CMS Revises Nursing Home Guidance for Visitation Following Vaccination

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On March 10, 2021, CMS revised its guidance on visitations to nursing homes in acknowledgement of the fact that millions of residents and staff in nursing facilities have received COVID-19 vaccinations in the last few months. Although outdoor visitation remains the preferred method, CMS now recommends that facilities allow indoor visitation “at all times and for all residents” regardless of vaccination status, except for a few circumstances when visitation should be limited due to high risk of COVID-19 transmission.

Throughout the pandemic, CMS has recommended limiting visitation to nursing homes due to the threat posed by COVID-19 to nursing-home residents. With the rollout of the vaccine, CMS has revised its guidelines, effective immediately, to allow indoor visitation. Outdoor visitation remains the preferred method of visitation, even where the resident and visitor are fully vaccinated against COVID-19. However, indoor visitation should be limited only in the following circumstances:

  • Indoor visitation should be limited for unvaccinated residents only if the nursing home’s COVID-19 county positivity rate is higher than 10% and less than 70% of residents in the facility are fully vaccinated.
  • Indoor visitation should be limited for residents with confirmed COVID-19 infection, whether or not they are vaccinated, until they have met the criteria to discontinue Transmission-Based Precautions.
  • Indoor visitation should be limited for residents in quarantine, whether or not they are vaccinated, until they have met criteria for release from quarantine.
  • Indoor visitation should be suspended if there is a new case of COVID-19 among residents or staff until at least one round of facility-wide testing is completed.
    • If testing reveals no additional COVID-19 cases in other areas or units of the facility are found, then indoor visitation can resume in the other areas. The facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing.
    • If testing reveals one or more additional COVID-19 cases in other areas/units of the facility, then the facility should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.

CMS emphasized that compassionate-care visits, such as end-of-life care, should be permitted at all times, even in the event of the above circumstances. CMS encourages visitors to become vaccinated when they have the opportunity, but visitors should not be required to be tested or vaccinated, or show proof of such, as a condition of visitation. Federal and state surveyors are also not required to be vaccinated and must be permitted entry into facilities unless they exhibit signs or symptoms of COVID-19 infection.

CMS continues to recommend that facilities, residents, and families adhere to public health guidelines such as maintaining at least 6 feet between people. However, CMS notes that if a resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after. Visitors should also physically distance themselves from other residents and staff in the facility.

The revised guidance, which is effective immediately, is here.

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