Here’s a bit of good news for those with friends and family in nursing homes. Federal visitation guidelines have been updated that might allow you to share a little in-person love and attention with your loved one.
Isolation and loneliness have significant negative health impacts. It’s why nursing homes encourage social interactions among residents and encourage family and friends to visit their loved ones. But social distancing and infection control protocols required to control the spread of COVID-19 have exacerbated the isolation of residents in nursing homes and elder care facilities. In fact, in March 2020, the U.S. Centers for Medicare & Medicaid Services (CMS) issued guidance to shut all nursing homes to visitors, except in limited “compassionate care” situations (the resident was dying).The dramatic move was deemed essential when experts acknowledged how easily the virus could spread and how lethal it could be.
Indeed, elderly Americans living in long term facilities have been the hardest hit by death from the virus. The federal government reports 55,845 nursing home residents have died from the virus (updated September 13, 2020). And data reflecting a broader group of long-term care facilities (nursing homes, skilled nursing facilities, assisted living facilities, and other care homes) show even higher death count: 80,193 (updated September 24). These deaths account for more than 40% of all COVID-19 deaths in the U.S.
Certainly it’s been essential to implement stringent protocols in nursing homes to prevent the spread of the virus. But as the weeks have turned to more than six months, there has been growing concern about fall-out from the extended time that many elderly residents have been in lock-down, isolated from family and friends. Some deleterious impacts of isolation on health are increases in the risk of premature death and dementia. Loneliness is also linked with depression, poor sleep quality and even impacts an individual’s immunity.
In a significant shift in policy, on September 17, CMS acknowledged that the continued isolation of nursing home residents is negatively impacting residents and altered its guidance on visitation policies.
“While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones,” said CMS Administrator Seema Verma in a CMS press release.
The new CMS guidance now encourages nursing homes to offer visitation in outdoor settings because the additional space and airflow reduces the risk of the spread of the virus. The memo also outlines how nursing homes can safely support visitation, both outdoors and indoors, based on best practices to reduce COVID-19 transmission. Additionally, the guidance expands upon the types of situations that allow for compassionate care visits, despite a facility’s shut down for an outbreak.
The policy is clear that no visitation is allowed unless there have been no new COVID-19 cases in the previous 14 days and the facility is not conducting testing for a suspected outbreak.
If there are no active or suspect cases of COVID that trigger testing, CMS states that “outdoor visitation should be facilitated routinely.” Courtyards, patios or even parking lots and tents are suggested. Visits should follow social distancing protocols and the facility should have a process to limit the number and size of visits to minimize risk of virus transmission. “Reasonable limits” on the number of visitors for each resident is also recommended..
The new guidance asks facilities to use the county positivity rate (the percentage of those who test positive over all who have been tested) to determine if indoor visits should be allowed. If there are less than 10% of positive COVID tests of those tested in the county, indoor visitation may be possible. But the facility must also satisfy their own virus benchmark: no new onset of COVID-19 cases in the last 14 days and the facility cannot be currently conducting outbreak testing. If these parameters are met, CMS suggests a process to prevent free movement of visitors throughout the facility and limits on the number of visitors overall. Visitors should adhere to the infection prevention core principles such as temperature checks, hand hygiene, face coverings and social distancing.
Compassionate care visits
If a county has a positivity rate over 10%, only compassionate care visits are permitted. Prior to the September 17 guidance, CMS had used the example of “end-of-life” as qualifying for compassionate care visits. The new order includes additional examples, allowing for more instances that allow an exemption from visitation prohibitions.
“When a resident who was living with their family before recently being admitted to a nursing home is struggling with the change in environment and lack of physical family support.
When a resident who is grieving after a friend or family member recently passed away.
When a resident needs help and encouragement with eating or drinking, previously provided by family, is experiencing weight loss or dehydration.
When a resident who used to talk to others, is experiencing emotional distress, seldom speaking, and crying frequently (when he/she had rarely cried in the past).”
The guidance clarifies that this list is not exhaustive and there may be other situations that might qualify for a compassionate care visit. CMS also clarifies that compassionate care visits can be conducted by family members or others “such as clergy or lay persons offering religious and spiritual support.” It also restates federal law that preserves the right of representatives of the Office of the State Long-Term Care Ombudsman to have immediate access to a resident if requested by the resident. Access by the ombudsman may not be limited because of infection control concerns “without reasonable cause.”
For those living in areas that are not experiencing high rates of COVID-19, this change in visitation policy is welcome news. Ensuring safe but important connections with friends and family members will help to alleviate the isolation of nursing home residents and provide some relief to those who are worried about them.
Senior Director, Health Care Campaigns, PIRG
Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior policy advisor at NJ Health Care Quality Institute, associate state director at AARP New Jersey and consumer advocate at NJPIRG. She was appointed to the Ground Ambulance and Patient Billing Advisory Committee in 2022 and works with patient advocates across the U.S. Patricia enjoys walking along the Potomac River and sharing her love of books with friends and family around the world.