Visits to Most Nursing Home Residents Again Allowed

Today marks the year anniversary of when the coronavirus disease 2019 (COVID-19) pandemic officially started its siege upon the United States and the rest of the world. The siege actually began in December 2020 (or maybe November 2020, depending on which estimate one uses), but on March 11, 2020, the World Health Organization (WHO) officially labeled COVID-19 a global pandemic.

The nexus of COVID-19 infection—resulting in a big proportion of the victims—festered in nursing homes and other long-term-care facilities (LTCFs). About 172,000 of the nearly 530,000 people who have died from COVID-19 in America—nearly 35%—were either residents or workers at nursing homes, the New York Times reported last month.

And as Infection Control Today® (ICT®) has reported, COVID-19 casualties are particularly heartbreaking for friends and families because the contagious nature of the disease means that the persons often have to die alone.

No mention of the COVID-19 anniversary made the official announcement yesterday by the Centers for Medicare and Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), that the agencies will relax restrictions for visiting residents in nursing homes and other LTCFs. Still, in so many words, they said enough is enough. The agencies noted the psychological, emotional, and physical harm that prolonged isolation afflicts upon LTCF residents. The 3 million vaccinations administered in nursing homes and the fact that nursing home COVID-19 deaths have plummeted over the last month, mirroring the death rate trend in the rest of the country, made the decision easier.

Lee Fleisher, MD, the director of CMS’ Center for Clinical Standards and Quality, said in the press release that “that is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely.”

The updated guidance encouraged LTCFs to allow indoor visitation for all residents at all time no matter what the vaccination status of the resident or the victim might be.

“High vaccination rates among nursing home residents, and the diligence of committed nursing home staff to adhere to infection control protocols, which are enforced by CMS, have helped significantly reduce COVID-19 positivity rates and the risk of transmission in nursing homes,” the press release states.

No more dying alone, because the updated guidance “emphasizes that ‘compassionate care’ visits should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak. Compassionate care visits include visits for a resident whose health has sharply declined or is experiencing a significant change in circumstances.”

The updated guidance doesn’t allow visitation carte blanche; there are some exceptions. According to the press release, visitations would be limited for:

• Unvaccinated residents, if the COVID-19 county positivity rate is greater than 10 percent and less than 70% of residents in the facility are fully vaccinated;
• Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions; or
• Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

COVID-19 unveiled serious systemic problems at LTCFs that will be fodder for public debate and possible remedies in the years to come. Those problems, as reported by ICT®, include the absence of state mandates that the facilities should be staffed with fulltime infection preventionists, something that the Association for Professionals in Infection Control and Epidemiology (APIC)continues to lobby for.The current political woes besetting New York Gov. Andrew Cuomo began with a scathing report by New York Attorney General Letitia James—Nursing Home Response to COVID-19 Pandemic—which takes state health care officials to task for their management of nursing homes during the pandemic.

Despite not having anywhere near the financial resources that hospitals have, there are cost-effective ways to operate nursing homes, as Linda Spaulding, RN, BC, CIC, CHEC, CHOP, and a member of ICT®’s Editorial Advisory Board outlined in an article in ICT® last July. And Cedric Steiner, a nursing home administrator, recently wrote an article for ICT® about one nursing home in particular that managed to hold off COVID-19 and the ways it did so.