The majority of nursing homes will not be able to take advantage of the Centers for Disease Control and Prevention’s (CDC) updated mask policy as many are still in high transmission zones for Covid-19.
The CDC last month issued updated guidance that removed its blanket masking policy to better reflect vaccine efforts, infection-induced immunity and the availability of treatments and prevention tools. Approximately 56% of counties are considered to be high transmission areas, according to the most recent data.
In a nursing home stakeholder call on Thursday, CDC Medical Officer Kara Jacobs-Slifka said the decision to update masking recommendations based on community transmission rather than community levels will help with earlier intervention, leading to less overload across different parts of the care continuum.
Jacobs-Slifka also reiterated that vaccination status will no longer play a role in “source control,” screening, testing or post-exposure recommendations, including those for quarantine and work restrictions.
Staff can also choose to not wear masks if they are in an area of a building restricted from patient access, despite being in a county with high community transmission, however community levels must not be high in those instances.
Levels refer to the impact of Covid on the community, measures like hospitalizations and health care system strain.
Regarding universal personal protective equipment (PPE), the CDC changed its guidance to leave this up to the operator’s consideration.
“Your facility could choose to use or recommend universal PPE when community transmission is high, but we’ve essentially left this to the facilities to make a determination,” added Jacobs-Slifka.
Even if facilities were in a position to discontinue masking in a facility, some operators don’t want to face the back and forth of implementation in case their community transmission rate changes. Infection control expert and epidemiologist Dr. Buffy Lloyd-Krejci advises against it too; it’s better to continue masking through flu season to protect the nation’s most vulnerable communities, she said.
“There may be pockets of counties that are lower than high [transmission], but for the majority, our map is red,” Lloyd-Krejci, founder and president of IPCWell, told Skilled Nursing News. “Move slow. Plan it out.”
Other operators like Cascadia Healthcare plan to adopt CDC recommendations in Arizona, New Mexico, Montana and Idaho – all of these states lifted their blanket masking mandate in accordance with the CDC.
Zendi Meharry, director of clinical operations for the Idaho-based operator, said she’s looking forward to Monday when select facilities, depending on transmission and community level, will be able to remove masks and face shields.
“I believe that if we didn’t do it, we would be impacting our patients in a negative manner,” Meharry said. “There’s a whole lot of research that goes the opposite way, that you shouldn’t keep people in isolation that don’t belong in isolation.”
Deke Cateau, CEO of nonprofit Georgia operator A.G. Rhodes, said he believes mask wearing will be in the skilled nursing environment for a long time.
“The decrease in incidences of flu that we’ve had in the last two years has shown us that masking does help,” said Cateau. “I am very, very cautious … we have to be practical and smart, and where we use these masks – i.e. in patient care areas – is very important.”
It’s harder to go back, Valley Hi Nursing and Rehabilitation Administrator Thomas Annarella said, if someone tells their staff they don’t have to worry about masking one day and then have to reimplement it the next.
“It’s kind of a moot point because the rates are so high. We figure we’re going to be in masks through the flu season,” he said. “The one thing that we keep coming back to is, we’ll likely be in a surgical mask going forward. It just makes sense from an infection control standpoint.”
Masks and the staffing crisis
The decision to keep surgical masks could be seen as a relatively easy ask compared to what nursing home staff have had to contend with the past couple of years – namely restrictive N-95 masks and testing twice a week.
But as operators fight to recruit and retain staff in the midst of a labor shortage, Annarella said, there needs to be parity between nursing homes and other health care settings, not to mention other industries, in terms of infection prevention.
“If you’re a housekeeper, it’s a minimum wage job; there’s [different] avenues to go into. You can go into hotels, you can go into schools, homes, office buildings, and then there’s long-term care,” said Annarella.
Other industries weren’t burdened with years of strict PPE, eye protection, masks and N-95 respirators, added Lloyd-Krejci. Operators need to be careful with a populace that is already worn thin.
Lloyd-Krejci used summer 2021 as an example of angry public response to such changes – the CDC changed masking recommendations based on vaccination only to backtrack once flu season hit.
Vaccine fatigue has set in with nursing home staff too, Annarella said. Every time a new booster comes out, every time the definition of “current” or “fully vaccinated” changes, it wears on people.
“When do all of these requirements stop? In Illinois, if you have not had the bivalent [booster], you are not considered current. The minute it was approved, that definition changed in Illinois,” said Annarella. “We went from most of the staff being current to zero staff being current overnight.”
Nursing homes are being asked to do things that no one else in our society is doing, added Cateau. He understands it’s very difficult for a staff member, family or other visitor to come from a grocery store or elsewhere, where there is no masking requirement, into a nursing home.
“I’m also concerned when I see such a lack of masks and requirements in hospitals and other health care settings, yet they are so strong in nursing homes,” he added. “Most people tell me it’s because nursing homes take care of the most vulnerable … They come to us from the hospital. I think we have some contradictions in that.”