CMS Releases Updated Guidance on Nursing Home Resident Home Visits for the Holidays

Introduction

On November 18, 2020, CMS released an alert to nursing homes, their residents, and the residents’ family members for those residents that may want to leave the nursing home temporarily to visit family and friends for the holidays or go on other family holiday outings. CMS recommends against residents leaving the facility during the public health emergency because it increases the resident’s risk for exposure to COVID-19. The agency also recognizes the emotional and mental stress endured by nursing home residents and their families during the pandemic. With the holiday season starting, residents and their families will naturally want to spend more time together. During holidays past, visitation in and out of the facility increased. While encouraging continued safe in-facility visitation, less travel, and alternative ways to celebrate, CMS offers recommendations for residents and families that still want to celebrate at home.

Safe Visitation Inside and Outside the Nursing Home

This alert reminds facilities that its September 17, 2020 guidance for ensuring safe visits with residents in the facility has not changed. Nursing homes, residents, and visitors shall continue to follow CMS’ guidelines for in-facility visitation and adhere to the core principles of infection prevention, including wearing mask, social distancing, and limiting the number of visitors per visit. CMS also recommends that facilities try new ways to celebrate the holiday season that limit the risk of infection such as “virtual parties or visits” and offering “seasonal music, movies, decorations,” and other trappings. CMS’ alert includes a link to the CDC’s webpage on holiday celebrations for more suggestions on how to celebrate the holidays safely in the time of COVID-19. The CDC specifically discourages holiday travel stating that “postponing travel and staying home is the best way to protect yourself and others this year.”

Nonetheless, some residents and families will still choose to enjoy their holiday celebrations at home or outside the facility. A nursing home is only responsible for the safety of residents within its care, and nursing homes, residents and residents’ families should discuss the increased risks from COVID-19 infection outside the facility. If a resident leaves the nursing home even for a short outing, CMS proposes the following safeguards:

• Limit close contact (maintain physical distancing of six feet or more), keep gatherings as small as possible, and use technology to engage with others remotely;
• Wear facemasks or cloth face covering at all times (including in cars, homes, restaurants, etc.);
• Limit contact with commonly touched surfaces or shared items;
• Keep safe around food and drinks. Avoid communal serving utensils, passing of food, potluck, or buffet style food service, and instead opt for individually prepared plates by a single server;
• Perform hand hygiene often (e.g., wash hands with soap and water or alcohol-based hand sanitizer);
• Avoid large gatherings, crowded areas, and high-risk activities such as singing;
• For those attending a gathering, avoid contact with individuals outside of their household for 14 days prior to the gathering;
• Ask anyone who has signs or symptoms of COVID-19, or has been exposed to someone diagnosed with COVID-19, to not attend the gathering;
• If possible, conduct gatherings outdoors. Indoor gatherings should have good ventilation with open windows and doors if possible;
• Verbally greet others instead of shaking hands or giving hugs. Think ahead about how you will manage to prevent physical interactions with loved ones of different ages such as young children; and
• Check local conditions and state requirements for precautions and restrictions, including positivity rates and quarantine requirements, before crossing state lines.

When the resident returns, the facility should continue screening and monitoring for signs of the virus, test residents with symptoms or reported exposure, and place residents on “transmission-based precautions” (isolate and monitor) if the family reports possible exposure to COVID-19.

CMS further recognizes the danger of holiday gatherings for everyone in the facility and directs nursing home staff to follow similar safe practices when they are home for the holidays.

Conclusion

This alert builds upon CMS September guidance requiring facilities provide their residents an opportunity to visit safely with their families. Facilities should continue to hold the health and safety of residents paramount, but CMS has made clear that the emotional and physical well-being of nursing home residents requires expanded in-person visitation, and sometimes that means outside the facility.

If you or your practice have any questions about this guidance, please contact Peter Mellette, Harrison Gibbs, or Elizabeth Dahl Coleman at Mellette PC.

This client alert is for general educational purposes only. It is not intended to provide legal advice specific to any situation you may have and does not cover all the provisions of the new guidance. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice.