Trump administration advises 'extreme caution' in reopening nursing homes

Trump administration advises 'extreme caution' in reopening nursing homes
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The Trump administration is urging states to proceed with "extreme caution" in reopening nursing homes, advising them to relax restrictions at the facilities much later than those on other businesses in the surrounding communities.

The new guidance from the Centers for Medicare and Medicaid Services (CMS) outlines three separate phases that build off the White House guidelines for state reopenings, but recommends that no nursing home in any state should start to reopen or relax any restrictions until all residents and staff have received a base-line negative test.

CMS Administrator Seema Verma told reporters that residents should be tested for COVID-19 weekly, but all residents and staff should be screened daily. The guidance says no visitors should be allowed into a facility until every resident has tested negative for four weeks straight.

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The agency guidance comes more than two months after the administration ordered nursing homes across the country to ban visitors.  

"It's clear this virus will continue to be a threat to nursing homes," Verma said, citing the vulnerable nature of nursing home residents. "We are urging nursing homes and states to exercise extreme caution."

States and the Trump administration have said reopening plans need to protect the most vulnerable populations, and nursing homes have been hit hardest by the coronavirus. 

According to a Kaiser Family Foundation analysis of publicly reported data, nursing homes and other assisted-living facilities account for 41 percent of COVID-19 deaths in the country. The figures vary by state, with some as high as 80 percent of deaths, but not every state is reporting. 

A new administration rule that took effect on Sunday requires nursing homes to report to CMS their numbers of coronavirus infections and deaths, as well as staff shortages and access to personal protective equipment (PPE). The information will be made available to the public at the end of May.

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The guidance recommends that even when a community begins to relax restrictions for other businesses, nursing homes should be among the last to reopen within the community. 

The guidance recommends that a nursing home’s reopening should lag behind the general community’s reopening by 14 days, and visits should not resume until every resident and staff member has tested negative for 28 days. 

The guidance also recommends states should take into account the level of infections in the community.

The administration's guidance is just a recommendation, and ultimately the decisions on nursing homes are up to individual governors. While the suggestion is tied to the administration's Opening Up America guidance, it recommends a much higher bar for states.

While many states have begun to reopen despite not meeting the administration's reopening guidelines, with the urging of President TrumpDonald John TrumpMulvaney: 'We've overreacted a little bit' to coronavirus Former CBS News president: Most major cable news outlets 'unrelentingly liberal' in 'fear and loathing' of Trump An old man like me should be made more vulnerable to death by COVID-19 MORE, Verma said she thinks governors will proceed with caution and will do what's best for families. 

However, Verma said it will be up to the state to ensure nursing homes have enough tests and PPE for staff. She said governors told her they feel they have enough testing capacity.

New York, for example, has already mandated nursing homes test staff twice a week, and Gov. Andrew CuomoAndrew CuomoCuomo rings bell as NYSE reopens to big gains The Hill's Morning Report - Presented by Facebook - US death toll nears 100,000 as country grapples with reopening Watch Live: New York Gov. Andrew Cuomo gives coronavirus update MORE (D) said the state will be sending 320,000 testing kits to homes across the state. More than 5,500 people have died in New York long-term care facilities.