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Visitation in Long-Term Care Facilities

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Residents of long-term care have been subject to strict visitation policies for months since the beginning of the COVID-19 pandemic.  These policies have had a significant effect on the health and well-being of residents.  Find information and resources below on the latest federal guidance on visitation, things to look for as visitors begin to be permitted into facilities, voting resources, and how to advocate for long-term care residents.

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Visitation and Quarantine FAQs

In March and April 2021, the Centers for Medicare and Medicaid Services (CMS)  and the Centers for Disease Control and Prevention (CDC) revised their guidance on visitation and quarantine.  Despite these changes, many families still have questions and concerns relating to visitation and quarantine.

Consumer Voice created a document reviewing Frequently Asked Questions by family members. Our responses are based on the CMS and CDC guidance and show how the guidance can be used to help families advocate for their loved ones.  The document also includes general advocacy strategies and tips if the facility is not following the guidance or is denying residents’ rights.


How Limitations on Visitations Have Affected Residents

Despite the efficacy of COVID-19 vaccinations, the precipitous decline of COVID-19 cases and deaths in nursing homes, and the relaxation of some visitation restrictions, residents and families continue to face limitations on visitation and daily activities.  In January 2021, Consumer Voice released a report detailing the devastating effects of lockdowns on nursing home residents. Six months later, Consumer Voice is still hearing from residents and families that residents are suffering from visitation limitations.  Additionally, residents continue to be significantly limited in their activities inside facilities, including being confined to their rooms, being unable to dine communally, and having little or no group activities.  

In May 2021, Consumer Voice began to survey both residents and families to gauge the current effects of visitation and activity limitations in nursing homes.  Families continue to report severe physical and mental decline of residents worsened by arbitrarily applied visitation policies. In addition, residents said they faced significant barriers to visitation and were struggling with isolation inside the facility because of limits on movement and group activities.  

Consumer Voice has released reports on both surveys:

The reports show that limitations on visitation and daily activities continue to harm residents. The reports’ findings also support Consumer Voice’s call for the lifting of all restrictions on visitation.


CMS Visitation Guidance

 The Centers for Medicare & Medicaid Services (CMS) released new guidance on March 10, 2021 around visitation for nursing homes.  It is effective immediately.  After a year of significant restrictions imposed because of COVID-19, the new guidance allows indoor and outdoor visits for all residents, except in limited circumstances.  Infection prevention protocols are still in place and must be followed by all visitors.  Visitation is allowed regardless of vaccination status. 

Nursing Home Visitation Guidance (QSO-20-39-NH)

Core Principles of COVID-19 Infection Prevention

CMS Fact Sheet (Spanish)

Consumer Voice's Summary, Key Takeaways, and Concerns

Conversation with Consumer Voice about using the guidance to open nursing home doors (4/30/2021)

Webinar on revised guidance with a presentation by Evan Shulman, CMS Director, Division of Nursing Homes (3/12/2021)


How Vaccinations Affect Visitation

The new CMS guidance allows indoor and outdoor visits for all residents, except in limited circumstances. Visitation is allowed regardless of vaccination status of residents or visitors, though vaccination is encouraged.

Vaccinated residents can now have close contact with visitors, including hugs.

Limitations on visitation may occur:

  • for unvaccinated residents if the COVID-19 county positivity rate is greater than 10% and less than 70% of residents in the facility are fully vaccinated;
  • for residents with COVID-19, regardless of vaccination status, until they have met criteria to discontinue precautions; or
  • for residents in quarantine, regardless of vaccination status, until they have met criteria to be released from quarantine.

CDC Guidance on Quarantine

The Centers for Disease Control and Prevention (CDC) updated their guidance (3/29/21) regarding infection prevention and control to prevent COVID-19 spread in nursing homes. It includes important information about when nursing home residents are required to quarantine.  Whether a resident should be quarantined depends on factors such as vaccination status, exposure to someone with COVID-19, and length of time outside of the facility. Read the summary from Consumer Voice providing basic information about quarantine and indicating when quarantine is necessary.

Accessing COVID-19 Vaccines in Long-Term Care Facilities

Until early April, the Pharmacy Partnership for Long-Term Care Program facilitated on-site COVID-19 vaccination of residents and staff at participating long-term care facilities through three on-site vaccination clinics. Although these vaccination clinics have concluded, all nursing home and assisted living facility residents and staff can receive a COVID-19 vaccine from the long-term care facility where they live or work.  Read our information sheet to learn more.


Making the Case for Compassionate Care Visits

Compassionate care visits are special visits in which a family member or other visitor provides comfort, support, and/or assistance to a resident whose well-being is suffering or at risk, or who is dying.  Read our fact sheet for information on what the Centers for Medicare & Medicaid Services (CMS) considers a compassionate care visit, what makes a compassionate care visit special and different from other visits, and when a resident can receive compassionate care visits, and further information on visitation.


What to Look for as You Start Visiting Again

The COVID-19 pandemic has significantly impacted residents of long-term care facilities and their families. In-person visitation restrictions imposed to reduce the spread of COVID-19 required residents and families to adapt quickly to other means of communication. As in-person visits resume, you will want to look for any changes in your loved one’s appearance or demeanor to get a better sense of the impact on him or her.  See our fact sheet.

  

Tips:

  • Ask your loved one about their experience
  • Ask how they like living there and what types of activities they have been doing
  • Ask if staff wear face masks and ask when/if they wear a face mask
  • Ask if they are getting the help they need from staff
  • Ask if they have been tested for COVID-19 or if they have seen any residents or staff who appear to have symptoms
  • Observe your loved one's appearance and demeanor
  • Have they lost or gained weight? Have their hair and nails been cut and cleaned and teeth brushed? Does their skin look healthy and is it free of bruises or sores?
  • Has your loved one's energy level changed? Are they confused or talking slowly?
  • Has their been a change in their physical abilities like the ability to walk or get in and out of bed?
  • Observe what is happening in the building
  • Are face masks being worn in the building and is there access to hand sanitizer?
  • Do rooms appear clean and well-maintained?
  • Do any staff members or residents appear to be experiencing COVID-19 symptoms?
  • Are their sufficient number of staff in the building?

Resources to Help You Advocate for Yourself or Your Loved One

The resources below provide information for residents and family members about how they can advocate

Part of being a good advocate is taking care of yourself, read our fact sheets for tips on how family caregivers and residents can take care of themselves during the COVID-19 pandemic.


What to Do If You Are Denied Entry

What can you do if you are denied the ability to enter a facility and visit your loved one?

  • Contact your Long-Term Care Ombudsman Program.  The Long-Term Care Ombudsman program advocates for residents of nursing homes, assisted living facilities, board and care homes, and similar adult care homes. LTCOPs provide information about how to find a facility and what to do to get quality care and they are trained to resolve problems. Find contact information for a program near you.
  • Contact your state legislators and local representatives.  Decision-makers need to hear from you!  Call or email your local officials and share what you are experiencing.

Share Your Story: What are you seeing as you resume visits?

Over the past several months, the Centers for Medicare & Medicaid Services (CMS) has updated its guidance on visitation in nursing homes.  Despite the updated guidance and significant decrease in COVID-19 cases in facilities, there are nursing homes that are still prohibiting visitation or placing inappropriate restrictions on how visitation and activities may occur.  We want to hear from residents of long-term care facilities and their family members about what your experience has been since CMS has updated its visitation guidance.  Consumer Voice is seeking your input so that we may use it to advocate, at the state and federal levels, on behalf of residents. 

Family Members and Friends Survey

Resident Experience Survey

Note: If you have previously completed these surveys earlier this year or last year, we invite you to complete the forms again as the questions have changed.


Connection Matters

Connections – to family, to friends, and to the community – are essential components of good health and quality of life for residents.  The months of restrictions on visitation in long-term care facilities and the inability of residents, families, and friends to be together during the coronavirus pandemic has emphasized the importance of connection, of relationships, and the impact they have on all of our well-being.  During this crisis, many creative ways of staying connected were shared that can be replicated and built upon in all communities.

See activity suggestions and resources for staying connected and engaged.