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CMS FAQs Detail Best Practices and Key Elements for Skilled Nursing Visitation

Posted on December 27, 2021 in Health Law News, Long-Term Care, Home Health & Hospice

Published by: Hall Render

In an effort to clear the fog created by its recent skilled nursing facility guidance for visitation, CMS released a list of best practices and key aspects of visitation that skilled nursing providers should follow as they encounter certain scenarios.

On December 23, 2021, CMS released several questions and answers in “Nursing Home Visitation Frequently Asked Questions (FAQs)” (“CMS FAQs”) to provide clarifications to the revised memorandum that the Quality, Safety & Oversight Group at CMS issued on November 12, 2021, entitled “Nursing Home Visitation” that announced updated visitation standards for nursing homes.

CMS emphasized that nursing homes should enable visitation based on: (1) adherence to the core principles of infection prevention, especially wearing a mask, performing hand hygiene and practicing physical distancing; (2) avoiding having large gatherings where physical distancing cannot be maintained; and (3) working with state or local health department when an outbreak occurs.

Key clarification elements in the CMS FAQs include:

  1. Visitation and High Volume Visitor Periods.

The CMS FAQs provide that visitation should be allowed for all residents at all times. However, facilities should ensure that physical distancing can still be maintained during peak times of visitation and facilities should avoid large gatherings (e.g., parties and events). If physical distancing between other residents cannot be maintained, the facility may restructure the visitation policy, such as asking visitors to schedule their visit at staggered time slots throughout the day and/or limiting the number of visitors in the facility or a resident’s room at any time. CMS emphasized that it expects these strategies to only be used when physical distancing cannot be maintained. Also, if physical distancing cannot be maintained or infringes on the rights and safety of others, the facility must demonstrate that good faith efforts were made to facilitate visitation.

  1. Visitation and Masks.

The CMS FAQs detail that visitors, regardless of vaccination status, must wear face coverings or masks and physically distance from other residents and staff when in a communal area in the facility. CMS strongly recommends that visitors wear face coverings or masks when visiting residents in a private setting, such as a resident’s room when the roommate isn’t present, they may choose not to. Prior to visiting, facilities should make visitors aware of the risks of engaging in close contact with the resident and not wearing a face covering during their visit.

  1. Visitation and Roommates.

As long as physical distancing can be maintained, a visit may be conducted in the resident’s room with their roommate present. Visitors and residents should adhere to the principles of infection control, including wearing a mask and performing frequent hand hygiene.

  1. Visitation and Meals.

Visitors may eat with a resident if the resident (or representative) and the visitor are aware of the risks and adhere to the core principles of infection prevention.

  1. Visitation and Outbreaks.

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. CMS expects 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.

CMS offered the following example: In a nursing home where, despite collaborating with the health department over several days, there continues to be uncontrolled transmission impacting a large number of residents, 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 the CMS requirements.

Key Takeaways

Nursing homes should:

  • Document all efforts to educate and communicate with families and residents on visitation, best practices and risks.
  • Document all of their good faith efforts taken to facilitate visitation.
  • Revise their visitation policies and procedures.
  • Work with local health departments when outbreaks occur.

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Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer an individual’s questions that may constitute legal advice.