Today, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance providing detailed recommendations on ways nursing homes can safely facilitate visitation during the coronavirus disease 2019 (COVID-19) pandemic. After several months of visitor restrictions designed to slow the spread of COVID-19, CMS recognizes that physical separation from family and other loved ones has taken a significant toll on nursing home residents. In light of this, and in combination with increasingly available data to guide policy development, CMS is issuing revised guidance to help nursing homes facilitate visitation in both indoor and outdoor settings and in compassionate care situations. The guidance also outlines certain core principles and best practices to reduce the risk of COVID-19 transmission to adhere to during visitations.
“While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones,” said CMS Administrator Seema Verma. “With the Trump administration’s unprecedented efforts to bolster testing resources and deploy infection control support, we believe nursing homes should be able to resume visitations reuniting residents with their families within the recommendations outlined in our guidance.”
The vulnerable nature of the nursing home population, combined with the inherent risks of congregate living in a healthcare setting, have required aggressive efforts to limit COVID-19 exposure, including limiting visitation. As a result, in March 2020, CMS issued guidance instructing facilities to restrict visitation except for certain compassionate care situations. In May 2020, CMS released Nursing Home Reopening Recommendations, which provided guidance on visitation as nursing homes progress through the phases of reopening. In June 2020, CMS also released a Frequently Asked Questions document on visitation, which expanded on previously issued guidance on outdoor visits, compassion care situations, and communal activities.
In the revised guidance issued today, CMS is encouraging nursing homes to facilitate outdoor visitation because it can be conducted in a manner that reduces the risk of transmission. Outdoor visits pose a lower risk of transmission due to increased space and airflow. The guidance released today also allows for indoor visitation if there has been no new onset of COVID-19 cases in the past 14 days and the facility is not conducting outbreak testing per CMS guidelines. Indoor visitation is subject to other requirements as well as indicated in the guidance.
The guidance also clarifies additional examples of compassionate care situations. While end-of-life situations have been used as one example, there are other examples including:
- When a resident who was living with their family before recently being admitted to a nursing home is struggling with the change in environment and lack of physical family support.
- When a resident who is grieving after friend or family member recently passed away.
- When a resident needs help and encouragement with eating or drinking, previously provided by family, is experiencing weight loss or dehydration.
- When a resident who used to talk to others, is experiencing emotional distress, seldom speaking, and crying frequently (when he/she had rarely cried in the past).
For additional details on the revised nursing home visitation guidance released today, visit here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19
The full list of CMS Public Health Actions for Nursing Homes on COVID-19 to date is in the chart below.
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CMS Public Health Action for Nursing Homes on COVID-19 as of September 17, 2020 |
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February 6, 2020 |
CMS took action to prepare the nation’s healthcare facilities for the COVID-19 threat. |
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March 4, 2020 |
CMS issued new guidance related to the screening of entrants into nursing homes. |
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March 10, 2020 |
CMS issued guidance related to the use of PPE. |
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March 13, 2020 |
CMS issued guidance on the restriction of nonessential medical staff and all visitors except in certain limited situations. |
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March 23, 2020 |
CMS announced a suspension of routine inspections, and an exclusive focus on immediate jeopardy situations and infection control inspections. |
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March 30, 2020 |
CMS announced that hospitals, laboratories, and other entities can perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital – including nursing homes. |
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April 2, 2020 |
CMS issued a call to action for nursing homes and state and local governments reinforcing infection control responsibilities and urging leaders to work closely with nursing homes on access to testing and PPE. |
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April 15, 2020 |
CMS announced the agency will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases. |
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April 19, 2020 |
CMS announced it will require nursing homes to report cases of COVID-19 to all residents and their families, as well as directly to the CDC. On May 1, CMS published the proposed policy in an Interim Final Rule. The rule became effective on May 8. |
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April 30, 2020 |
CMS announced the formation of an independent commission by a contractor that will conduct a comprehensive assessment of the nursing home response to COVID-19. |
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May 6, 2020 |
CMS released a memorandum to State Survey Agency directors providing more details on the new reporting requirements of the May 8, 2020, Interim Final Rule. |
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May 13, 2020 |
CMS published a new informational toolkit comprising recommendations and best practices from a variety of front line health care providers, governors’ COVID-19 task forces, associations and other organizations and experts that is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19. Toolkit is found here: Toolkit |
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May 18, 2020 |
CMS issued guidance for state and local officials on the reopening of nursing homes. |
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June 1, 2020 |
CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes. CMS also issued a letter to Governors. |
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June 4, 2020 |
CMS posted the first set of underlying COVID-19 nursing home data and results from targeted inspections conducted by the agency since March 4, 2020, linked on Nursing Home Compare. |
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June 19, 2020 |
CMS announced membership of Independent Coronavirus Commission on Safety and Quality in nursing homes |
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June 23, 2020 |
CMS released FAQs on nursing home visitation. |
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June 25, 2020 |
CMS released a memo announcing the end of the emergency blanket waiver for the nursing home staffing data submission requirement. |
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July 10, 2020 |
CMS announced it will deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in hotspot areas.
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July 14, 2020 |
HHS and CMS announced an initiative for rapid point-of-care diagnostic devices and tests in nursing homes. |
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July 22, 2020 |
CMS announced several new initiatives designed to protect nursing home residents from COVID-19, including new funding, enhanced testing and additional technical assistance and support. |
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August 7, 2020 |
HHS announced the distribution of $5 billion in Provider Relief Funds, consistent with the Administration’s announcement in late July, which will be used to protect residents of nursing homes and long-term care facilities from the impact of COVID-19. |
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August 14, 2020 |
CMS released nursing home enforcement actions during pandemic. |
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August 24, 2020 |
CMS issues informational bulletin on Medicaid Reimbursement Strategies to Prevent Spread of COVID-19 in Nursing Facilities |
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August 25, 2020 |
CMS announced an unprecedented national nursing home training program for frontline nursing home staff and nursing home management. |
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August 25, 2020 |
CMS strengthens COVID-19 Surveillance with New Reporting and Testing Requirements for Nursing Homes, Other Providers. On Aug. 26, CMS posted guidance for the new requirements. |
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September 16, 2020 |
CMS makes public Independent Nursing Home COVID-19 Commission Findings that validate unprecedented federal response to COVID-19 to date. |
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