Headshot of CMS Administrator Chiquita Brooks-LaSure

The Centers for Medicare & Medicaid Services on Thursday acknowledged “very limited and rare exceptions” that would allow nursing homes to restrict some visits.

Three major nursing home associations asked CMS Administrator Chiquita Brooks-LaSure last Friday for latitude to restrict some visits in light of recent COVID-19 omicron variant outbreaks. The agency posted a Frequently Asked Questions (FAQs) notice that appears, in part, to respond directly to that appeal. Providers urged “more flexibility to temporarily limit, restrict, or prohibit visitors from entering the facility.”

CMS announced Nov. 12 that all nursing home visitors should be allowed “for all residents at all times.” It reiterated that guidance Thursday, while also noting exceptions may exist.

In their letter, the American Health Care Association, LeadingAge and AMDA worried that “it appears that a facility is not permitted to place any restriction on visitation, regardless of staffing levels, community positivity rates, or severity of facility outbreak. We are concerned that the absolute, unconditional language may pose a risk to nursing homes and their residents, placing skilled nursing facilities in precarious situations when outbreaks occur.”

Consumer advocates immediately criticized what they saw as CMS softening on its original position. Research has well documented the adverse effects of isolation, especially on elders.

“The Center for Medicare Advocacy … is concerned that many nursing facilities failed to follow CMS’s absolute guidance in November and will exploit the December 23 FAQs to expand the ‘very limited and rare exceptions’ to bar or limit visitors,” the group said in an email alert to its followers.

As McKnight’s reported Tuesday, Canadian researchers found that residents without visits from family or friends early in the pandemic were far more likely to die. 

CMS explained in its FAQs that if physical distancing cannot be maintained, “facilities may restructure the visitation policy, such as asking visitors to schedule their visit at staggered time-slots throughout the day, and/or limiting the number of visitors in the facility or a resident’s room at any time. The Center for Medicaid Advocacy noted in its alert that, “CMS insists that ‘the facility must demonstrate that good faith efforts were made to facilitate visitation,’ but provides no guidance on what these efforts must be.”

The center intends to keep pressure on providers, and their government overseers. It went on to urge Congress to revise Thursday’s instructions and guarantee certain family visits by enacting the Essential Caregivers Act.

“If CMS has now identified a new need for limits on absolute visitation rights, which are guaranteed by the Nursing Home Reform Law, it needs to spell out specifically how and under what circumstances limits may be imposed,” the group said.

Of the more than 800,000 Americans who have died from the coronavirus, more than 140,000 have been involved with nursing homes.