Nursing Homes Seek Flexibility to Limit Visits as Omicron Surges

The nursing home industry—bracing for a spike in Covid-19 infections due to the omicron variant—has asked the Biden administration to amend current guidelines requiring them to provide unlimited, unrestricted visitation for residents and preventing them from restricting access to the facilities.

The agency’s updated November guidance on visitation appears to forbid “any restriction on visitation, regardless of staffing levels, community positivity rates, or severity of facility outbreak,” officials from three leading industry trade groups said in a Dec. 17 letter to Chiquita Brooks-LaSure, administrator for the Centers for the Medicare & Medicaid Services. “We are concerned that the absolute, unconditional language may pose a risk to nursing homes and their residents, placing skilled nursing facilities in precarious situations when outbreaks occur.”

“It seems counterintuitive and potentially dangerous to limit facilities’ ability to temporarily restrict access to the building when a deadly and highly transmissible illness like COVID-19, especially with omicron expected to surge, is already rampant inside the facility, in the surrounding community, or when hospitals in the area are experiencing a surge,” the letter said.

The letter was signed by David Gifford, chief medical officer for the American Health Care Association; Karl E. Steinberg, president of AMDA—the Society for Post-Acute and Long-Term Care Medicine; and Katie Smith Sloan, president of LeadingAge, which represents nonprofit aging services providers.

The letter also said industry staffing shortages “may lead to the inability to ensure that safe visiting policies are being followed.”

Some 221,000 nursing home workers have left their jobs since the pandemic began. Nearly 187,000 residents have died from Covid-19 at nursing homes and other long-term care facilities as of Nov. 16, according to the Kaiser Family Foundation.

The CMS did not respond to a request for comment in time for publication.

On Nov. 12, the CMS issued updated guidance allowing nursing home residents to once again receive visitors inside the facilities whenever they want. During the pandemic, the CMS had restricted visitation in order to reduce infections. But under the new guidance, nursing homes could no longer limit the frequency and length of visits or number of visitors, nor could they require that visits be scheduled in advance.

The new access reflected a decline in Covid-19 infections at nursing homes, a rise in staff vaccinations, and growing concern about the effect that isolation was having on residents during the pandemic.

The agency would “continue to monitor vaccination and infection rates, including the effects of COVID-19 variants on nursing home residents, which have recently caused the number of cases to slightly increase,” the guidance said. “However, at this time, continued restrictions on this vital resident’s right are no longer necessary.”

Rising Infections

But in the weeks since the new guidance was issued, the omicron variant has caused Covid-19 infections, hospitalizations, and deaths to increase nationwide. Nursing home operators and medical staff said in their letter that they need the CMS to grant more flexibility “to temporarily limit, restrict, or prohibit visitors from entering the facility” in order to keep residents safe.

“We do not wish to unnecessarily restrict our residents’ access to their loved ones in nursing homes,” the letter said. “However, we are hopeful that CMS will issue further clarification” to “help nursing facilities, medical directors, infection preventionists, and local health departments to navigate outbreak situations.”

Before the pandemic, nursing homes were able to restrict visitors for safety reason during norovirus and influenza outbreaks, the letter said.

Nationally, nearly 77% of nursing home workers were vaccinated as of Dec. 5, federal data shows. That’s up from about 71% on Oct. 10. The rates vary among states, with more than 99% of staff vaccinated in Rhode Island, nearly 98% in Maine, and more than 96% in the District of Columbia. Missouri had the worst staff vaccination rate at just over 62%, followed by Oklahoma at nearly 63% and Ohio with just over 63%.

Among nursing home residents, 87% have been vaccinated nationally. The Biden administration is strongly encouraging that nursing home residents and staff get vaccinated and get booster shots as soon as possible.