En español | With most nursing home residents nationwide having received their COVID-19 vaccinations and new data showing a downward trend in cases and deaths, states are moving to ease restrictions on in-person visits at long-term care facilities.
Where visits have resumed, they are very different from those before the pandemic, which has taken the lives of more than 170,000 long-term care residents and staff. Nursing homes have had to take many steps to minimize the chance of further transmission, and those policies won't change right away, even with residents having largely received their shots.
Though the vaccines “should considerably lessen risk” in long-term care facilities, “this does not mean that it is not important to practice diligence,” says Jennifer Schrack, an associate professor at the Johns Hopkins Bloomberg School of Public Health who specializes in the epidemiology of aging. “Precautions are still important. No visit is without risk."
The federal Centers for Medicare and Medicaid Services (CMS) laid out guidelines last September for state and local officials to use in determining when and how visitors can return, but there have been differences, from state to state and facility to facility, in when loved ones can visit and on what terms.
"Families need to have good communication with the facilities about what's going on in that facility,” says Lori Smetanka, executive director of the Consumer Voice, a nonprofit that advocates for the public on long-term care issues. “Are they following proper protocols? What are the expectations of the family or the staff? There needs to be really good communication and the setting of expectations so that everyone's on the same page."
AARP is urging the CMS to provide more updated guidance that makes it easier for family members and friends to safely visit loved ones in nursing homes, assisted living and other long-term care facilities. Here is key information about the next steps toward reuniting with loved ones in long-term care.
Can I resume visiting my loved one?
It likely depends on whether there are active COVID-19 cases in your loved one's facility, and possibly on case numbers in the surrounding community.
The CMS guidelines from September remain the agency's most recent word on the subject and have been largely followed by states. They recommend allowing indoor visits if a facility has been case-free for 14 days and is located in a county with a positivity rate on coronavirus tests of less than 10 percent.
For practical purposes, that kept facilities mostly closed to visitors as COVID cases and deaths surged nationally in late 2020, inside nursing homes and out.
In recent weeks, some states have released expanded visitation guidelines, or announced plans to do so soon, as the federal pharmacy program conducting COVID-19 vaccinations in most of the country's long-term care facilities wraps up. But case counts among staff and residents, and in surrounding communities, remain a major factor in determining visitor access.
Where visits are allowed, they generally must be by appointment, during specified hours. In some states, only one or two people are allowed to visit a particular resident at a time, and the overall number of visitors in a facility at a given time is capped. Ask your loved one's facility about its own regulations before you show up.
What about “compassionate care” visits? Can I see my loved one that way?
Even when a facility or the surrounding community is considered to be in outbreak status, the CMS and state regulations generally stipulate that exceptions can be made for “compassionate care” situations, at a facility's discretion.
Early in the pandemic, this was widely interpreted as meaning when a nursing home resident is near the end of life. But in its September guidance, the CMS spelled out other situations “consistent with the intent of compassionate care,” such as:
- A newly admitted resident is struggling with the change in environment and lack of physical family support.
- A resident is grieving for a recently deceased friend or family member.
- A resident needs prompting or encouragement to eat or drink, help previously provided by a loved one or other caregiver, and is experiencing weight loss or dehydration.
- A resident is showing signs of emotional distress from isolation, for example, speaking seldom or crying frequently.
The CMS says that the list of scenarios is not meant to be exhaustive and that compassionate care visits should not be limited to family members but “can be conducted by any individual that can meet the resident's needs, such as clergy or lay persons offering religious and spiritual support.”
A number of states, including Florida, Illinois, Indiana, Minnesota, Nebraska, New Jersey, Rhode Island, South Dakota and Texas, have adopted "essential caregiver” policies. Under these programs, nursing homes may allow greater access (for example, longer and more frequent visits) to a designated family member or other person who provides essential support to a resident, such as help with daily living activities like eating, bathing and grooming.
Talk to your loved one's facility or your local long-term care ombudsman about arranging compassionate care visits.
What kinds of health checks do nursing homes run on visitors?
The federal recommendations call for everyone entering a facility to undergo “100 percent screening,” including:
- checking visitors’ temperatures,
- questioning them about symptoms and potential exposure, and
- observing them for any symptoms or signs of infection.
The CMS guidelines do not require nursing homes to test visitors for COVID-19 but encourage them to do so if they are located in counties with medium or high rates of transmission, so that people who are infected but asymptomatic don't unknowingly infect others.
Some states have put this into practice. In Maryland, for example, a visitor must have tested negative within the previous 72 hours. New York also requires a negative test if the nursing home is in a county with a positivity rate above 5 percent, but the state is allowing facilities to do rapid testing at no cost to visitors, using state-provided kits.
Will I have to wear a mask and stay 6 feet from my loved one?
Almost certainly. Face-covering is one of the “core principles” for preventing new nursing home outbreaks listed in the federal guidelines and is a staple of state-level rules for resuming visitation.
The CMS also calls on nursing homes that allow visitors to ensure physical distancing, and states that have authorized visits are generally mandating that facilities enforce the 6-foot rule (except for some compassionate care or essential caregiver visits).
To maintain distancing, and in accordance with federal and state guidance, nursing homes are generally:
- limiting visitors’ movements within a facility, requiring them to go directly to their loved one's room or a designated visiting area;
- requiring visits to be scheduled in advance;
- permitting visits only during select hours; and
- regulating the number of people who can visit a resident, and the overall number of visitors on site, at any given time.
What else can I do to minimize risks to residents?
Consider getting a COVID test, whether or not the facility or your state requires it.
"Testing is much easier to access [than it was earlier in the pandemic], so it is a good idea to get tested before going,” says Schrack, the Johns Hopkins epidemiologist. And if you do feel even mildly ill, stay away.
Schrack also suggests keeping visits on the short side and having them outdoors when possible. “The longer you're in a small or enclosed space with somebody, the greater the risk of transmission,” she says.
Another option is to make some visits virtual. Videoconferencing and chat platforms like Zoom, Skype and FaceTime have been lifelines for residents and families during the pandemic, and continuing to use them at times even after lockdowns lift can minimize opportunities for illness to spread.
AARP is calling on nursing homes to prioritize virtual visits between residents and families as well as facilitating a return to in-person contact.
Editor's note: This story, originally published in May 2020, has been updated to reflect new information.