Nursing homes "should be among the last to reopen" in a community, according to new guidance from CMS on Monday.
The agency recommends that nursing homes reopen after they have baseline test results for each of their staff members and residents. Likewise, state survey agencies should inspect nursing homes with a previous COVID-19 outbreak before they reopen.
Nursing homes would be able to accept visitors once there's a sustained decline in COVID-19 cases, but states should decide whether nursing homes can reopen on a case-by-case basis. They shouldn't rely on case counts alone, CMS said in a statement.
"State and local leaders are urged to regularly monitor the factors for reopening and can adjust their plans accordingly, depending on local data about the circulation of the virus in their community," the agency said.
The Trump administration recommends that state officials coordinate with inspectors and local health departments to decide how to implement CMS' reopening guidance. They should consider a wide range of factors, including COVID-19 case counts, staffing levels, access to personal protective equipment and hospital capacity.
CMS' recommendations are part of the Trump administration's broader framework for reopening the country. Under the so-called "Opening Up America Again" plan, state and local officials are primarily responsible for deciding when and how to lift stay-at-home orders.
The administration and its supporters have defended the plan, arguing that governors and local officials are better equipped to decide when to reopen because they're closer to the situation on the ground. But critics say the Trump administration is trying to abdicate its responsibilities, pushing the burden onto state and local governments that are under tremendous financial pressure and short on resources. According to the administration's critics, the federal government should coordinate reopening among the states because the pandemic cuts across borders.
Acknowledging that the virus can quickly spread across borders, states have entered cooperative, regional agreements to coordinate their reopening plans. But it's unclear how effective the arrangements will be since governors will be under intense pressure to get their economies humming again with tax revenues tanking, unemployment shooting through the roof and increasing demand for social services.