The Centers for Medicare & Medicaid Services (CMS) issued Frequently Asked Questions (FAQs) on Nursing Home Visitation on June 23, 2020. The FAQs provide clarification to many common provider questions since CMS published its reopening nursing home recommendations on May 18, 2020. Here are some of the key points to be aware of.
Factors to Consider When Reopening
The FAQ repeats the recommendation that CMS made regarding factors in the community and the facility itself to be assessed before opening, including:
- Community Case Status
- Nursing Home Case Status
- Nursing Home Staffing Adequacy
- Adequate Supply of PPE for Staff
- Adequate COVID-19 Testing Access
- Local Hospital/Referral Hospital Capacity
While a number of nursing homes have gotten many of these factors addressed, with recent upticks in community spread, whether due to loosening restrictions or due to more testing, what is going on in the surrounding community continues to be a key factor in whether a nursing home considers opening its doors to visitors. The FAQ clearly states that CMS does not recommend nursing homes reopen to visitors with the exception of compassionate care situations until phase three when the above criteria have been met.
Clarity on “Compassionate Care Situations”
The FAQ includes information on visitation related to what is considered an appropriate compassionate care visit – which probably would have been helpful for providers to know several months ago. The example that CMS has been using in its guidance and recommendations relates to end-of-life care scenarios, and that strict limit to visitation has been what providers have been using for their policies. Now, in this new FAQ, CMS states that the term “compassionate care situation” does not exclusively refer to end-of-life situations. Instead, providers could have considered visits for newly admitted nursing home residents who had been living with their family before entering a nursing home. This is because the environmental change and lack of family could be considered traumatic to the resident. Another example would be allowing an individual to visit a resident whose family member or friend had recently passed away. Hopefully, providers were able to accommodate these and similar types of visits as necessary for their residents over the past few months, but if not, going forward this is a helpful clarification.
The FAQ does, however, state that even these types of visits should not be routine and only be allowed on a limited basis. Additionally, these situations still require facilities to ensure that visitors receive appropriate screening, perform hand hygiene and practice social distancing. Both the visitor and the resident should wear a cloth face covering/facemask for the duration of the visit. These visits can be conducted in “safe spaces” created by the facility, which many facilities have been doing by putting in drive-through visiting with clear separators.
Flexibility in “creative” visitation prior to Phase 3 of Reopening
The CMS FAQ states that its guidance does provide some flexibility for a facility to get creative with their visitation prior to Phase 3 of Reopening Nursing Homes becoming effective. Facilities, per the FAQ, can create space, such as outdoor space, for residents who do not have COVID-19, including residents who have fully recovered. All precautions to prevent the transmission of COVID-19 that have been in place must be followed. Additionally, if outdoor visits are being conducted, the number of visits occurring simultaneously should be restricted, as should the number of visitors for each resident.
Residents who have COVID-19, are suspected of having COVID-19 or who are in isolation for observation should not have in-person visits. The same applies to visitors. Visitors who have tested positive for COVID-19 or who have symptoms consistent with COVID-19 should not go to a facility for a visit. However, visitors who have tested negative for COVID-19 may be able to visit under “creative” means. This is because of the potential gaps in time between the negative test and the visit, and thus, these visitors must follow the same transmission precautions as others – social distancing, appropriate hand hygiene, and wearing appropriate cloth face coverings/face masks.
In its reopening recommendations, CMS stated that communal dining and some group activities could be conducted, for certain resident groups, but excludes residents with COVID-19 symptoms or who are confirmed COVID-19 positive. The FAQ clarifies that some group activities may take place for:
- Residents who have fully recovered from COVID-19
- Residents who are not isolation for observation, are suspected to have COVID-19 or are COVID-19 positive
In general, CMS states that nursing homes are encouraged to run any decisions to relax their visitation requirements or implement creative solutions for visitation by state and local officials. The above-mentioned factors should also be considered.