Many aspects of the COVID-19 pandemic have created controversy, and nursing home visitation rules have been no exception. The Centers for Medicare & Medicaid Services (CMS) regulates nursing homes which receive government funding for payment of care. Throughout the pandemic CMS provided both specific regulations and general guidance related to the handling of COVID-19 by nursing homes. Where general recommendations were in place, individual care facilities had the ability to establish their own specific procedures related to visitation during and between outbreaks.
As a result, nursing home visitation procedures varied widely between different facilities and also had the potential to change from day to day at any specific community. Challenges were present on all sides as employees and families grappled with safety considerations for when, where, and how visits could/should take place. The restriction of all visitation due to a new positive test(s) of a resident(s) or employee(s) occurred frequently.
On November 12th, CMS updated their nursing home visitation guidelines. The most significant changes are as follows: “Facilities must allow indoor visitation at all times and for all residents as permitted under the regulations. While previously acceptable during the PHE (public health emergency), facilities can no longer limit the frequency and length of visits for residents, the number of visitors, or require advance scheduling of visits.” CMS also makes it clear that visits must take place in a manner that does not endanger other residents.
While these changes are welcome news for families, they do not mean that nursing home visitation is the same as it was prior to the pandemic. There are best practices that CMS recommends family and friends follow when visiting their loved ones in nursing homes or other congregate living communities, and communities of all types continue to have certain procedures in place to prevent the spread of the virus during visitation.
Best practices for families and friends include:
- Abstaining from visiting if you have had a positive viral COVID test, are experiencing signs/symptoms of COVID, or meet the current guidelines to quarantine
- Wash your hands or use hand sanitizer prior to, during, and after your visit
- Maintenance of physical distancing from your loved one if you and/or your loved one are unvaccinated or at risk of developing severe disease. Physical distancing should be maintained from all other residents and community employees as much as possible
- The use of masks continues to be recommended, especially if the greater community where the nursing home is located is experiencing a significant number of COVID cases or either party is unvaccinated.
Some of the current CMS guidance for nursing home visitation includes:
- The requirement (established 11/4/21) that all employees receive vaccination for COVID-19.
- The requirement to provide education for residents and staff about the risks and benefits of vaccination, offer vaccine administration, and report vaccination data about both groups to the Centers for Disease Control.
- Testing for staff and residents according to the guidelines found here: https://www.cms.gov/files/document/qso-20-38-nh-revised.pdf
- Limitation of visitor access to resident rooms or designated visiting areas
- Avoidance of visitation in a resident’s room if the resident’s roommate is unvaccinated or immunocompromised (if possible)
- Avoidance of group activities in which CDC guidelines for COVID-19 infection prevention cannot be maintained.
- Education for visitors about the risks associated with visiting residents who are on transmission-based precautions or quarantine (Yes, these residents are allowed to have visitors although it isn’t recommended,) or while the nursing home is in the process of an outbreak investigation.
- Visitors cannot be required to be tested or vaccinated, or show proof of either step in order to visit. Nursing homes are allowed to ask about this status during visitor screening.
- A nursing home may choose to offer testing or personal protective equipment for visitors, but is not required to do so.
- Residents may leave a nursing home for activities of their choosing, however they may be screened and tested upon their return and potentially asked to quarantine based upon certain risk factors.
This new guidance from CMS lifts some of the previous restrictions for visitation and resident activities which were previously in place. While residents and families may welcome these changes, resident safety is a core function of nursing homes, and should be a common goal between both the nursing home and resident families.
Differences of opinion about how resident safety is best accomplished are bound to occur. While a family may be focused on only one resident, the nursing home must evaluate how an action or lack of action will impact all of the residents in their care. The safety of a large number of people living in a congregate setting is not an easy or straightforward task. It will not always be possible to please every family. Nursing home regulations can be complex and not fully understood by family members. A little give and take on both sides can foster cooperation and help develop strong working partnerships between families and a nursing home, which creates a more pleasant environment for residents, staff members, and families. In the long run, the result will be a higher quality of care for your loved one.
For the complete notice about these changes, visit: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19-revised
Karen Kaslow, RN, BSN