Across the country, long-term care facilities are vaccinating their staff and residents, with approximately 3.1 million doses delivered as of last week and rates of COVID-19 infection in nursing home residents declining for the past four weeks. 

This excellent news leads to questions about how the vaccination rollout will impact the daily lives of staff and residents who have been under lockdown since last March. 

Residents, families and staff are eager to return to as many of their previous activities as possible, yet understandably wary given their experiences during the pandemic. The past year has been marked by tragic loss, shifting safety guidance, inconsistent availability of personal protective equipment in some areas and other challenges. 

Those in long-term care have many questions regarding when and how to loosen restrictions. Answers to some of them may be on websites such as the Centers for Disease Control and Prevention or the Centers for Medicare and Medicaid Services, or found in the news media, but it would be helpful to have one easily navigated site geared specifically to their concerns. 

For example, while this CMS offering, Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes, provides a list of various state guidelines and best practices, it doesn’t contain post-vaccination information and its state-by-state approach is confusing. 

In contrast, I found this article, Answers to All Your Questions About Getting Vaccinated for Covid-19, with a dropdown menu, to be informative and easy to navigate. Each answered question offers links to additional information, including to each state health website when relevant. It contains an experimental tool using machine learning to help readers find the answers to their questions within the document and for the authors to get input about what information has yet to be addressed. 

It would be helpful as we navigate the process of emerging from lockdown to have a data-driven, up-to-date document with a title such as, Answers to All Your Questions About Reopening Nursing Homes.

Below are examples of questions that could be included:

Visitors and off-campus pass restrictions:

  • Can residents who have been vaccinated go out on day passes with their family members if the community rate is low? What’s an acceptable community rate?
  • If residents can go on day passes, do their family members need to have been vaccinated? Or show proof of being COVID-19 negative within three days? Or do they need a rapid response test? Who pays for those tests?
  • If a resident goes out on pass, can they come back to their room or do they need to be quarantined?
  • Can family members visit on site? What type of restrictions are needed now?

Resident/Unit restrictions:

  • Do all new residents need to be quarantined? For how long?
  • If residents declined the vaccine, should they be transferred to a unit for unvaccinated people?
  • If all the residents on a unit are vaccinated, can we have regular activities again? Vaccinated entertainers? What restrictions are needed?
  • Can the hair stylist come back into the facility? 
  • In facilities with elevators, is this a potential area of transmission? Should we have COVID-19 elevators for transportation of infected residents to medical appointments?

Fully vaccinated workers: 

  • Can I still transmit the virus?
  • Can I visit people outside of work who have not yet been vaccinated?
  • How many masks do I need to wear at work?
  • How many masks do I need when I’m off duty?
  • Will I need a booster shot for the new variants?

Unvaccinated workers:

  • Should there be any restrictions on staff members if they declined the vaccine? 
  • Can unvaccinated staff members work on a unit with residents who are positive for COVID-19?
  • Is there sufficient virus protection for unvaccinated staff members if they already have antibodies? 

Whatever the format for information delivery, in order to begin the cautious loosening of restrictions in long-term care facilities there will be a need for clear, consistent communication at all levels. Some decisions will be left to each state, but many others flow from national and international data about transmission of the virus.

Despite the challenges of safely reopening facilities, it will be highly rewarded — by reuniting elders with their families and by a return to vital aspects of long-term care that have been missing for almost a year. 

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at