Expanded Visitation Rules for Nursing Homes

State officials are recommending easing some visitor restrictions at Kansas nursing facilities

Governor Laura Kelly and Kansas Department for Aging and Disability Services (KDADS) Secretary Laura Howard this week revised recommendations for nursing facilities to expand visitation in response to significant reductions in COVID-19 infections and transmission resulting from ongoing infection control practices, and high vaccination rates in the nursing home population.

“This updated guidance is great news for Kansans with loved ones in long-term care facilities and proof that our efforts to slow the spread of COVID-19 are working,” said Governor Laura Kelly. “While this is another step towards our return to normalcy, I encourage all Kansans to follow the guidance, continue to mask up, and receive the vaccine when it is their turn.”

According to Memorandum QSO-20-39-NH-Revised issued March 10, 2021 by the Federal Centers for Medicare and Medicaid Services and effective immediately, “… vaccines have received Emergency Use Authorization from the Food and Drug Administration. Millions of vaccinations have since been administered to nursing home residents and staff, and these vaccines have been shown to help prevent symptomatic SARS-CoV-2 infection (i.e., COVID-19). Therefore, CMS, in conjunction with the Centers for Disease Control and Prevention (CDC), is updating its visitation guidance accordingly, but emphasizing the importance of maintaining infection prevention practices, given the continued risk of COVID-19 transmission.”

CMS directs that visitation can be conducted through different means based on a facility’s structure and residents’ needs, such as in resident rooms, dedicated visitation spaces, outdoors, and for circumstances beyond compassionate care situations. Regardless of how visits are conducted, QSO-20-39-NH-Revised  outlines certain core principles and best practices consistent with the Centers for Disease Control and Prevention (CDC) guidance for nursing homes that reduce the risk of COVID-19 transmission and should still be adhered to at all times.

“Our Survey, Certification and Credentialing Commission has been acutely aware of the need to keep residents and workers in faculties healthy and safe during this pandemic by conducting inspections and investigations and at the same time they have worked very hard to offer and help implement programs that have allowed residents and their loved ones to communicate during the visitation restrictions using technology and other alternative methods,” KDADS Secretary Laura Howard said. “This new guidance is welcome news because we all recognize the emotional and physical toll being separated has on our seniors.”

Key revisions outlined in the new CMS memorandum include, but are not limited to:

  • Outdoor visitation:
    • While taking a person-centered approach and adhering to the core principles of COVID-19 infection prevention, outdoor visitation is preferred even when the resident and visitor are fully vaccinated* against COVID-19. Outdoor visits generally pose a lower risk of transmission due to increased space and airflow. *Fully vaccinated refers to a person who is ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine, per the CDC’s Public Health Recommendations for Vaccinated Persons.
  • Indoor visitation:
    • 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 (note: compassionate care visits should be permitted at all times). These scenarios include limiting indoor visitation for:
      • Unvaccinated residents, if the nursing home’s COVID-19 county positivity rate is >10% and <70% of residents in the facility are fully vaccinated
      • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the criteria to discontinue Transmission-Based Precautions; or
      • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
    • Indoor visitation during an outbreak:
    • Visitor testing and vaccination:
      • We encourage visitors to become vaccinated when they have the opportunity. While visitor testing and vaccination can help prevent the spread of COVID-19, visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation. This also applies to representatives of the Office of the State Long-Term Care Ombudsman and protection and advocacy systems.
    • Compassionate care visits:
      • Compassionate care visits, and visits required under federal disability rights law, should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak.
      • If the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after. Regardless, visitors should physically distance from other residents and staff in the facility.

KDADS recognizes there are other long-term care settings in Kansas not subject to the guidance issued by CMS for certified nursing facilities. Using federal guidelines as a road map, KDADS has issued its Visitation Guidance for Long Term Care Settings for those facilities throughout the state.