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Nursing Homes and COVID-19

Health & Benefits

Roughly 93,000 Texans live in licensed nursing homes throughout the state. On March 13, 2020, Governor Abbott declared a state of disaster for all Texas counties due to the COVID-19 pandemic and directed state agencies to restrict visitation at nursing homes to protect those most vulnerable to COVID-19. In addition, the Centers for Medicare and Medicaid Services (CMS) directed all nursing homes to restrict visitation and allow access only to staff or other individuals providing critical services. However, Texas long-term care facilities — even those with active COVID-19 cases — can allow visitors beginning Sept. 24, 2020Texas Health and Human Services Commission (HHSC) has prepared the following FAQ that includes pertinent COVID-19 information affecting nursing facilities.

On May 20, 2020, Governor Abbott directed the Texas Health and Human Services Commission (HHSC), the Texas Division of Emergency Management (TDEM), and the Texas Department of State Health Services (DSHS) to test 100% of residents and staff in Texas nursing homes. The Texas Division of Emergency Management has contracted with Omnicare to administer COVID-19 tests in nursing facilities and assisted living facilities. Omnicare is providing point-of-care testing of staff and residents at no charge to the facility. Results are typically provided to the facility within 24 to 48 hours. Omnicare will contact certain facilities to schedule COVID-19 testing and will provide more detail about the process at that time. Facilities can request testing by contacting their HHSC regional director if they have not been contacted by Omnicare.

What are nursing facilities supposed to do when they believe someone has been exposed or infected?

Long-term care facilities in Texas are required to maintain strong infection prevention and control programs to prevent the spread of communicable diseases. If a facility believes a resident, visitor, or employee might have been exposed or infected with COVID-19, it is required to immediately report it to their local health department or to HHSC. Nursing homes need to call ahead to the hospital if they are transferring a resident with respiratory symptoms. They should work closely with local hospitals and health authorities to share all information needed to protect residents, health care workers, and hospital patients.

Can nursing home residents go outdoors on facility property so long as there are 10 people or fewer?

The Centers for Medicare & Medicaid Services (CMS) recommends the cancelation of all group activities. However, residents can go outside within a protected area – defined as an area restricted only to nursing home residents and staff – if fewer than 10 people are in that area and they are all practicing social distancing (at least six feet between each person).  

Can residents receive visitors and visit on nursing home property but only outside?

HHSC’s current visitation guidelines for nursing homes require visitors to wear a mask at all times and limits visitation to no more than two “essential caregivers” per resident.  Read more here.

Can nursing home prohibit staff (drivers, for example) from wearing masks while they work? What about staff who are personally immunocompromised?

Nursing homes should not discourage staff from wearing personal protective equipment. CMS has stated that that for the duration of the state of emergency all nursing home personnel should wear a facemask while they are in the facility. 

What protocols are facilities required to following during this pandemic?

Texas HHS is also requiring facilities to post signs at the entrance about access restrictions; check for fever of visitors, staff, and residents; suspend group gatherings; continue to monitor and isolate residents with fever or acute respiratory symptoms; provide infection control training to staff; execute frequent handwashing; and provide personal protective equipment to residents or staff as needed.

If a nursing home resident tests positive for COVID-19, how are staff quarantined?

Providers will have to determine what kind exposure (risk) their staff had with a resident who tests positive. If it is determined exposure occurred, the facility should follow these CDC guidelines:

  • Staff in the high- or medium-risk category should undergo active monitoring, including restriction from work in any health-care setting until 14 days after their last exposure.                                                                                                                                                                                                                                                                          
  • Staff in the low-risk category should perform self-monitoring with delegated supervision until 14 days after the last potential exposure.                                                         
  • Staff who adhere to all recommended infection prevention and control practices should still perform self-monitoring, with delegated supervision as described under the low-risk exposure category.                                                                                                                                                                                                                                            
  • Staff in the no identifiable risk category do not require monitoring or restriction from work.                                                                                                                                      
  • Staff who have a community or travel-associated exposure should undergo monitoring as defined by the applicable risk category.

Can nursing homes still have volunteers?

No. Per Governor Abbott’s March 19 executive order, access to nursing homes can be granted only to people providing critical services, including staff, and they all must be fully screened for any fever or respiratory symptoms. 

Are there exceptions to the rules when it’s emotionally hard for family members to not visit?

No. Per the Governor's executive order, CMS, and HHSC, only individuals providing critical services, including staff, should be allowed in the facility. Nursing homes should offer alternate means of communication such as phone calls, video calls (FaceTime, Zoom, Skype,etc.), or other means of electronic communication. If possible, the resident can also be taken to a window so their family members can see them.

Should nursing home residents be confined to their rooms?

If a resident is under transmission-based precautions, the individual should be confined to his or her room. CMS has also directed the following:

• Cancel communal dining and all group activities, such as internal and external group activities;

• Implement active, daily screening of residents and staff for fever and respiratory symptoms;

• Remind residents to practice social distancing and perform frequent hand hygiene.

Is it okay for family members to do laundry for residents and leave it at the front door? If so, how do they get the laundry?

It is not recommended. Nursing homes are required to have policies and procedures in place for staff to handle, store, process, and transport all linens and laundry in accordance with national standards to produce hygienically clean laundry and prevent the spread of infection to the extent possible. 

Additional Information

Long-Term care (LTC) ombudsmen are advocates for resident rights. They help protect the quality of life and quality of care of anybody who lives in a nursing home or an assisted living facility. Ombudsmen can be volunteers or paid employees of agencies that are independent of any long-Term care facility. Services are free, confidential and available statewide. More information can be found here. Call 1-800-252-2412 to speak with an LTC Ombudsman in your area.

The National Center on Law & Elder Rights (NCLER)  has created this FAQ for guardians.

Disability Rights Texas has published this Nursing Homes and COVID-19 resource to help you navigate all the changes that impact nursing facility residents and their care and treatment during the outbreak.

Reliable sources of information include:

• The Centers for Disease Control and Prevention

• The Centers for Medicare and Medicaid Services

• The Texas Department of State Health Services

• The Health and Human Services Commission

• CMS COVID-19 Long-Term Care Facility Guidanc