CMS Relaxes Guidance on Nursing Home Visitation, Could Influence Assisted Living Policies

Senior living providers across the United States have begun relaxing their visitation policies in recent weeks, as Covid-19 vaccination has brought down the risk of infections. Now, the Centers for Medicare & Medicaid Services (CMS) has relaxed its guidance governing visitation in nursing homes, further accelerating a return to more normal operating procedures in senior housing and care settings.

“Facilities should allow indoor visitation at all times and for all residents (regardless of vaccination status), except for a few circumstances when visitation should be limited due to a high risk of Covid-19 transmission,” CMS wrote in an updated memorandum issued Wednesday.

The CMS memo was released in conjunction with updated visitation guidance for post-acute health care settings and nursing homes from the Centers for Disease Control & Prevention (CDC).


Assisted living is largely regulated at the state level, and providers have been following state guidelines regarding visitation rules, which have varied across the country. States may refer to the new CMS and CDC guidelines as they make determinations about these rules in the days and weeks ahead.

CMS issued the new guidance almost one year to the day after the agency issued guidance restricting visitation as the Covid-19 pandemic swept across the United States. While the agency is taking steps to ease the “physical and emotional toll” that isolation has taken on nursing home residents, the new guidance does come with some caveats, including:

— Outdoor visitation is still “preferred,” given that these visits pose a lower risk of Covid-19 transmission


— Indoor visitation should be limited for unvaccinated residents if the Covid-19 positivity rate for the county is greater than 10% and less than 70% of the facility’s residents are fully vaccinated

In addition, residents with confirmed Covid-19 infection and residents in quarantine would need to meet certain criteria before being allowed to engage in indoor visitation.

The CMS memo also outlines how indoor visitation should be approached if Covid-19 outbreaks occur in certain parts of a nursing home. And, the memo addresses visitor testing and vaccination, noting that visitors should not be required to be vaccinated or tested for Covid-19 as a condition of visitation. Compassionate care visits should be allowed at all times.

Leaders with senior housing and care industry associations praised the CMS memo.

“The health and wellbeing of our residents will improve thanks to this important guidance,” Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, stated. “It is critical that public health officials continue to prioritize vaccines for long term care residents and staff in order to help facilitate these reunifications.”

LeadingAge President and CEO Katie Smith Sloan noted that there is “no substitute for an in-person visit” for residents.

“With today’s announcement, federal policy now reflects the real progress that has been made in vaccinating nursing home residents and staff,” she said. “This is the right thing to do.”

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