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Feds Tell Nursing Homes to Open for Visitors

CMS cites benefits of interaction for residents, threatens citations if homes don't comply

spinner image Marlys Meckler, 81, on left, meets with her husband, Milton Meckler, 87, at his assisted living facility that opened its doors to visitors 6 months after the coronavirus restricted in-person visits.
September 10, 2020, St. Petersburg, Florida, USA: Marlys Meckler, 81, on left, as she met with her husband, Milton Meckler, 87, and gave him roses at an assisted living facility that has opened its doors to visitors after not permitting visitors for the past six months.
ZUMA Press, Inc. / Alamy Stock Photo

The federal government is urging nursing homes that aren't actively battling coronavirus outbreaks to welcome residents’ friends and loved ones for controlled reunions, with new guidelines released Thursday spelling out “reasonable ways a nursing home can safely facilitate in-person visitation.”

Nursing homes in most states are already allowing scheduled visits, but Thursday's guidance is the sharpest change to date of the federal visitation moratorium on nursing home visits implemented in March by the Centers for Medicare and Medicaid Services (CMS).

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The new guidelines warn nursing homes in counties with high rates of coronavirus infection to hold off on welcoming visitors. But if facilities haven't had a new case in 14 days and are in counties with low or moderate coronavirus spread, federal officials aren't only encouraging nursing homes to welcome visitors — they're threatening to issue citations to homes that don't have a valid reason for keeping their doors closed.

"Families and their loved ones have waited for months to see one another, and we know that family visits are an important way to spot problems and to make sure people are getting the care they deserve,” says Bill Sweeney, senior vice president of government affairs at AARP.

The new guidelines urge nursing homes to offer outdoor visits when weather and conditions permit. The guidelines also ask facilities to “accommodate and support” indoor visits, which many states have been reluctant to offer amid the pandemic. According to federal data, more than 54,000 nursing home residents have died from the coronavirus since the pandemic began.

"While CMS guidance has focused on protecting nursing home residents from COVID-19, we recognize that physical separation from family and other loved ones has taken a physical and emotional toll on residents,” David Wright, director of the quality and safety oversight group with the CMS, wrote in the memorandum.

Facilities are also encouraged to allow residents to resume eating in the same room and to participate in book clubs, exercise classes, bingo games and other activities, provided they maintain social distancing and wear masks when appropriate.

States to this point have mostly blazed their own trails in developing visitation policies in recent months, lacking a more defined federal set of guidelines. And although officials have argued that a state- and county-specific road map makes sense — since the virus has hit different communities at different times and with varying degrees of severity — the country's patchwork visiting requirements have created confusion and inconsistencies for residents and their loved ones.

"When it comes to nursing home operations, states really look to the feds. There needs to be a standardized approach to this,” says Brian Lee, executive director of the Families for Better Care advocacy group.

Long list of recommendations

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The new guidelines were issued shortly after a federally organized independent commission released a long-awaited analysis of the government's response to the pandemic. Although CMS Administrator Seema Verma has described the report as a “resounding vindication” of the government's efforts to keep nursing home residents safe during the pandemic, it includes a laundry list of recommendations for how to better combat the virus going forward.

"There has to be a little bit better accountability,” Lee says. “Hopefully this report is going to change the trajectory for how our nation is operating in this pandemic in these facilities and make things safer for the people living and working there."

At least some of the recommendations in the report, which was assembled by the 25-person Coronavirus Commission on Safety and Quality in Nursing Homes, appear to have worked their way into the latest CMS guidelines. Safe in-person visitation was listed as a priority in the commission's report and is a central pillar to the CMS update.

Similarly, the first recommendation in the commission's report relates to the development of a national nursing home testing strategy to prevent and control coronavirus outbreaks. Although the CMS guidelines stopped short of requiring that nursing home visitors be tested for the virus, they listed testing as an option nursing homes should consider before opening their doors. Testing is already required for staff and residents.

However, the new CMS guidelines — and the commission's overall recommendations — are unlikely to please everyone. It is still unclear how federal officials plan to enforce some of the new protocols. And despite nursing homes receiving billions of dollars in federal support, many facilities say they are still struggling to purchase enough personal protective equipment and coronavirus tests for residents and staff — items necessary for them to welcome visitors.

"It's a little unbelievable, and, frankly, it's outrageous, that we're still lobbying for personal protective equipment and testing and visitation and staffing — these same issues that we have known about for months,” Sweeney says. “We're still fighting to get just the basic stuff done."

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