CMS loosens nursing home visitation guidance to allow indoor visits

CMS on Wednesday relaxed guidance on nursing home visitation, allowing unrestricted indoor visits for the first time in a year.

While the guidance permits indoor visitation for both vaccinated and unvaccinated residents, CMS still recommends outdoor visitation to reduce the risk of COVID-19 transmission.

“Given the ongoing risk of COVID-19 transmission, CMS continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection control, including maintaining physical distancing and conducting visits outdoors whenever possible,” the guidance reads.

CMS loosened its restrictions in response to the declining numbers of COVID-19 cases in nursing homes since mass vaccination began and the mental and physical toll the pandemic has had on residents.

The guidance is the first update on nursing home visitation since September when CMS permitted some indoor visitation in COVID-19-free facilities for the first time since March 2020.

Under the guidance, indoor visitation should be restricted for unvaccinated residents if the county positivity rate is higher than 10% and less than 70% of the residents have been fully vaccinated.

During a COVID-19 outbreak, nursing homes should pause visitation until a facility-wide round of testing can take place, the guidance says. If an outbreak is found to be limited to one area of the facility, other units can resume indoor visitation but if there is at least one COVID-19 case outside of the unit, visitation should temporarily be suspended for all residents, according to the guidance.

The guidance recommends that visits for compassionate care, including end-of-life situations and when residents are in decline should be allowed at all times for both vaccinated and unvaccinated residents.

Visitors are not required to be vaccinated or get tested under the guidance but are encouraged to do so when they can.

CMS and the CDC recommend facilities, residents and visitors continue to follow infection prevention guidance, including physical distancing, but said fully vaccinated residents can choose to have close contact and even hug visitors while wearing masks.

“We acknowledge the toll that separation and isolation has taken. We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one,” the guidance reads.

Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, said the organization fully supports allowing residents to visit with their loved ones.

“It has been nearly one year to the day since visitors were restricted from nursing homes, and now thanks to the vaccines, we cannot wait to safely reopen our doors,” Parkinson said in a prepared statement. “Our dedicated staff members have done an extraordinary job filling in for loved ones and adapting visitations during this difficult time, but nothing can replace engaging with family members in-person. The health and wellbeing of our residents will improve thanks to this important guidance.”

Parkinson also said public health officials need to continue to prioritize vaccines for nursing home residents.

“After the three rounds of on-site clinics, it is unclear how long-term care facilities will be able to quickly access vaccines moving forward,” Parkinson said. “We need the CDC to ensure the vaccine is readily available for new admissions as well as current residents who have since decided to get the vaccine, so they are able to visit with their families per the new CMS guidance. A steady, ongoing allocation of vaccines to long-term care will also help ensure we continue to build upon the progress we have already made in reducing COVID in long-term care.”

Nationwide, there have been 639,658 confirmed COVID-19 cases and 130,079 deaths among residents and 551,667 confirmed cases and 1,619 deaths among nursing home workers, according to the latest CMS data available.

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