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The Centers for Medicare & Medicaid (CMS) has revised QSO-20-39-NH on November 11, 2021, related to visitation guidance while also emphasizing the importance of maintaining infection control practices.
- Visitation is now always allowed for all residents in support of the resident right to make choices about aspects of his or her life in the facility that are significant to the resident.
- Provide visitors and residents, and resident representatives of risks associated with visitation.
- Ensure a visit occurs in a manner that does not place other residents at risk (e.g., in the resident’s room).
- Continue to provide required education to residents and staff on the risks and benefits of the vaccines, offer to administer the vaccine, and report resident and staff vaccination data to CDC’s National Healthcare Safety Network.
Providers will continue to be mindful to mitigate concerns associated with visitation, such as visitation with an unvaccinated resident while the nursing home’s county COVID-19 level of community transmission is substantial or high and adhere to the core principles of COVID-19 infection prevention.
Core Princ
Additions to Core Principals of COVID-19 Infection Prevention 11/11/20211
- Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine, should not enter the facility. Facilities should screen all who enter for these visitation exclusions.
Indoor Visitation
- Facilities must always allow indoor visitations for all residents.
- No longer limit the frequency and length of visit for residents, the number of visitors, or require advance scheduling of visits.
- Ensure physical distancing can be maintained during peak times of visitation.
- Avoid large gatherings like parties and events where large numbers of visitors are in the same space at the same time and distancing cannot be maintained.
- Limit visitor movement during visitation.
- Room visits should not occur in dual occupied room if one resident is not vaccinated and/or immunocompromised.
- If the nursing home’s county COVID-19 community level of transmission is substantial to high, all resident and visitors should wear face coverings or masks, physically distance.
- If the resident and all their visitors are fully vaccinated and the resident is not moderately or severely immunocompromised, they may choose not to wear face coverings or masks and to have physical contact.
- Visitors should wear face coverings or masks when around other residents or healthcare personnel, regardless of vaccination status.
While not recommended, resident who are on transmission-based precautions (TBP) or quarantine can still receive visitors but only in the resident’s room with appropriate PPE.
- Unvaccinated residents may also choose to have physical touch based on their preferences and needs however, all should be advised of the risks associated with this choice and advised on mitigation of the risks.
Indoor Visitation during an Outbreak Investigation
- It is safer for visitors not to enter the facility during an outbreak investigation, visitors must be allowed in the facility.
- Visitors should be made aware of the risk of visitation and understand the core principals if infection prevention.
- Wearing of face coverings or masks during visits, regardless of vaccination status and ideally in the resident’s room.
Visitor Testing and Vaccination
- Visitors are not required to be tested or vaccinated.
- Unvaccinated visitors should wear a mask or face covering at all times.
- Facilities are not required to test visitors but encouraged to offer testing to visitors if feasible.
- Encourage visitors to be tested on their own before coming to the facility within 2-3 days when not offered at the facility.
- Encourage all visitors to become vaccinated by providing education, and resources.
Compassionate Care Visits
- No changes
Access to the Long-Term Care Ombudsman
- If an Ombudsman is planning a visit with a resident in TBP or quarantine or unvaccinated resident in a nursing home in a county with substantial or high community transmission in past 7 days, the resident and ombudsman should be made aware of potential risk of visiting and the visit should take place in the resident’s room.
- Accommodate alternative communication in lieu of an in-person visit if requested.
Federal Disability Rights laws and Protection & Advocacy (P&A) Programs
- If the P&A is planning to visit a resident who is in TBP or quarantine or unvaccinated resident in a county with level of community transmission is substantial or high in the past 7 days, the resident and P&A representative should be made aware of the potential risk of visiting and the visit should take place in the resident’s room.
- Clear mask or mask with a clear panel is recommended with individuals who are deaf or hard of hearing.
Entry of Healthcare Workers and Other Providers of Services
- No changes
Communal Activities, Dining and Resident Outings
- Everyone should wear face coverings/masks regardless of the vaccination status.
- If a resident chooses to leave the facility, they should be reminded of infection prevention practices, including face coverings/masks, physical distancing, and hand hygiene.
- Upon return, screen residents for signs and symptoms of COVID-19.
- If possible close contact with COVID-19 outside of the nursing home, test the resident, regardless of vaccination status, and place on quarantine if the resident has not been fully vaccinated.
- If resident develops signs or symptoms of COVID-19 after the outing, test the resident and place on TBP regardless of vaccination status.
- Facilities may opt to test unvaccinated residents without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time.
- Facilities may consider quarantining unvaccinated residents who leave facility based on assessment of risk.
Survey Considerations
- Facilities are not permitted to restrict access to surveyors based on vaccination status, nor ask a surveyor for proof of vaccination status as a condition of entry.