On March 10, 2021, the Centers for Medicare & Medicaid Services (CMS) confirmed that all nursing home residents can have visitors indoors: “Facilities should allow indoor visitation at all times and for all residents (regardless of vaccination status), except for a few circumstances when visitation should be limited due to a high risk of COVID-19 transmission.” A resident who is fully vaccinated “can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.” CMS and the Centers for Disease Control and Prevention recommend that facilities, residents, and families adhere to core infection control principles.
In three situations, CMS allows indoor visits to be limited (except for compassionate care visits, discussed below):
- Unvaccinated residents, the nursing home’s COVID-19 county positivity rate is more than 10%, and less than 70% of the residents in the facility are fully vaccinated.
- Residents with confirmed COVID-19, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions.
- Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
“Compassionate care visits,” expanded in the September 2020 guidance to include, in addition to end-of-life situations, other circumstances where residents are struggling, grieving, or needing cueing and encouragement, “should be allowed at all times, regardless of a resident’s vaccination status, the country’s COVID-19 positivity rate, or an outbreak.”
If there is a COVID-19 outbreak (defined as a single new case among residents or staff), “the facility should immediately begin outbreak testing and suspend all visitation (except that required under federal disability law), until at least one round of facility-wide testing is completed.” Indoor visitation can resume as follows:
If no additional COVID-19 cases are identified in other units of the facility, visitation can resume in units where there is no COVID.
If the first round of testing reveals one or more additional cases of COVID-19 in two or more units, the facility “should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.”
Although CMS encourages visitors to become vaccinated “when they have the opportunity,” facility should not require visitors to be tested or vaccinated “(or show proof of such) as a condition of visitation.”
CMS continues to recommend outdoor visitation, even when residents and visitors are fully vaccinated.
T. Edelman – March 11, 2021
 CMS, “Nursing Home Visitation – COVID-19 (REVISED),” QSO-20-39-NH (revised Mar. 10, 2021), https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf