CMS Administrator Seema Verma speaks in mid-September in Washington D.C. following the release of the national nursing home commission’s report.

Providers who fail to facilitate in-person visitations “without a reasonable clinical or safety cause” could be cited and face other penalties under new guidance issued Thursday by the Centers for Medicare & Medicaid Services.

The agency updated its guidance on nursing home visitation during the COVID-19 pandemic, which creates a framework for providers to facilitate in-home visitation, and resume communal activities and dining. 

The agency stated in a memo that it believes the guidance represents reasonable ways a nursing home can facility in-person visitation and failure to do so “without adequate reason related to clinical necessity or resident safety” would constitute a potential violation. It could also lead to a citation and enforcement actions.

“No one should be forced to weather this pandemic alone — especially the most vulnerable among us — so we’re using every lever at our disposal to ensure America’s seniors in nursing homes can continue seeing loved ones in a safe way,” CMS Administrator Seema Verma wrote in an op-ed Thursday. 

Core principles 

The guidance explains that outdoor visits are preferred because it poses a lower risk of transmission due to increased space and airflow. Facilities should accommodate and support indoor visits, beyond compassionate care situations, if there have been no new cases in the last 14 days and visitors adhere to core principles. 

Providers must adhere to the “Core Principles of COVID-19 Infection Prevention” in order to conduct visits. Those principals include screening everyone who enters the facility, cleaning and disinfecting frequently touched areas often and conducting resident and staff testing. Nursing homes can restrict access to visitors who don’t adhere to the core principles. 

Nursing homes also should limit the number of visitors per resident and the number of visitors in the facility at a single moment, and limit movement within the facility. The guidance also recommends that visits can occur at facilities in areas with low or medium COVID-19 county positivity rates; while visits at facilities in areas with high rates should only occur for compassion care situations.  

The moves come a half year after the agency suspended visitor access, communal dining and all group activities in mid-March. CMS stated though the initial guidance was focused on protecting residents from COVID-19 it has since recognized that “physical separation from family and other loved ones has taken a physical and emotional toll on residents.

“CMS understands that nursing home residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends. In light of this, CMS is revising the guidance regarding visitation in nursing homes during the COVID-19 [public health emergency,]” the agency wrote in the memo. 

Vice President Mike Pence and CMS
Administrator Seema Verma speak

Praise for nursing home commission

Vice President Mike Pence said the release of an extensive report by a national nursing home commission laid the framework for resuming in-person visits at nursing homes.

“The recommendations’ today that will lay a framework for communities to begin opening up once again — open up for in-person visitation in our nursing homes. I know it’s going to be a blessing for families across the country,” he said during a routable discussion Thursday with several commission members. 

“Setting up this commission was a great idea. It really helped guide our efforts and essentially after looking at the results of the report it validated all of the work that we’ve done,” Verma added. 

Pence also assured that the federal government “will continue to do our part to make sure that we scale testing and provide testing supplies, including point-of-care testing that makes it possible to be able to visit.”