Evan Shulman

The Centers for Medicare & Medicaid Services is not ready to update nursing home visitation guidance, despite a significant drop in COVID-19 cases following widespread resident vaccinations, a top official said Thursday. 

“For the current time, all existing recommendations and guidance for visitation need to be adhered to,” Evan Shulman, CMS director for the Division of Nursing Homes, said during a LeadingAge call for members. 

“First, it’s too early,” he added. “We do hear that pretty much the vast majority of residents in nursing homes all received their first dose by the end of January, which is great news. But we have to remember that it’s a two-dose deal and that the immunization period occurs about 10 days after the second dose.”

Shulman noted that even though cases are plummeting, which he called “exciting,” it’s unclear whether 100% of that decline can be attributed to vaccinations. He added health officials don’t yet know if the vaccine prevents transmission or how well it will hold up against COVID-19 variants. 

Shulman said those three issues convinced agency officials they “cannot change our visitation or other guidance now at this moment in time, but we are looking at it and want to change it as soon as possible.” 

“Until then, everyone needs to keep doing what you’re doing, adhere to all infection control guidelines, when it’s your chance to get vaccines [then] get vaccinated and as more people get vaccinated then more visitation will occur,” he said. 

Shulman explained that current guidance does not restrict communities from resuming some internal activities, such as opening dining rooms, if infection control practices and social distancing are maintained. Nor does it restrict all visitation, instead offering scenarios during which visitation can happen.

“As cases fall, visitation will naturally be able to be increased through our guidance,” he said. 

No collaborative surveys

Shulman also addressed survey enforcement and the possibility of more collaborative, less-punitive nursing home surveys in the future.

A LeadingAge moderator said many members had been pleased by the willingness of surveyors to work through issues that surfaced in pandemic-era focused infection control surveys in real time.

Shulman said it isn’t surprising those surveys seemed more collaborative because “everyone was learning about COVID at the same time.” But nursing homes should not expect the same approach as more routine inspections resume, he warned.

“We do not support collaborative surveys and here’s why: The foundation of oversight depends on accountability from a regulator and the people that it regulates,” Shulman said. “That needs to be objective.”

“There are numerous ways nursing homes can get collaboration and quality improvement,” he added. He suggested nursing homes looking for collaborative approaches to improvement use free resources from local health departments and Quality Improvement Organizations. He also stressed the importance of pursuing systemic improvements through Quality Assurance & Performance Improvement programs. 

“But there is only one way, one lane, one avenue where we hold nursing homes accountable through compliance and that is through the survey process,” Shulman said. “The integrity of that process needs to be maintained through an objective assessment.”