On Friday, March 13, 2020, Centers for Medicare & Medicaid Services (CMS) again revised its guidance for infection control and prevention of COVID-19 in nursing homes – this time to include guidance for visitation.
The new guidance applies to all facilities nationwide and calls for a restriction on visitation of all visitors and non-essential health care personnel. If a state issues a more restrictive ban, a surveyor cannot cite the facility for noncompliance with visitation requirements when complying with heightened state orders. Facilities should notify all potential visitors to defer visitation through signage posted at entrances/exits, letters, emails, phone calls, recorded messages, and other means by which the facility normally communicates.
Exceptions to the Restriction
1. Cases of compassionate care or end-of-life
These visits are to be evaluated on a case-by-case basis. Before a visitor is permitted into the facility, they must undergo careful screening for symptoms of respiratory illness including fever, cough, shortness of breath, or sore throat. If the potential visitor has any of these symptoms, they should not be allowed in the facility at any time.
If the visitor is permitted, facilities must require the visitor to frequently perform hand hygiene and use personal protective equipment, including a facemask. The visit should be limited to a specific room. This could either be the resident’s own room or another room designated by the facility.
2. Health care workers
Health care workers are permitted into facilities given they meet the criteria outlined by the CDC here.
Surveyors must be allowed to enter, unless they are exhibiting symptoms of respiratory illness.
Monitoring after Visitation
Facilities should advise any individual who is allowed in the facility to monitor themselves for symptoms of respiratory infection for at least 14 days and, if symptoms occur, to:
- self-isolate at home;
- contact their healthcare provider; and
- immediately notify the facility with details of their visit such as the date of visit, who they were in contact with, and the locations within the facility they visited.
Facilities should the immediately screen the individuals of reported contact and take appropriate actions.
Additional Updated Guidance
CMS added some general additional guidance for infection control, such as:
1. Canceling communal dining and group activities;
2. Implementing active screening of residents and staff for symptoms of respiratory illness;
3. Reminding residents of proper hand hygiene and social distancing;
4. Screening staff for and documenting symptoms of respiratory illness at the beginning of each shift;
5. If staff work at multiple facilities, actively screen and restrict appropriately so illness is not spread between facilities; and
6. Restricting access to the Ombudsman program per the guidelines above, but allowing review on a case-by-case basis.