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CMS Issues Visitation FAQ Amid Winter Surge; Mechanism for Pause

As the Omicron-inflused Winter Surge has caused a steep climb in COVID-19 cases, CMS issued a visitation FAQ that provides a mechanism for a pause in rare outbreak situations.

CMS reminded nursing homes that visitation is a patient right, and they must:

• Adhere to the core principles of infection prevention, especially wearing a mask, performing hand hygiene, and practicing physical distancing;
• Don’t have large gatherings where physical distancing cannot be maintained; and
• Work with your state or local health department when an outbreak occurs.

Should a facility have an outbreak that is severe enough to warrant a visitation pause, CMS included the following mechanism:

Prior to the COVID-19 Public Health Emergency (PHE), there were occasions when a local or state health department advised a nursing home to pause visitation and new admissions due to a large outbreak of an infectious disease. Consultation with state health departments on how to address outbreaks should still occur. In fact, we remind nursing homes that they are still expected to contact their health department when any of the following occur, per CDC guidelines:

• • ≥ 1 residents or staff with suspected or confirmed SARS-CoV-2 infection
  • Resident with severe respiratory infection resulting in hospitalization or death, or
  • ≥ 3 residents or staff with acute illness compatible with COVID-19 with onset within a 72- hour period

While residents have the right to receive visitors at all times and make choices about aspects of their life in the facility that are significant to them, there may be times when the scope and severity of an outbreak warrants the health department to intervene with the facility’s operations. We expect these situations to be extremely rare and only occur after the facility has been working with the health department to manage and prevent escalation of the outbreak. We also expect that if the outbreak is severe enough to warrant pausing visitation, it would also warrant a pause on accepting new admissions (as long as there is adequate alternative access to care for hospital discharges). For example, in a nursing homes where, despite collaborating with the health department over several days, there continues to be uncontrolled transmission impacting a large number of residents (e.g., more than 30% of residents became infected*), the health department advised the facility to pause visitation and new admissions temporarily. In this situation, the nursing home would not be out of compliance with CMS’ requirements.

CMS does not have a specific threshold for what constitutes a large outbreak and this could vary based on facility size or structure. However, we emphasize that any visitation limits should be rare and applied when there are many cases in multiple areas of the facility.

 Any facility that needs to exercise this mechanism, must be prepared to demonstrate ot the Department of Public health all steps taken to provide safe visition, and show how vsafe visitation is not feasible during the outbreak.

The visitation FAQ is here, with the mechanism highlighted: Nursing Home Visitation Frequently Asked QuestionsCMS 12.23.2021