As part of continuing efforts to contain the spread of the new coronavirus to vulnerable people in nursing homes, the Centers for Medicare and Medicaid Services (CMS), which regulates most skilled nursing homes, has issued new and very stringent guidelines restricting nearly all nursing home visitors https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf.
While the right of nursing home residents to visitation is protected by law, under federal and state emergency declarations, these protections have been temporarily suspended to help prevent visitors from infecting residents whose age or illness may make them very susceptible to the virus. https://www.whitehouse.gov/presidential-actions/proclamation-declaring-national-emergency-concerning-novel-coronavirus-disease-covid-19-outbreak/; https://www.gov.ca.gov/2020/03/04/governor-newsom-declares-state-of-emergency-to-help-state-prepare-for-broader-spread-of-covid-19/.
Under the most recent CMS latest guidelines issued on March 13, 2020, facilities should restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, for example when residents are near the end of life. Even in those cases, however, CMS requires that visitors be limited to a specific room only and must use hand hygiene and personal protective equipment.
CMS is requiring that facilities notify potential visitors to defer visitation until further notice.
Under the guidelines, exceptions to visiting restrictions exist for healthcare workers, hospice workers, EMS personnel, or dialysis technicians that provide care to residents. These personnel should be permitted to come into the facility as long as they meet the CDC guidelines for health care workers.
CMS emphasizes that, in lieu of permitting visits, facilities should consider:
- Offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.).
- Creating/increasing listserv communication to update families.
- Assigning staff as primary contact to families for inbound calls, and conduct regular outbound calls to keep families up to date.
- Offering a phone line with a voice recording updated at set times (e.g., daily) with the facility’s general operating status, such as when it is safe to resume visits.
CMS provides some specific additional guidance to nursing homes in addition to visitation rules, including:
- Cancel communal dining and all group activities.
- Implement active screening of residents and staff for fever and respiratory symptoms. Remind residents to practice social distancing and perform frequent hand hygiene.
- Screen all staff at the beginning of their shift for fever and respiratory symptoms.
It is crucial that residents of nursing homes, their families, and their friends make efforts to stay in contact with one another. Fostering these relationships, and speaking with facility administrators, will be key to ensuring that meaningful alternatives to in-person visits are provided. This can be done through email groups, Facebook pages, or even phone “trees”.
Finally, the coronavirus crisis in no way restricts the access of residents and their families to the ombudsman program. The name and contact information of the facility ombudsman should be displayed in public areas in the facility, but the ombudsman can also be located at the state website: https://www.aging.ca.gov/Find_Services_in_My_County/. While the ombudsman will likely be subject to the same visitation restrictions as other visitors, they can still offer advocacy by phone and email.