En español | With most nursing home residents nationwide having received their COVID-19 vaccinations and recent data showing a dramatic decline in COVID-19 cases and deaths since winter, the federal Centers for Medicare & 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 183,000 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 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 is 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.
For states that have adapted the 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 previous CMS 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.
Check where your state stands on nursing home and long-term care visitors. But you should also 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 laypersons 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.
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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
- observing them for any symptoms or signs of infection
Entry would be denied to anyone who has COVID-19 or symptoms of the illness or who has had close contact with a coronavirus-positive person in the previous 14 days.
The newest CMS guidelines do not require nursing home visitors to be vaccinated against COVID-19, although the agency encourages them to do so when they have the opportunity. Certain privileges may be granted to vaccinated visitors, such as being able to unmask with a vaccinated resident in a private setting, as recommended by the Centers for Disease Control and Prevention (CDC) in late April. But it’s likely these privileges will be offered on an honor system, given the CMS guidance says: “While visitor testing and vaccination can help prevent the spread of COVID-19, visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation.”
As such, the CMS guidelines also do not require visitors to get tested for COVID-19, although the agency suggests 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.
This change in federal guidance has led some states, such as Maryland and New York, to drop the testing requirements they had earlier in the pandemic as conditions of entry, although they still encourage testing prior to visiting. Alaska, on the other hand, is now requiring visitors for unvaccinated residents to show proof of their vaccination status or of a recent negative COVID-19 test.
Check where your state stands on nursing home and long-term care visitors and ask your loved one's facility about its regulations before you show up.
Will I have to wear a mask and stay 6 feet from my loved one?
According to new recommendations from the CDC, when both the resident and visitor are fully vaccinated (meaning both are two or more weeks past their final vaccine dose), they can unmask alone in the resident’s room or in a designated visitation room and have close contact or touch (for example, hugging and holding hands).
But don’t leave your mask at home: Visitors should wear masks at all other times during their visit and stay 6 feet from health care personnel and other residents and visitors who are not part of their group.
If a resident is fully vaccinated but his visitors are not, close contact and touch are allowed, but all present should continue to wear a mask. The safest approach, however, is for everyone to maintain physical distancing, per CDC guidance.
If a resident is not fully vaccinated, parties should wear face coverings and maintain the appropriate physical distance.
Face-covering and physical distancing remain “core principles” for preventing new nursing home outbreaks in federal guidelines. To maintain distancing in accordance with 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
- 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 yourself and your loved one in a nursing home vaccinated against COVID-19. All vaccines available in the United States have been proved to be safe and effective at preventing the coronavirus. Vaccination greatly reduces people’s risk of contracting the virus and keeps those who do contract it from getting seriously ill, the CDC says. Also, once you are fully vaccinated, you can live with fewer restrictions, such as unmasking in private settings with other fully vaccinated people.
Also consider getting a COVID-19 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.
Editor's note: This story, originally published in May 2020, has been updated to reflect new information.