Moving to a nursing home or long-term care facility is often a difficult transition for an older person. Accustomed to living on their own or among family, they may find life in a facility more lonely. Unfortunately, the COVID-19 pandemic has made an already-challenging situation much harder for nursing home residents. As vaccination rates increase, and infection rates drop, how have nursing home resident rights to visitation changed?
The pandemic created a dilemma for long-term care facilities, which house some of the most frail elderly—those who were most vulnerable to the ravages of COVID-19. In order to keep residents safe, nursing homes initially severely curtailed visits or eliminated them altogether. Even with those measures, the virus has claimed the lives of over 183,000 nursing home residents and staff. Yet the toll might have been even worse had visitation not been limited.
States continue to take measures to protect skilled nursing facility patients and staff, but rules for nursing home visitation, in Michigan and elsewhere, have become much less restrictive.
Reporting by the Centers for Disease Control and Prevention (CDC) indicates that as of May 3, 2021, the number of confirmed nursing home resident COVID-19 cases has dropped to 0.99 cases per 1,000 residents. In contrast, at the end of December 2020, that number was 30.89 cases per 1,000 residents.
At the time of this publication, most nursing home residents have received their COVID-19 vaccinations, and AARP reports that nursing home infections and death continue to trend downward (though we’re not out of the woods just yet). In light of these developments, the federal Centers for Medicare and Medicaid Services (CMS) have encouraged facilities to ease up on visitation restrictions. Most states have followed the CMS guidelines.
Under the latest federal guidance, nursing homes should allow residents to have indoor visitation in most situations. Visits may be allowed even if the facility or community are considered to be in COVID-19 outbreak status. That said, there are some limitations. If the resident you want to see is battling an active infection, you may not be allowed to visit. Similarly, if the community spread of the coronavirus in your area is high, and the nursing home resident has not been vaccinated for some reason, the facility may restrict visitation.
The previous CMS guidelines were issued in September 2020 and were much more restrictive. At that time, indoor visits were permitted only when the entire facility had not had a case of COVID-19 for 14 days and COVID-19 tests in the county were returning a positivity rate of less than 10 percent. Given conditions at that time, most skilled nursing facilities remained closed to visitors.
The decreasing numbers of infections, hospitalizations, and deaths are good news, but nursing homes are not throwing caution to the winds or celebrating the end of the pandemic just yet. If you have a loved one in a nursing home, you should contact the facility to learn their current rules so that neither you nor your loved one will be disappointed.
In many nursing homes where indoor visiting is now allowed, visits must be scheduled in advance during limited hours. However, as of mid-March, Michigan is no longer directing facilities to require appointments, limit each resident to two visitors at a time, or make visitors get a COVID-19 test before visiting. Testing is still encouraged, however. And because individual facilities may place more restrictions on visitors than the state requires, it is still a good idea to call ahead before visiting a loved one to learn about the nursing home visitation policy.
Compassionate care visits should be allowed at all times, regardless of whether a resident is vaccinated or where infection or positivity rates stand in the community. “Compassionate care” includes not only end-of-life visits but visits for a resident who is distressed and having difficulty adjusting to a facility, whose health is in sharp decline, or who is grieving the recent loss of a family member.
Per the most recent CMS guidance, there is no reason that a nursing home should ban visitors except in the very limited circumstances outlined above. Facilities continue to balance the need to protect vulnerable residents from serious illness with the very real need that residents have for personal contact with loved ones. Family members visiting loved ones in a nursing home should, of course, continue to take measures to avoid contracting or spreading COVID-19, such as frequent hand-washing and testing as appropriate.
If you would like to learn more about visiting nursing homes during this phase of the pandemic, there are helpful resources available from the Center for Medicare Advocacy and The National Consumer Voice for Quality Long-Term Care. If you have additional questions about elder rights advocacy, we invite you to contact us to schedule a consultation.