Earlier this week, the Center for Medicare & Medicaid Services (CMS) revised its previous guidance concerning nursing home visits, and—in much welcome news to residents and their loved ones—is instructing nursing homes to allow indoor visits effective March 10, 2021.

Because the population of nursing homes is particularly at risk for COVID-19 infection, CMS first severely restricted visits in long-term care settings on March 13, 2020, in the early stages of this pandemic.

In guidance released in September 2020, CMS updated its initial guidance to allow for additional visiting opportunities, citing the adverse health effects of prolonged social isolation on the nursing home population, including an increased risk for depression, anxiety and other expressions of distress. However, at the time, even with those concerns about the negative effects of resident isolation, CMS continued to limit any indoor visits to end-of-life or other compassionate care situations.

Noting that, since that September 2020 guidance, millions of COVID-19 vaccinations have been administered to nursing home residents and staff, CMS updated its guidance to now allow for indoor visits, but still requires that many important precautions remain in place. Given the severe risk COVID-19 presents to nursing home residents, outdoor visits continue to be preferred; however, now facilities are being instructed that they also should allow indoor visits at all times for all residents without regard to vaccination status except for in a few limited circumstances. The exceptions to permitting unlimited indoor visits are situations where:

• the visit relates to an unvaccinated resident if the nursing home’s COVID-19 positivity rate is greater than 10% and less than 70% of residents in the facility are fully vaccinated;
• the resident has a confirmed case of COVID-19 infection and they have not yet met the CDC’s criteria to discontinue transmissions based precautions; or
• the resident is in quarantine.

CMS also instructs nursing homes that indoor visits can be permitted even if the facility is experiencing a COVID-19 outbreak if there is evidence that the transmission of the virus is contained to a single area of the facility. Facilities continue to be required to conduct routine staff testing and testing of individuals with COVID-19 symptoms, and upon identifying any new cases they are required to immediately conduct outbreak testing and immediately suspend all visitation until at least one round of facility-wide testing is completed. If the outbreak testing does not reveal any other infections, then visits can resume except in the area of the facility with the confirmed case. Visitation should resume in the affected area only after the discontinuance of outbreak testing following at least 14 days of the most recent positive result. In the event the initial outbreak testing reveals any positive cases in other areas of the facility, then visits should be suspended for all residents until it has satisfied the criteria for discontinuing outbreak testing.

In an effort to continue combatting the virus in long-term care environments, facilities are reminded to continue the required testing of residents and staff and to inform residents and visitors about potential COVID-19 exposure. In addition, facilities must continue adherence to the core principles of COVID-19 infection control, including:

• screening everyone who enters the facility for signs and symptoms of COVID-19, as well as those who have been in contact with someone with the virus in the 14 days prior to the visit;
• effective hand hygiene;
• requiring use of face coverings;
• social distancing of at least 6 feet apart;
• utilizing instructional signage and other visitor education information;
• routinely cleaning and disinfecting high-frequency touch surfaces and any designated visit areas after each visit;
• use of PPE; and
• cohorting of residents.

While permitting visits is welcome news to residents and their loved ones, this change clearly is not an indication that the long-term care industry should relax its ongoing efforts to mitigate the spread of COVID-19 in their facilities. Instead, it presents yet another opportunity for facilities to inform and educate all community stakeholders of the necessity to diligently work together to protect this vulnerable population.

The full context of CMS’ revised nursing home visitation policy can be found here.

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