CMS Publishes New Guidance on Nursing Home Visitation

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The COVID-19 pandemic has disrupted the lives of many, and one particularly hard-hit group is nursing home residents. Nursing homes have greatly limited visitation, leading many residents to feel isolated, depressed, and confused. Last week, the Centers for Medicare & Medicaid Services (CMS) issued new guidance on nursing home visitation during the pandemic. Previously, CMS urged nursing homes to only permit onsite visitation during times of compassionate care. With this new guidance, CMS is urging nursing homes to establish new guidelines for visitation based on CMS’ core principles and public health data..

CMS’ guidance focuses on two key areas to prevent the spread of COVID-19 in nursing homes.

  • Implementation of “core principles”
  • Evaluating visitation policies based on a county’s positivity rate

“Core Principles” to prevent the spread of COVID

CMS recommends nursing homes implement the following procedures:

  • Screen all visitors for signs and symptoms of COVID-19 (e.g. temperature checks, questions or observations about signs or symptoms)
  • Mandate proper hand hygiene. Use of alcohol-based hand rub with 60-95% alcohol is preferred
  • Visitors must wear a face covering or mask (covering mouth and nose)
  • Social distancing of at least 6 feet between persons
  • Visitors who are unwilling to adhere to these rules should not be permitted to visit

Evaluating visitation policies based on a county’s positivity rate

A county’s positivity rate is the percentage of all tests performed that results in a positive diagnosis. According to CMS, the guidelines for indoor visitation are as follows:

  • Low (<5%) = visitation should occur according to the core principles of COVID-19 infection prevention and facility policies (beyond compassionate care visits)
  • Moderate/Medium (5% – 10%) = visitation should occur according to the core principles of COVID-19 infection prevention and facility policies (beyond compassionate care visits)
  • High (>10%) = visitation should only occur for compassionate care situations according to the core principles of COVID-19 infection prevention and facility policies

CMS details specific guidance in terms of outdoor and indoor visitation.

Outdoor visitation

  • Preferred whenever practicable because being outside poses a lower risk of transmission.
  • Should be offered if the weather permits and if the resident’s conditions permit.
  • Nursing home staff should limit the number of visitors with any one resident at the same time.

Indoor visitation

  • Indoor visitation should be permitted when there have been no new COVID-19 cases in the last 14 days and the facility is not conducting outbreak testing. An outbreak is defined as two or more laboratory-confirmed COVID-19 cases among residents or staff with onsets within 14 days, who do not share a living space.
  • Visitors should adhere to the core principles.
  • Facilities should limit the number of visitors any one resident receives at any one time and limit the total number of visitors at any one time.
  • Facilities should limit movement in the facility, meaning facilities should not allow visitors to wander into different parts of the facility

Also, on August 28, 2020, the Arizona Department of Health (ADHS) issued visitation guidance at congregate settings. While most of the recommendations in ADHS’ guidance mirrors CMS’ guidance, there are a few differences:

  • ADHS does not recommend indoor visitation if the county’s positivity rate is moderate, whereas CMS does.
  • Nursing homes may impose stricter visitation policies. For instance, access to a resident’s living space may depend on whether the visitor has been tested.

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