Citing Vaccine Rollout, CMS Relaxes Nursing Home Visitation Rules

The federal government on Wednesday issued updated guidance for nursing home visitations, calling on facilities to allow “responsible indoor visitation at all times and for all residents” — regardless of vaccination status — with a handful of situational exceptions.

“CMS recognizes the psychological, emotional, and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families,” CMS chief medical officer Dr. Lee Fleisher said in a Wednesday statement. “That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely.”

The news comes nearly a year to the day after the Centers for Medicare & Medicaid Services (CMS) shut down most non-emergency visits to nursing homes last March 13, at the very beginning of the COVID-19 crisis.


Calls for an overhaul to strict bans on visits, already loud given the heart-wrenching stories of residents’ physical and mental health failing amid extended separation from loved ones, reached a crescendo this week after the Centers for Disease Control & Prevention (CDC) on Monday announced looser new guidance for gatherings of vaccinated and unvaccinated people.

CMS specifically pointed to the success of the federal vaccine rollout in nursing homes as a driver of the new policy.

“High vaccination rates among nursing home residents, and the diligence of committed nursing home staff to adhere to infection control protocols, which are enforced by CMS, have helped significantly reduce COVID-19 positivity rates and the risk of transmission in nursing homes,” the agency noted in its announcement.


Exceptions still remain, however. Operators will be required to limit indoor visits for three specific reasons:

  • Unvaccinated residents will not be allowed visitors if the surrounding county COVID-19 positivity rate exceeds 10% and less than 70% of residents in a facility have been fully vaccinated
  • Residents who have been confirmed COVID-positive will not be able to receive visitors until they meet criteria to discontinue transmission-based protocols
  • Quarantined residents cannot accept visitors until they meet the criteria to be released from quarantine

Outdoor visits remain preferred, and CMS cautioned that physical distancing remains the safest option, especially in cases where one or both parties have not yet received a vaccine.

“However, we acknowledge the toll that separation and isolation has taken,” CMS wrote in an updated memo to states. “We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one. Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after. Regardless, visitors should physically distance from other residents and staff in the facility.”

Visitations can also continue during outbreaks, according to CMS, though only if the outbreak is contained within a specific wing or unit of a nursing home.

As was true prior to the new guidance, visits must always be allowed during end-of-life scenarios — as well as when residents are “in decline or distress.” Representatives of state long-term care ombudsman offices are also required access to residents at any time.

Additionally, operators cannot require visitors to provide proof of vaccination or submit to a coronavirus test as a prerequisite for entering a facility, though CMS is encouraging family and friends to roll up their sleeves when they have the opportunity. Federal and state surveyors also do not need to be vaccinated to perform their duties, though they can be denied access if they actively display COVID symptoms.

The two national trade groups that represent nursing homes and other long-term care settings welcomed the news late Wednesday.

“With today’s announcement, federal policy now reflects the real progress that has been made in vaccinating nursing home residents and staff,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “This is the right thing to do.”

Mark Parkinson, president and CEO of the American Health Care Association, called on federal officials to continue providing ongoing vaccine support for both nursing home residents and staff, as well as the general public to embrace the shots.

“Our dedicated staff members have done an extraordinary job filling in for loved ones and adapting visitations during this difficult time, but nothing can replace engaging with family members in person,” Parkinson said in a statement. “The health and wellbeing of our residents will improve thanks to this important guidance.”

This is a developing story. Please check back for updates.