Restrictions on Communal Dining for Long-Term Care Providers During COVID-19

Quarles & Brady’s Long-Term Care Practice Group has been monitoring the flurry of updates impacting long-term care providers, including skilled nursing facilities and assisted living facilities. On March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) released revised Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes, available here.

One aspect of this guidance recommends that facilities “cancel communal dining and all group activities, such as internal and external group activities.” While this document is guidance, and not mandatory, all long-term care providers, including assisted living providers who are not directly impacted by this recommendation, should consider how it can implement this recommendation. External factors such as the facility size, facility location, resident mix, and staffing limitations may all factor into the level of restrictions a facility can carry out. Canceling communal dining completely might not be feasible for certain facilities. However, restricting or reducing communal dining is one way that facilities can help residents practice “social distancing.”

The following are some suggestions put forth by long-term care industry experts, including the Indiana Health Care Association (IHCA) and LeadingAge:

• Increase the number of meal services offered or move to shifts to allow residents to dine alone if possible. 
• Allow those residents who have been assessed and are able to feed themselves without assistance to dine in their rooms.
• Limit tables to a couple of residents to maintain distance between individuals but allow residents to dine with someone else, perhaps a roommate or a friend. 
• Separate tables as far apart as possible consistent with the Centers for Disease Control and Prevention's (CDC’s) recommendations for “social distancing.” The CDC recommends 6 feet whenever possible. Prioritize this distance recommendation for residents who are high risk for choking or aspiration.
• Separate residents who need assistance with feeding as much as possible.
• Staff members providing feeding assistance to more than one resident at a time should comply with hand hygiene requirements when switching between residents and use hand sanitizer.
• Facilities should not rely on volunteers to assist with food service at this time. This is consistent with the new visitor recommendations for long-term care facilities.

Handwashing and proper hygiene during meal time is absolutely necessary. Keep in mind, “social distancing” does not mean social isolation. While residents may not be able to dine with others or participate in group activities during these challenging and unprecedented times, facilities should encourage residents to utilize other forms of virtual ways to maintain social connections such as engaging in FaceTime and Skype with family members and friends.

Quarles & Brady's Health Law Team is continuously monitoring the ever-changing landscape of the COVID-19 pandemic. For more information please contact your Quarles & Brady attorney or:

• Randall R. Fearnow: (312) 715-5194 / randall.fearnow@quarles.com
• Jaya F. White: (312) 715-5242 / jaya.white@quarles.com
• Shamika L. Mazyck: (317) 399-2835 / shamika.mazyck@quarles.com