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, the federal Centers for Medicare and Medicaid Services (CMS) is urging states to ease restrictions on in-person visits at long-term care facilities.
Where visits have resumed, they remain 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 some of those policies are likely to remain in place, 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."
Here is key information about the next steps toward reuniting with loved ones in long-term care.
Can I resume visiting my loved one?
State officials have generally followed CMS guidelines in restricting or opening up visitor access to nursing homes. If that pattern holds for the latest federal recommendations, you should soon be able to resume visits.
The updated federal guidance — which came after AARP and other advocates for older Americans called on the CMS to open up visitor access — urges nursing homes to allow indoor visitation in most circumstances, even if the facility or its community are considered to be in outbreak status for COVID-19. There would be a few exceptions — for example, if the resident you wish to see is infected, or if that person has not been vaccinated and community coronavirus spread in the surrounding area remains high.
Pending state adoption of those guidelines, visitation continues to depend largely 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's previous guidelines, issued in September 2020 and largely adopted by the states, recommended 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.
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?
The CMS is calling on states to allow indoor “compassionate care” visits in all circumstances. 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?
As it has throughout the pandemic, the CMS continues to recommend “screening of all who enter the facility for signs and symptoms of COVID-19,” including:
- checking visitors’ temperatures,
- questioning them about symptoms and potential exposure, and
- observing them for any symptoms or signs of infection.
Entry would be denied to anyone who has had close contact with a COVID-19-positive person in the previous 14 days.
The guidelines do not require nursing homes to test visitors for COVID-19. But they do suggest that facilities in areas with medium or high coronavirus transmission rates offer tests on-site where feasible or encourage visitors to get tested on their own, 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 remains 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 to ensure physical distancing, and states that have authorized visits are generally mandating that facilities enforce the 6-foot rule. The new federal guidance recommends that facilities allow some physical contact between residents and loved ones, such as hugging and holding hands, if the resident has been fully vaccinated and the visitor is masked. Visitors should remain at least 6 feet from other residents and staff.
To maintain distancing in accordance with state and federal guidelines, 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.