CMS has updated its guidance for
nursing home visitation. Visitation is now allowed for all residents at all times, in accordance with adherence to the core principles of COVID-19 infection prevention and control to mitigate the risk of infection spread. Residents may continue to deny or withdraw consent for a visitation at any time.
If a visitor, resident, or their representative is aware of the risks associated with visitation and the visit occurs in a manner that does not place other residents at risk (e.g., in the resident’s room), the resident must be allowed to receive visitors as he/she chooses.
Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine should not enter the facility. Facilities should screen all who enter for these visitation exclusions.
Indoor visitation:
- Must be allowed at all times and for all residents as permitted under the regulations. Facilities can no longer limit the frequency and length of visitation for residents, the number of visitors, or require advance schedule of visits.
- Facilities should ensure physical distancing can still be maintained during peak visitation times and avoid large gatherings where large numbers of visitors are in the same space at the same time and physical distancing cannot be maintained.
- If a resident’s roommate is not vaccinated or immunocompromised (regardless of vaccination status), visitation should not be conducted in the resident’s room if possible.
- If the nursing home’s county COVID-19 community level of transmission is substantial to high, all residents and visitors, regardless of vaccination status, should wear face coverings/masks and physical distance at all times.
- In low to moderate transmission areas, the safest practice is to wear face coverings/masks and physically distance.
- If all visitors and the resident are fully vaccinated and the resident is not moderately or severely immunocompromised, they may choose not to a wear face covering and have physical contact.
- Visitors should wear face coverings/masks while around other residents or health care personnel, regardless of vaccination status.
- Residents on transmission-based precautions (TBP) or quarantine, while not recommended, can still receive visitors in the resident’s room. The resident should wear a well-fitting facemask (if tolerated). Visitors should be made aware of the risks of visitation, core principles of infection prevention. A facility is not required to, but may offer masks and other PPE as appropriate.
Indoor Visitation During Outbreak Investigation:
- Visitors must still be allowed into the facility, but they must be made aware of the potential risk of visiting and adhere to core principles of infection prevention.
- Visitation during outbreak should include wearing face coverings/masks, regardless of vaccination status, and visits should ideally occur in the resident’s room.
Visitor Testing and Vaccination:
- Facilities may offer testing to visitors, if feasible, but it is not required. Facilities should educate and encourage vaccination.
- Facilities may ask visitors about their vaccination status, but visitors are not required to be tested or vaccinated, or show proof of such, as a condition of visitation. If a visitor declines to disclose their vaccination status, they should wear a face covering/mask at all times.
Compassionate care visits are allowed at all times.
Ombudsman Visiting:
- Ombudsman planning on visiting a resident who is on TBP or quarantine, or unvaccinated resident where county level transmission is substantial to high in the past seven days, should be made aware of the potential risk of visiting. The visit should take place in the resident’s room.
- If the ombudsman or resident requests alternative communication in lieu of an in-person visit, the facility, at minimum, must facilitate alternative resident communication with the ombudsman program.
Communal Activities, Dining, and Resident Outings:
- Everyone should wear face coverings/masks regardless of the vaccination status.
- If a resident chooses to leave the facility, they should be reminded of infection prevention practices, including face coverings/masks, physical distancing, and hand hygiene.
- Upon return, screen residents for signs and symptoms of COVID-19.
- If possible close contact with COVID-19 outside of the nursing home, test the resident, regardless of vaccination status, and place on quarantine if the resident has not been fully vaccinated.
- If resident develops signs or symptoms of COVID-19 after the outing, test the resident and place on TBP regardless of vaccination status.
- Facilities may opt to test unvaccinated residents without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time.
- Facilities may consider quarantining unvaccinated residents who leave facility based on assessment of risk.
Survey Considerations:
- Facilities are not permitted to restrict access to surveyors based on vaccination status, nor ask a surveyor for proof of vaccination status as a condition of entry.