CMS Visitation FAQ; Mechanism for Pausing Visitation

In December 23, 2021, CMS issued frequently asked questions regarding visitation during the COVID-19 winter surge. The FAQ does reiterate that visitation is a patient right in all except rare situations. Long-term care must allow visitation following three key areas:

• 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.

However, the FAQ does allow for visitation pauses when necessary for safety of residents if all options are exhausted. This mechanism is outlined here:

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.

Long-term care can exercise this mechanism when visitation is not feasible due to outbreak. However, facilities show each action to provide safe visitation, and that they have exhausted all options to provide safe visitation during the outbreak.

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