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CMS Issues Nursing Home Visitation FAQs

On Dec. 23rd, the Centers for Medicare and Medicaid Services (CMS) issued Frequently Asked Questions (FAQs) surrounding nursing home visitation. The document provides additional details about certain scenarios that nursing home leaders continue to have questions about. CMS was very clear that visitation must be permitted at all times, with very limited and rare exceptions, in accordance with resident rights.

Facilities should keep in mind three key principles:

  • Adhere to the core principles of infection control and prevention, especially wearing a mask, performing hand hygiene, and performing physical distancing.
  • Do not have large gatherings where physical distancing cannot be maintained.
  • Work with your state and local health departments when an outbreak occurs.

Several of the key questions examined by the FAQs are summarized below:

*Regarding visitation over the holidays and when large groups of visitors are expected*

If physical distancing cannot be maintained between other residents, the facility may restructure its visitation policy, such as asking visitors to schedule their visits at staggered timeslots throughout the day and/or limiting the number of visitors in the facility/resident room at one time. CMS notes that this is ONLY to be done when physical distancing cannot be maintained, such as during the holidays or when there are large numbers of visitors. There cannot be a time limit applied to a visit, in general, if there is no risk posed to other residents' rights and physical distancing can be maintained. If there is a risk noted or physical distancing cannot be maintained, the facility has to demonstrate that good faith efforts were made to facilitate visitation.

*Regarding visiting without a mask/having close contact with resident*

CMS states that visitors must wear a mask, regardless of vaccination status, and physically distance themselves from other residents and staff when in communal areas of a facility. In private settings (resident room), visitors and residents can visit without a mask and have close contact when the resident's roommate is not present (if applicable). CMS strongly encourages wearing a mask at all times during visitation. Visitors should be educated on the risks of close contact with resident(s) and removing their mask during a private visit. 

*Regarding having visitation in room with roommate*

In-room visits can occur if physical distancing can be maintained. If physical distancing cannot be maintained, CMS encourages the visit to happen in another part of the facility or when the resident's roommate is not present, or visitors should be asked to limit the number of visitors present and to wear a mask at all times during the visit and to perform frequent hand hygiene.

*Regarding sharing a meal with resident*

Sharing a meal with a resident should occur only if the resident and the visitor are aware of the risks and can adhere to the core principles of infection control and prevention. CMS recommends that the sharing of a meal with a resident should ideally take place in a separate part of the facility from other residents, but if that is not possible, it can occur in a common area, but the visitor must be physically distanced from other residents and must wear a mask except when eating or drinking. If the visitor cannot maintain physical distance from other residents, then the visitor cannot share a meal with the resident.

*Regarding contacting your state/local health department*

Per Centers for Disease Control and Prevention (CDC) guidelines, you must contact your local and state health departments if any of the following conditions are met:

  1. One or more residents or staff suspected of having or confirmed with having COVID-19
  2. Resident with severe respiratory infection resulting in hospitalization or death
  3. Three or more residents or staff with acute illness compatible with COVID-19 with onset within a 72-hour period

Your local or state health department can give you the guidance to pause visitation in your facility based on the circumstances. CMS reminds you that if that is the case, you will NOT be out of compliance with CMS regulations surrounding visitation. LeadingAge NY strongly encourages you to obtain any guidance to pause visitation you receive in writing for your records.

Contact: Mark Kepner-Clough, mkepner-clough@leadingageny.org, 518-728-2365