New CMS Visitation Guidance

March 16, 2021November 17, 2021 COVID-19

UPDATE: CMS has released new guidance. Read about it in our newest blog post.

For a year now, residents have been separated from their loved ones. In protecting residents from COVID-19, long-term care communities have left them isolated. The mental and physical toll this loneliness has had on residents is staggering. As such, families and senior rights advocates have been fighting for updated guidance that would allow residents to see their loved ones, especially in light of the vaccine’s distribution. 

New Guidance

On March 10, the Centers for Medicare and Medicaid Services (CMS) released new guidance that considers how long-term care communities should adjust their visitation given that many residents are now fully vaccinated. 

Who does this guidance pertain to?

CMS guidance must be followed by certified skilled nursing facilities and intermediate care facilities. Other levels of care (assisted living facilities and residential care facilities) are required to follow guidance from the Department of Health and Senior Services (DHSS). As of now, we do not have updated guidance from DHSS. The most recent DHSS guidance is outlined in our previous visitation blog post.

While DHSS has not released new guidance, it is being recommended that all levels of care follow the CMS guidance while waiting for DHSS’s updates. The important caveat is that this is recommended but not required. DHSS anticipates rolling out the state-level guidance soon, which is expected to mirror the federal CMS guidance. Both sets of guidance will provide us new directions for living in the new normal.

UPDATE: As of March 24, DHSS has released new guidance. Read more about it in our most recent blog post.

What does this guidance actually say?

While much of the guidance has remained the same, there are some key differences in place. The most important takeaways from the new CMS guidance are:

• CMS continues to state that outdoor visits are the safest form of visitation and are preferred.
• Instead of stating what needs to be in place to allow visits, CMS now states that allowing visits is the default, and visits should only be limited under specific instances. These scenarios include limiting indoor visits for:
  • Unvaccinated residents, if the nursing home’s COVID-19 county positivity rate is >10% and <70% of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the 2 criteria to discontinue transmission-based precautions; or
  • Residents in quarantine (whether vaccinated or unvaccinated) until they have met the criteria for release from quarantine.   
  • If a resident is fully vaccinated (which refers to a person who received their final dose at least 2 weeks ago), they can choose to have close contact (including touch) with their visitor. A well-fitted mask and hand hygiene are still required.
• All visitation should be suspended when a new case of COVID-19 among staff or residents is identified until outbreak testing is completed. 
• Compassionate care visits and visits required under federal disability laws should be allowed at all times, including during outbreak testing.

Can families and loved ones visit residents right now?

That depends. First, LTC communities still need to meet the criteria for visits. If a resident or staff member has recently tested positive for COVID-19, visitation is suspended until they complete at least one round of outbreak testing. If, after one round, it is determined that there are no additional cases in other areas of the LTC community, then visitation can resume for these other areas. 

LTC communities are also encouraged to consider the total number of visitors per resident and in the entirety of the home. It is therefore recommended that they schedule visits. Additionally, they still do not recommend that visitors walk around the LTC community. Instead, they suggest visitors go straight to the resident’s room or to the designated visitation area.

Testing and Vaccinations

It is highly recommended that visitors get vaccinated, but it is not required. Likewise, it is highly recommended that LTC communities offer to test visitors, but visitors are not required to get tested or prove that they have been vaccinated.

When You’re Told You Can’t Visit

This guidance is new, and many LTC communities are adjusting to it. If your loved one’s LTC community won’t allow visitors, reach out to your ombudsman.

The New Normal

Visits aren’t going to be like they were before. You won’t be able to walk into an LTC community and head into your loved one’s room. You won’t be able to walk the premises with them, seeing the common areas they frequent. Instead, you will need to call ahead and ensure that the home meets the criteria to allow visitors. You will need to make an appointment so they don’t end up with too many people in the home. You will still need to wear a well-fitted mask and adhere to proper handwashing, but as long as the resident is fully vaccinated, you won’t be visiting through plexiglass or be sitting across the room from each other. 

For the first time in a year, you can hug your loved one.

If you have more questions about these guidelines, reach out to your ombudsman or contact the state ombudsman office at 1-800-309-3282.