For the last year, many of us could not visit relatives and friends living in long-term care facilities (LTFC). It has been difficult for the residents, their healthcare professionals, doctors, and nurses, too.
The newly announced updates to Nursing Home Guidance visitation recommendations recognize the value of the contribution that the caring support of relatives and friends can make to long-term residents’ welfare.
The first questions we answer are:
- Am I free to visit my relative/friend now?
- Do I (or they) have to take any additional precautions?
- What if there is an emergency?
It is essential to remember why the restrictions were imposed in the first place and what has changed to allow the CMS* to take a more relaxed stance now.
A year ago, at the beginning of the Covid-19 pandemic, the elderly and individuals with underlying conditions (e.g., diabetes or a weakened immune system) were identified to be at the highest risk of infection. Understandably, nursing homes were localized points of increased infection rates.
Despite early protective measures, the pandemic caused over 100,000 deaths among residents and care workers. (Kaiser Family Foundation) .
The same study suggests that since 12/27/20, when vaccination started, nursing home resident deaths have fallen by 66%. It is still unclear how much of the decline can be attributed directly to the vaccine, but CMS is sufficiently confident to issue new guidance to Long-Term Care Facilities (LTCF).
“CMS is updating its visitation guidance to bring more families together safely. This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of Covid-19.”
Dr. Lee Fleisher MD, Chief Medical Officer and Director, CMS-Center for Clinical Standards and Quality
Now, to answer those questions:
Am I free to visit my relative/friend now?
Yes. The guidance is to facilitate all responsible requests for indoor visitation regardless of your vaccination status or the resident you are visiting. That is the intention, but there are some exceptions
- You cannot visit an unvaccinated nursing home resident if the Covid-19 positivity rate in the county is greater than 10% AND if less than 70% of the residents in the facility are vaccinated
- You may not visit a resident who has confirmed Covid-19 infection, whether vaccinated or unvaccinated. You may only visit WHEN they have met the criteria to discontinue transmission-based precautions
- You may not visit residents in quarantine, whether they are vaccinated or unvaccinated, UNTIL they have met the criteria for release from quarantine.
Do I, or they have, to take any additional precautions?
CMS continues to recommend LTCFs, residents, and families adhere to the core principles of Covid-19 infection control
- You will be expected to maintain social distancing
- Conduct visits outside whenever possible
- If the resident is vaccinated, they “can choose to have close contact (including touch) with their visitor while wearing a close-fitting mask and performing hand-hygiene afterward
- Regardless, visitors should physically distance themselves from other residents and staff in the facility.
What if there is an emergency?
The updated guidance to LTCFs is to allow “compassionate care” visits. “Compassionate care visits” include visits to residents whose health has sharply declined or are experiencing a significant change in circumstances, for instance, an end-of-life situation
A clergy member offering support may be appropriate in some compassionate care situations.
“Compassionate care” visits should be allowed regardless of the resident’s vaccination status. Such visits should be facilitated even if
- the county positivity rate is above 10%
- the facility has a Covid-19 outbreak
- YOU need not have full vaccination status, but you must observe the prevailing core principles of Covid-19 infection control whatever your vaccination status.
*Throughout the article, we have referred to the ‘CMS.’ We should make clear the role of the Centers for Medicare and Medicaid Services (CMS).
- CMS, one of 10 major operating divisions of the Department of Health and Human Services (HHS), is the federal agency that administers the nation’s major healthcare programs, including Medicare, Medicaid, and CHIP
- CMS works closely with the other operating divisions, including the Centers for Disease Control and Prevention (CDC), to guide nursing homes during the Covid-19 pandemic public health emergency (PEH)