On November 18, CMS released an
alert regarding holiday visitation. During the holidays, facilities, residents, and visitors should continue to follow the
guidelines for visitation and adhere to the core principles of infection prevention, such as remaining six feet or more apart, wearing a face covering at all times, and limiting the number of visitors in the nursing home at any one time. Families, residents, and providers need to work together to take precautions during the holidays to help reduce the risk of spread while supporting family and resident engagement as much as possible using these core infection prevention practices.
CMS recommends against residents leaving the nursing home during the public health emergency because it increases the resident’s risk for exposure to COVID-19. The risk may be further increased by factors such as a resident’s health status, the spread of COVID-19 in the community (e.g., cases or positivity rate), or attendance at large gatherings.
CMS states that nursing homes should educate residents and families of the risks of leaving the facility, the steps they should take to reduce the risk of contracting COVID19 and encourage residents to stay connected with loved ones through alternative means of communication. It is important to urge families to notify the facility if they suspect the resident has been exposed to COVID-19 while outside the nursing home. Families, residents, and staff should also refer to the Centers for Disease Control and Prevention’s (CDC)
webpage on holiday celebrations.
CMS outlines recommendations in the memo, should a resident ultimately choose to leave the nursing home for the holidays. Members should review for the full list. Some of the recommendations include:
- Limit close contact (maintain physical distancing of six feet or more), keep gatherings as small as possible, and use technology to engage with others remotely.
- Keep safe around food and drinks. Avoid communal serving utensils, passing of food, potluck or buffet style food service, and instead opt for individually prepared plates by a single server.
- Avoid large gatherings, crowded areas, and high-risk activities such as singing.
- Verbally greet others instead of shaking hands or giving hugs. Think ahead about how you will manage to prevent physical interactions with loved ones of different ages such as young children.
- Check local conditions and state requirements for precautions and restrictions, including positivity rates and quarantine requirements, before crossing state lines.
An important note from the CMS alert is that staff should also use extra caution, especially during the holidays. Staff should follow the same recommendations for residents and families regarding gathering with their families and friends outside of work to protect the vulnerable residents they care for.
CMS recommends providers take the following actions when residents who leave for the holidays return to the facility:
- Screen and increase monitoring for signs and symptoms.
- Test a resident for COVID-19 if signs or symptoms are present or if a resident or their family reports possible exposure to COVID-19 while outside the nursing home.
- A nursing home may also opt to test residents without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time, such as over 24 hours. For more information on testing guidelines see CMS memorandum QSO-20-38-NH.
- Place the resident on transmission-based precautions (TBP) if the resident or family member reports possible exposure to COVID-19 while outside of the nursing home, or if the resident has signs or symptoms of COVID-19 upon return.
- Residents and loved ones should report to the nursing home staff if they have had any exposure to COVID-19 while outside of the nursing home.
- Consider placing residents on TBP if they were away from the nursing homes for more than 24 hours.
AHCA/NCAL has drafted a template letter to families regarding holiday outings which you may customize as needed. You can find the letter
here.