CMS Nursing Home Visitation Guidelines and Resources

The COVID-19 Public Health Emergency (PHE) tested many aspects of healthcare — especially infection control. It resulted in the emergence of new infection prevention strategies, including visitor restrictions in healthcare facilities. These were particularly important in nursing homes, where it’s challenging to keep a highly vulnerable population safe.

Visitation guidelines stabilized after the federal COVID-19 PHE ended. Learn more about the CMS nursing home visitation policies to see how they may affect your facility.

Infection Prevention

Before we discuss changes to CMS visitation guidelines for nursing homes, it’s worth noting the other infection prevention regulations that are in place. CMS collaborates closely with the CDC to ensure the most current practice standards are available for Medicare and Medicaid facilities.

Primary prevention is crucial to preventing transmission of COVID-19 in nursing homes. CMS regulations require all nursing home staff to be vaccinated against COVID-19 to participate in Medicare and Medicaid programs. Nursing home residents are also encouraged to get vaccinated. Their vaccination status should be documented as “up-to-date” or “not up-to-date” instead of “vaccinated” or “unvaccinated.”

Additionally, facilities must adhere to the CDC’s core principles of infection prevention, which include guidance such as:

• hand washing
• staff personal protective equipment (PPE) use
• cleaning and disinfecting, especially surfaces that are used at a high-frequency
• visitor education about infection control policies, such as mask use or hand hygiene, displayed throughout the facility

Quarantine Guidelines

The CDC and CMS support quarantining nursing home residents if they test positive for COVID-19. Facilities may adjust their quarantine guidelines based on recommendations from their state or local health departments. Here are the CMS quarantine guidelines for nursing homes:

• If a nursing home resident contracts an infectious illness, they shouldn’t participate in communal activities. They may be placed on transmission-based precautions or quarantine.
• Residents with a positive COVID-19 infection should be placed in a single-person room when possible.
• Residents are not required to quarantine after leaving the facility for less than 24 hours.
• If an outbreak occurs in a facility, residents in the affected area may be required to quarantine. The CDC recommends testing residents every 3-7 days until there are no new cases for two weeks.

Visitation Policies

CMS visitation guidelines for nursing homes recognize the psychosocial impact of allowing visitors. Nursing home residents benefit from socialization — it improves mood, promotes activity, and supports healthier overall well-being. Visitation also promotes patient-and-family-centered care, which can improve patient satisfaction at your facility.

This consideration, along with ensuring a sufficient number of nursing home residents are vaccinated against COVID-19 and other contagious pathogens, allows facilities to relax their visitation policies. Post-COVID-19 updates that may impact your facility include the following.

Open Visitation

Can a nursing home deny visitors? No, they can’t, according to CMS nursing home visitation regulations. Facilities may no longer restrict the number of visitors and the length or frequency of their stay.

CMS says nursing home residents have the right to make choices about their life in the facility that are significant to them, such as seeing their loved ones. They may also deny visitors. Facilities that violate CMS regulations may be subject to citation.

Facilities may enforce visitor restrictions for high-risk residents (for example, someone who is severely immunocompromised). However, restrictions can be overridden for compassionate care visits (such as an impending death). In the event of an infectious disease outbreak, facilities may consult with their local health department for assistance with visitation guidelines.

Masks

Mask mandates depend on community transmission rates. If a community is experiencing high transmission rates (or if the facility has an outbreak), CMS recommends everyone in the facility wear masks. If community transmission is not high, it’s up to the facility to implement the appropriate infection prevention measures. Decisions can be informed by CDC recommendations or consultation with state or local health departments.

Indoor Visitation

CMS nursing home visitation regulations allow visitors at all times, even during an infectious disease outbreak. Outdoor visitation is preferred, but facilities may not restrict indoor visits. Facilities should follow these guidelines for indoor visitation:

• Visitors should keep to the resident’s room during a visit, and avoid going to other parts of the facility during an outbreak.
• Physical contact is allowed, but residents and visitors should be made aware of their risk during the visit.
• Visitors may choose to take off their masks in a resident’s room unless a roommate is present.

Service Providers

Traffic in a nursing home isn’t limited to healthcare staff and residents’ families. Facilities must allow entry to all visitors, such as vendors and service providers, to be compliant with CMS nursing home visitation guidelines.

Anyone with an active infection should avoid entering the facility. Visitors should take precautions when visiting a resident with an infection. CMS says nursing home residents have the right to meet with a healthcare ombudsman, regardless of infection status.

Healthcare surveyors, who suspended operations during the pandemic, should proceed as usual. They are expected to take proper precautions to conduct surveys. Facilities should not deny entry to surveyors based on their vaccination status.

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