The federal government on Friday directed the nation's 15,000 nursing homes to open up their doors and allow visits for “all residents at all times,” dropping many of the remaining COVID-19 restrictions. “At this time, continued restrictions on this vital resident’s right are no longer necessary,” the Centers for Medicare & Medicaid Services (CMS) said in the revised guidance.
Citing a national COVID-19 vaccination rate of 86 percent among residents and “dramatically reduced” weekly COVID-19 infections, the new guidance says nursing homes can no longer limit the frequency and length of visits, limit the number of visitors, or require advance scheduling.
Visits must also be allowed to take place indoors for all residents, whether they’re vaccinated or not, even when a facility is experiencing a COVID-19 outbreak investigation or when a resident is on transmission-based precautions or quarantine. While visits under such conditions are “not recommended” by the CMS, they must be allowed if that’s what a resident chooses.
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The updated guidance represents “our most comprehensive action to bring residents and loved ones closer together,” the CMS said, but it stops short of opening facilities to visitors who have a positive COVID-19 test, who are showing symptoms of COVID-19, or who currently meet the criteria for quarantine. CMS says that facilities should screen all visitors for these exclusions.
“We are pleased that the CMS is taking a person-centered approach to expanding visitation so that residents can exercise their rights and avoid the isolation and other challenges that too many have experienced during the pandemic,” said AARP's Rhonda Richards, a senior legislative representative. "But it’s important to remain vigilant and follow important infection prevention measures.”
Although the new CMS guidance offers more freedoms, it reinforces that “visits should be conducted in a manner that adheres to the core principles of COVID-19 infection prevention and does not increase risk to other residents.” It says all residents and visitors should wear face coverings and physically distance during visits to a nursing home where the surrounding community level of transmission is high, for example.
While the national COVID-19 death rate among nursing home residents is one-tenth of what it was during last winter’s devastating peaks, the virus has recently killed more than 2,000 residents per month, according to AARP’s ongoing analysis of federal nursing home data. That represents a sixfold increase in COVID-19 fatalities since early summer, when the death rate hit a low for 2021. In some states, like Montana and Wyoming, the death rate is near winter’s levels, despite a high proportion of residents being vaccinated this time around.
Many nursing homes are also navigating booster shots for residents and staff, as studies show waning efficacy, especially for older and immunocompromised people. As they do, more than a quarter of nursing home workers nationwide remain unvaccinated.
The CMS says it’s “concerned about the transmission of the virus from unvaccinated staff to residents” given that staff vaccination rates remain “significantly lower” than resident rates. However, a new federal mandate, which requires all nursing home staff be vaccinated against COVID-19 by Jan. 4 as a requirement for participating in the Medicare and Medicaid programs, aims to “ensure continued safety as facilities continue to open.”
The new guidance comes after 20 long months of visitation restrictions designed to reduce the risk of visitors introducing COVID-19 to a facility. Nursing homes went on lockdown in March 2020, barring residents from embracing their loved ones for an entire year. While the restrictions were designed to protect residents and staff from the virus — which has killed more than 186,000 in long-term care facilities, including nursing homes, assisted living facilities and others — they’ve also taken a heavy toll. Besides COVID-19 deaths, 40,000 more people than usual died in U.S. nursing homes last year, many from neglect and isolation, according to an Associated Press report published November 2020.