The Impact of COVID-19 on Assisted Living Facilities

Assisted living providers are uniquely impacted by the spread of COVID-19 because they offer a hybrid homelike and health care setting for one of the country’s most vulnerable populations. As the situation is constantly evolving, Arent Fox’s Health Care group analyzes what assisted living providers need to know about regulatory changes and guidance at the federal, state, and local levels.

Assisted living providers face a unique challenge when confronting the spread of COVID-19: continuing to maximize the independence of their residents while ensuring necessary protections are in place. Although operational requirements for assisted living facilities vary widely by state, they are based on the common principle that the assisted living setting must be a homelike environment that promotes the independence and wellbeing of each resident. To that end, state statutes and regulations specify resident rights, which almost always include a resident’s right to have visitors, subject to the safety of other residents.

States Are Restricting Visitors

Multiple authorities, including the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS), recommend restricting visitation for nursing homes to slow the spread of COVID-19. State licensing agencies are beginning to follow suit with respect to assisted living facilities. For example, on March 19, 2020, the Texas Health and Human Services Commission issued Guidance on COVID-19 Response in Assisted Living Facilities instructing assisted living providers to prohibit nonessential visitors, to screen essential visitors when possible, and to follow its or the CDC’s infection control guidance, whichever is more stringent. Similarly, on March 14, 2020, the Governor of Florida directed the Florida Division of Emergency Management to prohibit visitors to assisted living facilities and certain other long-term care settings for 30 days.

If a particular state has not issued a directive, assisted living providers may consider asking residents to limit their visitors to the extent necessary. Essential visitors typically would include healthcare professionals, emergency law enforcement or medical personnel, and state surveyors. Assisted living providers should also maintain open communication with residents’ family members and responsible parties so they are aware of the resident’s care and how they can contribute to the community’s efforts to protect its residents from exposure to the virus.

Staffing and Supplies Also Raise Concerns

While the visitation issue is at the forefront, assisted living providers are likely to face other operational challenges as the spread of the virus continues, such as maintaining adequate staffing levels; obtaining necessary food and supplies; managing resident transfers between hospitals, nursing homes, or other settings; and adjusting dining and activity schedules. Several state and local authorities are publishing guidance for assisted living providers in their jurisdiction and offering other informational opportunities for key stakeholders.

Providers Should Regularly Check Government Websites For Any New Guidance or Obligations

Assisted living providers should routinely check the websites for their state licensing agencies and local health departments to identify their new obligations and best practices while the nation struggles to confront the pandemic. As the circumstances continue to change, some providers may even need to seek waivers for certain regulatory requirements to maintain operations and protect their residents. Assisted living providers also should review the guidance issued for nursing homes by the CDC and CMS and apply such guidance to their operations where possible. For example, the CDC recently published a Coronavirus Disease 2019 (COVID-19) Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings, a tool to assist nursing homes and other long-term care facilities to assess and improve their response to the virus. The CDC explains that providers should adapt the checklist to their particular needs and circumstances, such as population characteristics and facility size. Additionally, CMS recently issued Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes, as more fully discussed in our alert from last week.


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