Written by Robert K. Schweitzer, CELA
Julian Gray Associates
On March 10, 2021, the Centers for Medicare and Medicaid Services (“CMS”) in consultation with the Centers for Disease and Prevention (“CDC”) issued new guidelines for nursing homes to increase visitation while the COVID-19 pandemic continues.
When the COVID-19 pandemic commenced a little over a year ago CMS prohibited all visitors and non-essential health care personnel (with some exceptions for compassion care visits for end of life situations) from entering nursing homes. This caused many nursing home residents, and their families,from having any direct contact with one another. Many of our clients have had to visit their loved ones through windows, often in inclement weather throughout the winter months, or through phone or video (e.g., Facetime, Zoom etc.) The lack of human interaction has caused the nursing home residents and their families to suffer. CMS has acknowledged the psychological, emotional and physical toll that prolonged isolation and separation from family has taken on nursing home residents, and their families.
Now, with over twenty-five (25%) percent of the United States population fully vaccinated for COVID-19 and with more than three million doses of vaccines having been administered within nursing homes, CMS has stated that nursing homes should now allow responsible indoor visitations at all times and for all residents regardless of vaccination status of the nursing home resident or visitor subject to certain scenarios that would limit such visitations. Those limitations are as follows:
- Unvaccinated residents: If the COVID-19 positivity rate of the county in which the nursing home is located is greater than 10 percent and Less than 70 percent of residents in the facility are fully vaccinated; or
- Residents with confirmed COVID-19 infection: Whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions cannot have visitors; or
- Residents in quarantine, whether vaccinated or unvaccinated: Until they have met criteria for release from quarantine cannot have visitors.
CMS has emphasized in its new guidelines that regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate or an outbreak in a facility, “compassionate care” visits should be allowed. Compassionate care visits include visits for a nursing home resident whose health has sharply declined, is experiencing a significant change in circumstances or is at end of life. CMS has further provided that facilities should not restrict visitation for all nursing home residents even during an outbreak provided that there is evidence that the transmission of COVID-10 is contained to a single area of the facility. In that event, a facility should adhere to CMS regulations and guidance regarding outbreaks and COVID-19 testing—including testing staff, symptomatic individuals and outbreak testing. Specifically, as it pertains to outbreak testing, all visitation is to be suspended until at least one round of facility wide testing is completed. Visitation is to resume if:
- The first round of outbreak testing reveals no additional COVID-19 cases in other areas (e.g., units) of the facility, then visitation can resume for residents in areas/units with no COVID-19 cases. However, the facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing.
- The first round of outbreak testing reveals one or more additional COVID-19 cases in other areas/units of the facility (e.g., new cases in two or more units), then facilities should suspend visitations for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.
While CMS now permits relaxed visitations, it continues to recommend that facilities, residents and visitors adhere to maintaining physical distancing and conducting outdoor visits if possible. If a visitation dispute arises, or you are unsure if you are being wrongly denied access, each Medicare and Medicaid certified nursing facility requires that the Office of the State Long-Term Care Ombudsman with immediate access to any nursing resident. In Pennsylvania, the Ombudsman program is run by the Pennsylvania Department of Aging. More information can be found at its website: https://www.aging.pa.gov or by calling at (717) 783-1550.