Federal officials say most indoor nursing home visits can resume, even if residents and visitors aren't vaccinated

Federal officials issued revised guidelines for nursing homes on Wednesday, saying people should now be allowed to visit residents indoors in most cases. The guidance, issued by the Centers for Medicare and Medicaid Services (CMS), would allow for visits regardless of the visitor or resident's vaccination status. 

The guidance, which is effective immediately, says nursing homes should allow "visitation at all times and for all residents" in most situations. The only scenarios in which facilities should limit visitation are:

• When unvaccinated residents are in a facility where less than 70% of residents are fully vaccinated while the county is experiencing a COVID-19 positivity rate greater than 10%
• When unvaccinated or vaccinated residents are confirmed to be infected with COVID-19
• When unvaccinated or vaccinated residents are in quarantine

If a case of COVID-19 is identified, facilities should suspend visits until everyone in the facility, including staff, has been tested. Visits can be permitted even if there are outbreaks in facilities, so long as the cases are contained to "a single unit or separate area of the facility," the guidance says. 

Nursing homes should not require that visitors be tested or show proof of testing prior to visitation, according to the guidelines, although it is still considered best practice to screen for signs and symptoms of the virus. The guidance encourages visitors to socially distance from residents — but noting that "there is no substitute for physical contact, such as the warm embrace between a resident and their loved one," the guidance says fully vaccinated residents can touch their visitors while wearing a mask and washing hands before and after.

"Compassionate care" visits, which are conducted when residents have sharply declining health or are experiencing a significant change in their situation, should be allowed at all times, the guidance says. The guidance states that these visits should be allowed "regardless of a resident's vaccination status, the county's COVID-19 positivity rate, or an outbreak." 

Dr. Lee Fleisher, CMS Chief Medical Officer and director of CMS' Center for Clinical Standards and Quality, said in a statement that prolonged isolation has taken a "psychological, emotional and physical toll" on nursing home residents and their families. 

"That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely," Fleisher said. "This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of COVID-19."

Despite the new guidance, CMS said in a press release that all facilities and individuals should continue adhering to the "core principles" of mitigating the spread of COVID-19, including social distancing and holding outdoor visits when possible. 

At least 639,658 nursing home residents in the U.S. have contracted COVID-19 since the pandemic began, and more than 130,000 have died, according to CMS. Nursing homes in Texas and California have seen the most cases. 

While the number of weekly cases and deaths in nursing homes has declined since the end of December, there are still hundreds of new cases reported each week. During the week of February 21, the last published data by CMS, there were more than 1,900 cases of nursing home resident infections and 976 nursing home residents died. That same week, there were more than 2,500 COVID-19 infections among staff, and 29 people died. 

More than 29 million people have contracted COVID-19 nationwide, and more than 529,000 people have died, according to Johns Hopkins University. 

The new guidance comes as President Biden said the administration will purchase 100 million more doses of Johnson and Johnson's coronavirus vaccine, the third and most recent vaccine to hit the U.S. market. As of Wednesday, more than 95.7 million vaccine doses have been administered in the U.S., according to the CDC, and nearly 33 million people are fully vaccinated, including 16.8 million people who are 65 years of age or older. 

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