Providers establishing essential caregiver programs will likely face a balancing act between complying with federal and state guidance and addressing resident isolation — issues that will continue as long as federal visitor restrictions remain in place during COVID-19 and in future public health crises. 

In a new paper, LeadingAge detailed how dozens of states have used the programs to keep residents connected with visitors in accordance with guidance established by the Centers for Medicare & Medicaid Services.

Reopening facilities to visitors has been a key issue since nursing home coronavirus cases and deaths started to drop at a rapid rate following widespread vaccinations. LeadingAge on Wednesday called on the federal government to rethink its regulations on indoor visitation policies following the vaccines’ administration. AARP has also echoed those sentiments. 

Most states define the essential caregiver as a person who was providing care or who already established a relationship with the resident prior to the pandemic, the group explained in the report. All states are also consistent with CMS guidance and require providers and caregivers to adhere to core infection control principles, set limitations on where the caregiver can be in the facility and allow providers to revoke access. 

LeadingAge explained that while the programs generally tend to follow federal guidance, they do differ from regulations in two ways: visitor restrictions during an outbreak and basing visitor access off on prevalence of COVID-19 in the community. 

A little more than half of essential caregiver programs reviewed allow essential caregivers to enter facilities during an outbreak, and most states allow essential caregivers without regard to the county positivity rate, LeadingAge explained.

Plenty of questions also still remain. 

“Should nursing homes designate essential caregivers for residents in a time-limited manner to address acute issues, such as weight loss or dehydration, only? What about residents for whom the need is ongoing,” the group asked. 

“If a state does not consider essential caregivers as staff, subject to testing and training, and determines that the essential caregiver program did not meet the description of a compassionate care visit given the routine nature of the visit, are caregivers simply ‘visitors?’ How then does the state allow for essential caregiver visits during outbreak, high positivity, and transmission-based precautions?” 

The group added that essential caregivers may be a step in the right direction, but more information is needed. Even if visitors are once again allowed to enter nursing homes routinely during the COVID-19 emergency, officials in states such as Indiana have set up their caregiver programs as permanent solutions for future public health crises.

“To move forward, we must confront these questions,” LeadingAge concluded in its report. “Most immediately, nursing homes choosing to implement an essential caregiver program must balance state and federal compliance. States developing these programs must carefully consider public health recommendations and weigh risks versus benefits. Careful planning and evaluation will help us address these issues more effectively during the next pandemic.”