Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities — Detroit, Michigan, March–May 2020

Early Release / July 1, 2020 / 69

Guillermo V. Sanchez, MSHS, MPH1; Caitlin Biedron, MD1; Lauren R. Fink, MPH2; Kelly M. Hatfield, MSPH1; Jordan Micah F. Polistico, MD3,4; Monica P. Meyer, MS, MPH3,4; Rebecca S. Noe, MN, MPH1; Casey E. Copen, PhD1; Amanda K. Lyons, MS1; Gonzalo Gonzalez, DNP2; Keith Kiama2; Mark Lebednick2; Bonnie K. Czander2; Amen Agbonze2; Aimee R. Surma, MS2; Avnish Sandhu, DO3,4; Valerie H. Mika, MS4; Tyler Prentiss, MA5; John Zervos, JD5; Donia A. Dalal2; Amber M. Vasquez, MD1; Sujan C. Reddy, MD1; John Jernigan, MD1; Paul E. Kilgore, MD4; Marcus J. Zervos, MD4,5; Teena Chopra, MD3,4; Carla P. Bezold, ScD2; Najibah K. Rehman, MD2 (View author affiliations)

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Summary

What is already known about this topic?

Symptom-based screening in skilled nursing facilities (SNFs) is inadequate to detect SARS-CoV-2 transmission. Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) can identify asymptomatic cases during outbreaks.

What is added by this report?

Repeated point prevalence surveys at 26 Detroit SNFs identified an attack rate of 44%; within 21 days of diagnosis, 37% of infected patients were hospitalized and 24% died. Among 12 facilities participating in a second survey and receiving on-site infection prevention and control (IPC) support, the percentage of newly identified cases decreased from 35% to 18%.

What are the implications for public health practice?

Repeated point prevalence surveys in SNFs can identify asymptomatic COVID-19 cases, inform cohorting and IPC practices, and guide prioritization of health department resources.

Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency

Memo #QSO 20-34-NH

Posting Date 2020-06-25

Fiscal Year 2020

Summary

The Centers for Medicare & Medicaid Services (CMS) is committed to transparency about changes in publicly reported information on nursing homes during the COVID-19 public health emergency. Changes to the Nursing Home Compare Website and Five Star Quality Rating System:

• Staffing Measures and Ratings Domain: On July 29, 2020, Staffing measures and star ratings will be held constant, and based on data submitted for Calendar Quarter 4 2019.

o Also, CMS is ending the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System. Nursing homes must submit data for Calendar Quarter 2 by August 14, 2020.

• Quality Measures: On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant.

CMS has issued seven Frequently Asked Questions to supplement existing guidance about the rules for nursing home visitations during the COVID-19 pandemic, starting with No. 1:

1. What steps should nursing homes take before reopening to visitors? 

Nursing homes should continue to follow CMS and CDC guidance for preventing the transmission of COVID-19, and follow state and local direction. Because nursing home residents are especially vulnerable, CMS does not recommend reopening facilities to visitors (except for compassionate care situations) until phase three when: 

• There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days (through phases one and two) 

• The nursing home is not experiencing staff shortages 

• The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents 

• The nursing home has adequate access to testing for COVID-19 

• Referral hospital(s) have bed capacity on wards and intensive care units

Preparing for COVID-19 in Nursing Homes

Updated June 25, 2020

Summary of Changes to the Guidance:

• Tiered recommendations to address nursing homes in different phases of COVID-19 response
• Added a recommendation to assign an individual to manage the facility’s infection control program
• Added guidance about new requirements for nursing homes to report to the National Healthcare Safety Network (NHSN)
• Added a recommendation to create a plan for testing residents and healthcare personnel for SARS-CoV-2

Related Pages

• Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes
• Considerations for Memory Care Units in Long-term Care Facilities
• Preparing for Covid-19 in Nursing Homes
• Responding to Coronavirus (COVID-19) in Nursing Homes
• Testing for Coronavirus (COVID-19) in Nursing Homes
• Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19

CMS approved additional state Medicaid waiver requests under Section 1135 of the Social Security Act (Act). The waivers were approved within days of states’ submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states. The waivers were approved within days of states' submitting them, and offer states new flexibilities to focus their resources on combating the outbreak and providing the best possible care to Medicaid beneficiaries in their states.

The Centers for Medicare & Medicaid Services (CMS) is aware of allegations that some nursing homes are seizing residents economic impact payments (or “Stimulus Checks”) authorized under the CARES Act.  This practice is prohibited, and nursing homes that seize these payments from residents could be subject to federal enforcement actions, including potential termination from participation in the Medicare and Medicaid programs.

While CMS has not received any specific complaints regarding this practice, we believe it is important for residents and families to know their rights, and for nursing homes to understand the liability associated with this practice.

Seizing residents’ stimulus checks could be a violation of federal regulations at 42 CFR §483.12, Freedom from Abuse, Neglect and Exploitation.  Specifically, this could be considered misappropriation of resident property, which is defined as “the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent.”   Further, nursing homes requiring residents to deposit their stimulus check with the nursing home could be in violation of 42 CFR §483.10 which gives residents have “the right to manage his or her financial affairs.”  Further, “The facility must not require residents to deposit their personal funds with the facility. If a resident chooses to deposit personal funds with the facility, upon written authorization of a resident, the facility must act as a fiduciary of the resident's funds and hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility, as specified in this section.”

Residents or their family who were compelled to sign their stimulus check over to their nursing home, are encouraged to file a complaint with their state survey agency for investigation of the nursing home. 

CMS and State investigators will make referrals to the States Attorneys General, as appropriate, if they find a nursing home in violation of these requirements.

Residents and families are also encouraged to contact their State Attorney General, directly, for redress of their individual loss. 

On June 4, 2020, the Centers for Medicare & Medicaid Services (CMS) posted the first set of underlying coronavirus disease 2019 (COVID-19) nursing home data. This data shows that as of May 31, 2020, about 13,600 nursing homes – approximately 88 percent of the 15,400 Medicare and Medicaid nursing homes – had reported the required data to the (CDC). These facilities reported over 95,000 confirmed COVID-19 cases and almost 32,000 deaths. The next set of data will be updated in two weeks.  Going forward after that date, CMS plans to update the data weekly.

On June 4, 2020, the Centers for Medicare & Medicaid Services (CMS)announced the release of the results from the targeted inspections announced on March 4, 2020, to allow inspectors to focus on the most serious health and safety threats like infectious diseases and abuse during the pandemic. Since March 4, CMS and its network of state-based inspectors have conducted over 8,300 surveys with the results of a total of 5,700 available as of June 4. CMS plans to post the results of the inspections monthly on an ongoing basis as they are completed.

While the results of health inspections conducted on or after March 4, 2020 will be posted publicly, they will not be used to calculate a nursing home’s health inspection star ratings. Per CMS's April 24, 2020 memorandum, the inspection domain of the Nursing Home Compare website will be held constant temporarily due to the recent prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers.

Targeted Inspection Results

 

Memo # QSO 20-33-NH

Posting Date 2020-06-04

Fiscal Year 2020

Summary

• Nursing Home Inspections: CMS will post health inspection (i.e., surveys) results that were conducted on or after March 4th, 2020, which is the first date that CMS altered the way that inspections are scheduled and conducted. This includes inspections related to complaints and facility-reported incidents (FRIs) that were triaged at the Immediate Jeopardy (IJ) level, and the streamlined Infection Control inspection process that was developed based on the guidance for preventing the spread of COVID-19.