Despite ongoing guidance from federal officials that nursing homes should continue to keep their doors open to visitors, at least two states are now imposing stricter rules as COVID-19 cases surge amid the omicron variant. 

A new California health order, which went into effect Friday, requires nursing home visitors to show proof of full vaccination, a booster shot, and a negative COVID-19 test before entering any skilled nursing facility. If it’s a rapid antigen test, it needs to be done within 24 hours of the visit and if it’s a PCR test, it needs to be within two days of the visit, according to the California Department of Public Health order. The order continues through February 7, however, it could be extended.

Also on Friday, Gov. Kathy Hochul (D-NY) announced that beginning Wednesday, nursing home visitors will need to show proof of a negative COVID test within 24 hours of their visit and wear a surgical mask as opposed to a cloth one. While Hochul encouraged visitors to test at home in advance of their visit, so as not to tax nursing home workers, the state will be providing rapid antigen tests at the facilities. 

“This development is another unfortunate consequence of COVID,” Deborah Pacyna, director of public affairs for the California Association of Health Facilities, told McKnight’s. “While the goal of testing visitors to protect residents is commendable, tests are unavailable, and once again residents are isolated. Fortunately, the order is temporary and expires in three weeks.”

Providers across the country have asked for federal permission to screen visitors before allowing them access, but Centers for Medicare & Medicaid Services rules do not allow them to restrict visitors except when outbreaks exceed 30% of the resident population.

It’s unclear whether providers in states with local health orders blocking unvaccinated visitors could face federal regulatory scrutiny or penalties. The situation is certainly not the first in which state regulators have gone against federal rulemakers. In Florida, for instance, lawmakers have forbidden the use of vaccine mandates by private businesses, some of which fall under federal provisions for workers now being challenged in court.  

Last week during a call with industry stakeholders, CMS officials emphasized that nursing could still only close off visitor access in “very limited and rare exceptions.” The acknowledgement followed a Nov. 12 announcement by the agency that all nursing home visitors should be allowed “for all residents at all times.”

“We have seen the negative effects of banning visitation, which can lead to worse outcomes for people in nursing homes,” CMS Administrator Chiquita Brooks-LaSure said Thursday. “I strongly encourage nursing home facilities to use extra caution, such as creating dedicated areas for visitation to occur, if possible, preferably outdoors for those of you so fortunate to live in the warmer parts of the country, or in designated spaces with good ventilation.”