CMS Issues Visitation FAQs for Nursing Home Providers

Regulation | June 25, 2020 | by Jodi Eyigor

CMS clarifies recommendations around visitation, including compassionate care visits, ombudsman visits, and creative ways to combat social isolation ahead of the relaxation of restrictions.

CMS released a new FAQ document on June 24 related to visitation in nursing homes. This FAQ comes months after CMS restricted visitation in nursing homes (QSO-20-14-NH-REVISED) and as states contemplate relaxing restrictions on nursing homes and the surrounding communities reopen. CMS maintains that nursing homes must continue practices to prevent the transmission of COVID-19, but offers clarity around flexibilities for providers in balancing resident’s health and safety needs versus social isolation.

Visitation

Consistent with reopening recommendations released on May 18, CMS advises that nursing homes should continue to restrict general visitation until the nursing home enters phase 3 of the reopening recommendations. However, nursing homes may consider creative ways to safely facilitate visits for residents and visitors who are not COVID-positive and who show no signs or symptoms of COVID-19 in advance of phase 3.

CMS suggests that nursing homes may create safe spaces for visitation, such as outdoor spaces in patios, courtyards, or parking lots. If outdoor visitation is not an option, nursing homes may create special visitation spaces, such as those that are separated by see-through physical barriers, for special circumstances. Residents who are COVID-positive or showing symptoms of COVID-19 should not participate in visitation. Visitors who are COVID-positive or showing symptoms of COVID-19 should be restricted.

When considering visitation, nursing homes must ensure precautions remain in place to prevent transmission of COVID-19. This includes screening of all visitors, face coverings or face masks for all residents and visitors, performing hand hygiene, and maintaining social distancing throughout the visit. Nursing homes may consider visiting schedules to ensure limited numbers of visitors and residents in a given space at a time and may also consider limiting the number of visitors per resident. Visiting spaces must be properly cleaned and disinfected.

CMS further clarifies in the FAQ the intent of “compassionate care situations.” When CMS restricted visitation in March 2020, they described the exception of allowing visitation in certain compassionate care situations. They provided end-of-life circumstances as an example of compassionate care. CMS clarifies in the FAQ that end-of-life is only one example and “compassionate care” could apply to a number of scenarios. Providers can consult with families, state leadership, or the ombudsman when making this determination, though CMS cautions that these visits should continue to be exceptions, rather than routine.

Dining and Activities

CMS outlines in the FAQ further options nursing homes have for addressing social isolation among residents. While communal dining and group activities were restricted in March 2020, CMS reminds providers that, as clarified in an FAQ in QSO-20-28-NH and according to the May 18 reopening recommendations, residents may eat in the presence of others, provided social distancing is observed (limited numbers of residents at tables and tables spaced at least 6 feet apart).

Additionally, CMS clarifies that nursing homes may offer activities for residents, provided precautions are maintained. CMS suggests that activities such as BINGO, crafts, movies, and book clubs can be safely conducted while maintaining social distancing, wearing face coverings or face masks, and practicing hand hygiene. Both dining and activities are also limited only to those residents who are not COVID-positive and not showing symptoms of COVID-19.

Ombudsman Visits

Lastly, CMS emphasizes the importance of continuing to facilitate residents’ access to the ombudsman program, despite visitor restrictions. If in-person visits are not possible, nursing homes should assist residents in other ways, such as facilitating telephone communication or virtual visits with the ombudsman. Also recall that while a federal blanket waiver issued by CMS relaxes some requirements around transfer and discharge notification, this waiver applies only to those residents who are discharged or transferred for the purpose of cohorting to prevent transmission of COVID-19. Under these circumstances, the nursing home must provide notice to the residents, resident representatives, and ombudsman as soon as practicable. All other transfers and discharges continue to require notification, including notification to the ombudsman, according to 42 CFR 483.15(c).

Nursing home providers must continue to exercise caution as the country staggers under the weight of this pandemic. While policies and approaches differ from state to state, one thing remains clear: nursing home residents are among a vulnerable population more likely to suffer serious illness from COVID-19. No matter how weary our nation becomes from battling this pandemic, we must remain vigilant and nimble as we provide for the health and well-being of residents in our communities. For more ideas about how to address social isolation in your communities, connect with other aging services providers in the COVID-19 group on the LeadingAge Member Community.