On March 10, 2021, the federal Centers for Medicare and Medicaid Services (CMS) revised QSO 20-39 to update the visitation guidelines for nursing facilities, effective immediately, in light of the more than three million doses of COVID-19 vaccines that have been administered in nursing homes across the country. IHCA/INCAL expects the Indiana Department of Health to update their visitation guidelines in the coming days, which apply to all long-term care facilities including assisted living communities, to align with the revised QSO.
Highlights of CMS’s updated visitation guidance are as follows:
- Core Principles & Screening: CMS’s Core Principles of COVID-19 Infection Prevention should continue to be maintained regardless of the vaccination status of the visitor or resident, including wearing masks and screening all visitors. The updated QSO specifies that entry should be denied to visitors who have had close contact with someone with COVID-19 in the prior 14 days (regardless of the visitor’s vaccination status), in addition to already denying those with COVID-19 signs or symptoms.
- Physical Contact: For those residents who are 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. However, visitors should continue physically distance from other residents and staff in the facility. “Fully vaccinated” means a person who is greater than two (2) weeks following receipt of the second dose in a two (2) dose series, or greater than two (2) weeks following receipt of one (1) dose in a single-dose vaccine.
- Indoor Visitation: While outdoor visitation is still preferred, indoor visitation should occur for all residents (regardless of vaccination status), except as follows:
- If the county in which the nursing facility is located is above 10% positivity and less than 70% of the residents are vaccinated, then visitation should be limited for unvaccinated residents until the county is below 10% positivity once again;
- Visitation should be limited for residents with a confirmed COVID-19 infection, whether the resident is vaccinated or unvaccinated, until the resident meets the criteria to discontinue transmission-based precautions;
- Visitation should be limited for residents who are in quarantine (i.e., a new admission in a Yellow Unit), whether the resident is vaccinated or unvaccinated, if the nursing facility is located in a county above 10% positivity; and/or
- An outbreak has occurred, as outlined further below.
- Please Note: Importantly, visitation for compassionate care visits should continue even if indoor visitation is otherwise restricted, regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak.
- Outbreaks: When one (1) new facility-onset COVID-19 case among residents or staff is identified, the nursing facility should immediately begin outbreak testing and suspend all visitation (except that required under federal disability rights law, which is by definition a compassion care visit), until at least one (1) round of facility-wide testing is completed. Visitation can resume based on the following criteria:
- If the first round of outbreak testing reveals no additional COVID-19 cases in other areas/units of the facility, then visitation can resume for residents in those areas/units with no COVID-19 cases. The facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing, meaning testing every three (3) to seven (7) days until no new COVID-19 case is identified for a 14-day period. In such a circumstance, visitors should be notified of their potential exposure to COVID-19 (i.e., when visiting residents on the non-affected units), and signage should be placed regarding the outbreak in the particular unit.
- If the first round of outbreak testing reveals one (1) or more additional COVID-19 cases in other areas/units of the facility (i.e., new cases in two (2) or more units), then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing, meaning testing every three (3) to seven (7) days until no new COVID-19 case is identified for a 14-day period.
- As a reminder, IHCA/INCAL’s Outbreak Toolkit can be here, and IHCA/INCAL’s article on routine and outbreak testing can be found here.
- Vaccination of Visitors: While testing is still encouraged among visitors, if feasible, the QSO makes clear visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation. Similarly, federal and state surveyors are not required to be vaccinated and must be permitted entry into facilities unless they exhibit signs or symptoms of COVID-19.
The revised QSO on nursing home visitation is independent from the CDC’s updated Infection Prevention and Control Recommendations that were issued today. IHCA/INCAL will provide an update if the Indiana Department of Health’s Infection Control Guidance is updated accordingly.