CMS Issues Holiday Guidance for Nursing Homes: No Visitation Changes, Leaving Facilities Discouraged

The federal government on Wednesday issued an alert to nursing home operators and residents, urging extreme caution during the impending holiday season — and compelling providers to warn families about the risks of taking residents out of facilities for off-site gatherings.

Notably, the Centers for Medicare & Medicaid Services (CMS) will not change its rules around visitation even during the Thanksgiving and Christmas season, division of nursing homes director Evan Shulman said.

“We think our visitation guidance is sound, and allows for the appropriate way to conduct visitation when there are or are not cases,” Shulman said on a Wednesday stakeholder call with nursing home leaders and staff. “As you all know, the virus does not take off for the holidays. We need to be just as vigilant … This is no time to back off.”

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The CMS guidance will advise operators to seriously explain the risk of COVID-19 infection to families who wish to have their loved ones come home for the holidays.

“While CMS supports family engagement and a resident’s right to leave the nursing home, everyone needs to work together to take extra precautions to help reduce the spread of COVID- 19, which can pose an elevated danger to the health of nursing home residents,” the agency noted. “Therefore, CMS recommends against residents leaving the nursing home during this PHE.”

If they still elect to leave the building, staff should advise residents and families to follow infection-mitigation strategies, such as avoiding buffet-style dining, capping attendance at gatherings, and wearing masks inside homes and in vehicles.

When residents then return to the building after an extended period, it will be “reasonable” for operators to place them on transmission-based precaution protocols, Shulman noted.

Finally, Shulman emphasized that all of these recommendations will apply to nursing home staff members in addition to residents and families.

“Every single precaution that all residents must take, all of us need to take because we are working with the resident in the same place as the resident,” he said. “So if residents take these precautions, but staff don’t adhere to these guidelines, they will transmit the virus when they go back into the facility. We all need to pitch in here.”

CMS most recently updated its visitation rules in mid-September, with a path toward allowing indoor reunions in certain scenarios. Social and familial isolation remain a particular source of pain for residents, families, and caregivers, with access to nursing homes severely restricted since the outset of the COVID-19 pandemic in March.

The warning comes as confirmed COVID-19 cases in nursing homes hit a record high in early November amid rapidly increasing community spread in areas across the country.

New infections surpassed 500,000 among the general population during the week ended November 1, and the Centers for Disease Control & Prevention (CDC) had bleak predictions about the future trend heading into December.

“This week’s national ensemble forecast indicates an uncertain trend in new COVID-19 cases reported over the next four weeks and predicts that 630,000 to 1,700,000 new cases will likely be reported during the week ending December 5, 2020,” the CDC observed on November 12.

Shulman did express some optimism about the progress on a COVID-19 vaccine.

“This year is going to be different around the holidays, unfortunately, but it needs to be different because of the position we’re in,” he said. “That said, with the vaccine on the horizon, there’s a light at the end of the tunnel. Hopefully in a few months — even shorter perhaps — we’ll all be celebrating all of the holidays together.”