Nursing Homes and Assisted Living Facilities (Long-Term Care Facilities)

The U.S. Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) have created important new measures that will help keep America’s nursing home residents safe from the virus that causes COVID-19. The measures direct nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict group activities, including communal dining, inside nursing homes. While visitor restrictions may be difficult for residents and families, it is an important temporary measure for their protection.

Additionally:

1- Most people will not be able to visit loved ones at this time. Some visitation may be allowed on a case-by-case basis by the facility. If you are allowed to visit your loved one in a nursing home, make sure you are not sick. If you are sick, delay your visit until you can see your doctor and get checked out.

2- If you are not sick and visiting your relative in a nursing home, make sure to wash your hands and wear a mask during  your visit. The CDC recommends that all people entering a health facility wear a mask to stop the spread of COVID-19.. Look for posted signs in the facility with any special instructions.

3- If your loved one is sick, especially with a cough, fever, or difficulty breathing, inform the doctor or staff at the nursing home for further guidance.

4- Visitors should not visit more than one resident. Visits should be in the resident’s room, and not in common areas.

Yes. Based upon available data, older adults and those with chronic illness or weakened immune systems are at greater risk for severe illness from COVID-19.

Immediately contact your local public health department for help and further guidance. All suspected clusters or outbreaks of any illness should be immediately reported to the local health department by the most rapid means available.

  • Set up the following restrictions now:
    • Require residents and staff to wear a face mask
      • Limit points of entry to the facility. Visitors, volunteers, and non-essential healthcare staff must be restricted from the facility, except for end-of-life situations.
    • Restrict all residents to their room and require social distancing. Cancel all group activities and communal dining.
    • Residents should be allowed to leave only for medically necessary purposes (e.g., hemodialysis), and should wear a face mask (if tolerated) when they leave.
  • Designate a location to isolate residents with suspected or confirmed COVID-19.
  • Identify cases as early as possible by actively screening all residents daily for fever and respiratory symptoms (pulse oximetry).
    • Long-term care (LTC) residents with COVID-19 may show atypical symptoms including new or worsening malaise, new dizziness, diarrhea, or sore throat.  Identification of these symptoms should prompt isolation and further evaluation.
  • Institute staffing recommendations at the facility:
    • Screen healthcare staff for fever, respiratory symptoms, and possible exposures at the beginning of their shift. If they are ill, have them put on a face mask (if they do not wear one already) and leave the workplace.
    • Implement universal use of face masks for healthcare staff while in the facility, as supply allows.
    • Designate healthcare staff who will be responsible for caring for COVID-19 patients.
    • To mitigate staffing shortages, exposed healthcare staff may continue to work while wearing a face mask as long as they remain asymptomatic. Testing exposed, asymptomatic healthcare staff is advised.
  • Follow environmental cleaning and disinfection procedures consistently and correctly.

Management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures.

Routine testing of long-term care facility staff who do not have COVID-19 symptoms is required. How often this staff testing happens is based on community-level COVID-19 activity, which is classified as either low, medium, or high. Low community activity (a test positivity rate of less than 5%) means that staff will be tested at least once a month, medium community activity (a test positivity rate from 5 - 10%) means that staff will be tested at least once a week, and high community activity (a test positivity rate greater than 10%) means that staff will be tested at least twice a week. More information on the current requirement for testing staff in long-term care facilities can be found here.

Not necessarily. Depending on the severity of the illness and capabilities at the facility, your loved one may be able to stay in their current location to receive supportive care. Residents with more serious illness may require admission to a hospital for treatment.

Current CDC and CMS guidance/recommendations do not mention the use, or non-use, of either physical or chemical restraints for COVID-19 patients, or close contacts, who have dementia and may display agitation, restlessness and/or wandering.  However, per CMS, physical and/or chemical restraints are indicated as safety measures of last resort for violent or overly aggressive residents whose behavior cannot be controlled by other means.  The use of physical or chemical restraints for residents with COVID-19, or their close contacts, as a means of behavior control does not seem consistent with their intended purpose.  Moreover, physical and chemical restraints have potentially harmful adverse effects. The appropriate decision should be taken by their healthcare providers.

Yes, under certain circumstances, restricting residents to their rooms is recommended (not mandated).  According to the CDC guidance document (dated March 21, 2020) “Preparing for COVID-19: Long-term Care Facilities, Nursing Homes,” this type of restriction would apply to care of residents with an undiagnosed respiratory illness, or care of symptomatic residents who are awaiting transport to a facility that can provide a higher level of care which the patient needs.  Residents diagnosed with, or suspected to have, COVID-19 are recommended to be isolated in their room(s) with the door closed, to the extent possible.  If there are cases of COVID-19 in the facility OR if there is widespread transmission (greater than 10% positivity rate) of the virus in the community, residents who have not been diagnosed with COVID-19 are encouraged to be restricted to their rooms to the extent possible.  If residents leave their rooms, they should wear a facemask, practice social distancing and wash their hands.  Residents who leave their rooms can be redirected back to their rooms. It may be helpful to engage the resident in light exercise in the facility – this may reduce restlessness, agitation and wandering.

Because of different reporting requirements and surveillance definitions, timelines, and other factors, the CMS nursing home data will likely differ from data reported by VDH.  CMS posts COVID-19 data submitted by nursing homes via the CDC's National Healthcare Safety Network (NHSN). As with any new reporting program, some of the data from early submissions to NHSN may be inaccurate.  Retrospective reporting to NHSN before May 1, 2020 is optional, therefore, not all facilities reported their cumulative data from the beginning of the outbreak.  VDH outbreak data are reported based on the state outbreak investigations, which are independently related to CMS reporting.

CMS nursing home data will be updated weekly and can be found at: https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg

Nursing homes/skilled nursing facilities fall under the Virginia Department of Health, Office of Licensure and Certification (OLC) for oversight and complaint reporting.

The contact number for complaints is:

Toll Free: 1-800-955-1819

Metro Richmond area: (804) 367-2106

More detailed information may be found here.

When Filing a Complaint via Telephone, Please Be Prepared To:

  1. Provide your name, telephone number, and address.
    Anonymous reports must be made in writing.
  2. Identify the name and address of the medical care entity being reported
  3. Provide a detailed summary of concerns
  4. Provide additional details as requested by the Hotline staff

Messages left after normal business hours, on weekends or holidays will be returned the next business day.

To File a Written Complaint:

  1. Select from the 2 types of complaint forms:
    Nursing Facility Complaint FormOther Licensed Entity Complaint Form
  2. Complete the form in its entirety; be as thorough as possible.
  3. Attach any available copies of documents related to your concerns.
  4. Forward the written form and applicable documents as follows:

By US Mail:
Complaint Intake
Office of Licensure and Certification
Virginia Department of Health
9960 Mayland Drive, Suite 401
Henrico, VA 23233-1463

OR By FAX: 1-804-527-4503

Or By EMAIL: OLC-Complaints@vdh.virginia.gov

Assisted Living Facilities (ALFs) are regulated by the Virginia Department of Social Services. Their contact information is:

Statewide toll-free number: 1-800-543-7545. In the Richmond area, call 804-692-2394.

Home health organizations are also regulated by the VDH Office of Licensure and Certification.  The process is the same as filing a complaint against a nursing home or skilled nursing facility.  Please see the FAQ “How do I file a complaint against a skilled nursing facility / nursing home.”

Page last reviewed: September 15, 2020