CMS Updates Guidance on Healthcare Worker and Visitor Entry

Regulation | March 24, 2020 | by Jodi Eyigor

CMS has released additional guidance related to visitors and healthcare workers in licensed providers.

In a memo on March 23, CMS announced re-prioritization of survey activities for all CMS-licensed provider types and released additional guidance related to visitors and healthcare workers in licensed providers. Analysis of the survey re-prioritization guidance can be found here. Visitor and healthcare worker guidance follows below. Visitor guidance applies to non-nursing home settings to include inpatient hospice and intermediate care facilities for individuals with developmental disabilities (ICF/IDD). Healthcare worker guidance applies to all provider types including nursing homes.

Visitor Guidance (Non-Nursing Homes)

Visitors and residents/patients should be screened for and restricted according to the following:

  • Fever or symptoms of a respiratory infection such as cough or sore throat.
  • International travel within the last 14 days to CDC Level 3 risk countries. For information on restricted countries visit: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
  • Contact with someone with known or suspected COVID-19 in the past 14 days.

Visitors with fever, cough, sore throat, body aches, or running nose or visitors who are not following infection control guidance should also be restricted. Facilities should screen and limit visitors with recent trips on cruise ships (last 30 days) or international travel to certain countries (last 14 days). Other limitations may include restricting the number of visitors per patient, limiting visitors to only those that provide assistance to the patient, or limiting visitors under a certain age.

Facilities should limit entry points for all visitors and/or establish alternative sites for screening prior to entry. Facilities should provide signage at entrances for screening individuals, provide temperature checks / ask about fever, and encourage frequent hand washing and use of hand sanitizer before entering the facility and before and after entering patient rooms. Facilities should instruct visitors to limit their movement within the facility (e.g., reduce walking the halls, trips to cafeteria, etc.) and consider closing common visiting areas and encouraging patients to visit with loved ones in their patient rooms.

Healthcare workers providing care in a home setting should provide education on infection control procedures and COVID-19, as well as maintaining clean equipment and supplies to minimize surface transmission risks.

Healthcare Worker Access

Earlier guidance on visitor restriction has resulted in healthcare workers being unnecessarily restricted from entering healthcare facilities. CMS has clarified that healthcare workers who are appropriately wearing PPE and who have not been restricted access due to screening must be allowed to enter the facility to provide services to the patient. The type of screening conducted is relative to the provider type. The screening outlined above applies to provider types that are not long-term care facilities. For guidance on screening in nursing homes, refer to CMS memo QSO-20-14-NH REVISED.

What This All Means for Providers

All LeadingAge-member providers should now be enacting protective measures including considering some type of screening of visitors to their settings. Inpatient hospices and ICF/IDD should screen according to the guidance above. Affordable housing, assisted living, and life plan communities should follow this CDC guidance. Nursing homes must continue to adhere to CMS guidance as well as applicable CDC guidance.

We note that for many settings including nursing homes, CMS and CDC are no longer recommending to screen for exposure to a person who has been confirmed or suspected with COVID-19. This is important to note, as it has implications for healthcare worker entry. A facility must be screening according to the appropriate guidance and permitting entry to healthcare workers who pass the screen and are appropriately wearing PPE. For example, nursing homes must allow entry for hospice workers who are appropriately wearing PPE and who have no fever or active respiratory symptoms. LeadingAge recommends providers coordinate with one another to strategize ways to minimize transmission risks while ensuring residents have access to services.