CMS Issues Updated Guidelines, Clarifications on Nursing Home Visitations as States Reopen

The Centers for Medicare & Medicaid Services (CMS) on Wednesday released an updated set of frequently asked questions designed to encourage safe visitation of residents in nursing homes.

While the federal government has largely left the decision to reopen nursing facilities up to the states, CMS emphasized that it supports safe visitation efforts — while also clarifying that aspects of the original ban, issued in March, may not be as strict as some facilities have interpreted.

“We are all aware of the emotional toll that the visitation restrictions and limitations have placed on not only nursing home residents but their families and loved ones,” Evan Shulman, director of CMS’s nursing home division, said on a Wednesday call with industry stakeholders. “Since we first issued the first memo on visitation back in March, though, we have learned a lot more — and anything we can do to bring residents closer to their loved ones we want to be able to do. However, we also want to make sure it can be done safely.”

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For instance, CMS took pains to note that the “compassionate care” exemption to the ban on non-essential visitors does not only apply to end-of-life situations.

“For a resident who was living with their family before recently being admitted to a nursing home, the change in their environment and sudden lack of family can be a traumatic experience. Allowing a visit from a family member in this situation would be consistent with the intent of the term ‘compassionate care situations,'” CMS observed. “Similarly, allowing someone to visit a resident whose friend or family member recently passed away, would also be consistent with the intent of these situations.”

That said, CMS warned that such visits should not be conducted on a routine basis, and left the final decision up to local officials.

“CMS cannot define each situation that may constitute a compassionate care situation,” the FAQ reads. “We encourage facilities to consult with state leadership, families, and ombudsman, to help determine if a visit should be conducted for compassionate care.”

CMS signaled its approval of outdoor visits, which many states have adopted as part of their reopening plans, and also suggested that operators can develop indoor “safe spaces” with see-through walls or other means of visual contact without touching or air contamination.

The agency also emphasized that rules regarding ombudsmen’s interactions with residents have not been suspended during the pandemic; under the Social Security Act, operators must grant state long-term care ombudsmen “immediate access” to nursing home residents upon request.

While facilities can prevent in-person ombudsman visits due to infection-control issues, operators must provide telephone or electronic access for ombudsmen, CMS advised.

“Since ombudsmen are critical resources for residents and their families, nursing homes should facilitate their in-person access as soon as is practicable,” the agency noted.

CMS issued a blueprint for reopening nursing homes back in May, with universal testing of residents a prerequisite for even starting the process.

States still retain the final say on when to grant nursing homes the blanket ability to begin receiving visitors, and individual facilities may remain on lockdown if conditions in the community or specific building are deemed unsafe.

In general, CMS only recommends reopening properties to the public when a state or region enters phase three of its multi-step protocol, with no new COVID-19 cases in the nursing home for 28 days — along with sufficient staff, personal protective equipment (PPE), access to testing, and capacity at area referral hospitals.

The new FAQ also emphasizes that group activities can occur with the proper precautions.

“Facilities may be able to offer a variety of activities while also taking the necessary precautions,” the document reads. “For example, book clubs, crafts, movies, and Bingo are all activities that can be facilitated with alterations to adhere to the guidelines for preventing transmission.”

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