – working in consultation with nursing homes - is developing plans for Michigan to implement.
Phase 1:
Visitation prohibited except for compassionate care situations where visitors are screened, wear face masks, practice social distancing, and clean their hands using an alcohol-based product upon entering. Communal dining is limited to COVID-19 negative or asymptomatic residents only, with social distance. Restriction of group activities to negative or asymptomatic residents. Non-medically necessary trips outside the building avoided. For medically necessary trips, residents must wear face coverings, and the facility must disclose COVID-19 status to the transportation service and those at the destination. Weekly testing and daily screenings for all residents; staff tested weekly and screened at the beginning of each shift.
Phase 2:
What’s lifted: Many of the Phase 1 mandates still enforced, lifted to allow for: Limited number of non-essential health care professionals in the building, with appropriate screening, masks, hand hygiene and social distancing. Screening of all entering the facility and for staff at the beginning of each shift. Group activities, including outings, limited to asymptomatic or negative residents. Daily screenings of all residents; staff tested weekly. Restrictions slowly adjusted to allow COVID negative residents more freedom in the nursing home. Criteria for Implementation: No new cases for 14 days and no staff shortages. Adequate supplies of personal protective equipment, and essential disinfecting supplies. Adequate access to testing. Referral hospital(s) have bed capacity on wards and intensive care units.
Phase 3:
What’s lifted: Visitors and volunteers undergo screenings, answer questionnaire regarding symptoms and potential exposure, and observed for signs or symptoms. Face masks, social distancing and hand hygiene required for all persons entering facility. Face masks and social distancing required for the duration of the visit. Weekly testing continues until all residents test negative. Criteria for Implementation: No new COVID cases for 28 days. No staff shortages. Adequate supplies and access to testing. Referral hospital(s) have bed capacity on wards and intensive care units. If a new case is identified in either Phase 2 or Phase 3, the facility must return to Phase 1 precautions. To learn more once Michigan’s reopening protocols have been finalized, contact the Long-Term Care Ombudsman program email mltcop@meji.org, call 1.866.485.9393, or visit www. cms.gov/files/document/covid-nursing-home-reopening-recommendation-faqs.pdf.