When the federal government prohibited all non-essential visits to nursing homes on Friday, in-house therapy teams and third-party companies were left wondering exactly who counted as “essential” — and whether they were part of the exempted health care workers that can continue to enter facilities.

In general, SNN found that therapy services are continuing throughout the country, though potentially in a modified format and with possible suspensions depending on region and individual providers.

“The ban is to restrict all visitors, volunteers, and non-essential health care personnel except for certain compassionate care situations, such as end-of-life situations,” according to the American Health Care Association (AHCA).


Health care workers are also exempt from the ban, with the Centers for Medicare & Medicaid Services (CMS) listing examples such as dialysis technicians and hospice workers. CMS deferred to the Centers for Disease Control & Prevention (CDC) guidelines for health care workers, though there was no explicit guidance around how to treat the therapists who work in nursing homes.

Therapy care plans must still be followed, AHCA noted, although some may be modified or suspended depending on the “current situation” at the facility. Changes in therapy care plans need to comply with CDC guidelines in an effort to reduce risk, according to AHCA.

“If specialized rehabilitative services (including those furnished by physical and occupational therapists and assistants, as well as speech-language pathologists) are required in a resident’s comprehensive care plan, the facility must provide the required services,” the nursing home trade group noted in a statement.

In fact, AHCA noted that therapists may need to go above and beyond their normal duties during this difficult time.

“As direct care staff, therapy professionals in a SNF should anticipate being asked to provide additional public health support activities within the center,” the organization noted.

At Genesis HealthCare (NYSE: GEN), one of the nation’s largest post-acute and long-term care chains, therapy is continuing as usual, according to a spokesperson.

“Therapists are considered essential health care workers and therapy is still occurring in the centers,” the spokesperson told SNN via e-mail.

But based on anecdotal information, facilities are handling therapists’ roles in the visitation exclusions on a case-by-case basis, and even responding in various ways within each state, American Speech–Language–Hearing Association (ASHA) director Monica Sampson told SNN.

“Some employers have said: No, we don’t want therapy services right now. It’s a non-priority. Stay at home. Don’t spread the disease,” Sampson said. “More providers that we hear from say: Our employers have classified us as essential services, so we’re going in, but what we’re required to do has been modified.”

Those modifications include a return to one-on-one therapy sessions — despite widespread reports of growing group and concurrent services under the new Patient-Driven Payment Model (PDPM) for nursing homes — and a focus on swallowing disorders.

“There’s a lot of one-on-one treatment that’s being encouraged in patients’ rooms,” Sampson said. “And yes, it’s a little bit different from where PDPM started.”

AHCA affirmed the shift toward individual therapy sessions in its guidance.

“To reduce transmission risks, more care may need to be delivered in individual resident rooms rather than in therapy gyms, and individualized one-on-one care would be provided to maintain social distancing between residents rather than concurrent or group therapy delivery,” the trade group noted.

Kara Gainer, director of regulatory affairs at the American Physical Therapy Association (APTA), agreed that that there isn’t complete clarity on the issue, and emphasized that her organization is working with other therapy groups for a better definition.

“APTA is aware of the confusion as well as questions and concerns regarding who constitutes essential vs. non-essential health care personnel in SNFs and other institutional settings,” Gainer said. “We acknowledge that facilities and health systems may define essential personnel pursuant to their policies and procedures.”