MS released the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission) report. The Commission was convened to solicit lessons learned from early experience during the pandemic and develop recommendations for future actions to improve infection prevention and control measures, safety procedures, and quality of life for residents of nursing homes. Alongside the report, CMS issued a response to the report, which compares the Commission’s recommendations to a list of actions the agency has taken to date; the response does not describe which, if any, of the recommendations issued by the Commission it plans to build upon. CMS also prepared and issued a compilation of guidance and updates for nursing homes during COVID-19.

The 186-page final Commission report submitted by the Commission to CMS includes 27 recommendations and accompanying action items organized into 10 themes with recommendations and associated action steps. These themes and some of the key recommendations include:

– Testing and screening: Develop and execute a national strategy with federal partners and SLTT authorities for testing and delivering rapid turnaround of results

– Equipment and PPE: Assume responsibility for a collaborative process with federal and SLTT partners regarding PPE procurement and availability; issuing specific guidance on the use, decontamination, and reuse of PPE; and issuing guidance on training on proper use of PPE and equipment, as needed

– Cohorting: Update cohorting guidance to balance resident and staff wellbeing with infection prevention and control; update cohorting guidance and reimbursement policies to reflect differences in nursing home resources

– Visitation: Emphasize visitation as a vital resident right and update and release consolidated, evidence-based guidance on safely increasing controlled, in-person visitation prior to Phase 3 re-opening; issue guidance on effectively planning for and implementing virtual visitation tools and techniques; provide resources to help facility staff assess the pychological wellbeing of residents; and streamline these and other resources into a single visitation source document

– Communication: increase specificity and expand breadth of guidance on communications between nursing home staff, residents, and families

– Workforce – stopgaps for resident safety: Mobilize resources to support a fatigued nursing home workforce, provide equity-oriented guidance that allows nursing home workforce to safely continue working in multiple nursing homes; support 24/7 registered nurse staffing resources at nursing homes in the event of a positive COVID-19 test within that facility, and leverage certified infection preventionists

– Workforce – strategic reinforcement: Catalyze interest in the certified nurse assistant profession and create a national CNA registry; update regulations to allow more fully qualified infection preventionists to be available in nursing homes; catalyze an overhaul of the workforce ecosystem in partnership with federal, SLTT, and other partners and convene a Long-Term Care Workforce Commission

– Technical assistance and quality: Increase availability of collaborative, on-site, data-driven and outcomes-oriented support prior to, during, and after a public health emergency

– Facilities: Identify and share with nursing homes short-term facility design enhancements to address pandemic-related risks; establish a national forum to share best practices and recommendations; establish long-term priorities and seek appropriate funding streams for redesign/facility strengthening

– Data: Standardize nursing home data; create an easy-to-use interactive technical infrastructure for nursing homes that streamlines reporting, dissemination of guidance, etc; enhance HIT interoperability to facilitate better communication, quality measurement standards, and data sharing