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CMS Releases Revised Visitation QSO Memo 

In addition to the revised testing QSO, CMS released a revised QSO memo on visitation (QSO-20-39-NH).  The visitation QSO revisions are outlined below. 

CMS added the definition for “up-to-date” meaning a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible.  

In the core principles of infection prevention, CMS added a statement that visitors who have a positive viral test, have symptoms of COVID-19, or currently meet criteria for quarantine should not enter the building until they meet criteria used for the residents to discontinue transmission-based precautions (quarantine).  

Outdoor Visitation:  

CMS continues to state outdoor visitation is preferred when the resident and/or visitor are not up-to-date with all recommended vaccine doses.  

Indoor Visitation:  

If a resident’s roommate is not up-to-date with all recommended COVID-19 vaccine doses, or immunocompromised (regardless of vaccination status), visits should not be conducted in the resident’s room, if possible.   

Face coverings and physical distancing during visits:  

  • Visitors should wear face coverings or masks and physically distance when around other residents or healthcare personnel, regardless of vaccination status.  
  • If the nursing home’s county COVID-19 community level of transmission is substantial to high, all residents and visitors, regardless of vaccination status should wear face coverings or masks and physically distance, at all times.  
  • In areas of low to moderate transmission, the safest practice is for residents and visitors to wear face coverings or masks and physically distance, particularly if either of them is at increased risk for severe disease or are not up-to-date with all recommended COVID-19 vaccine doses.  
  • Residents, regardless of vaccination status, can choose not to wear face coverings or masks when other residents are not present and have close contact (including touch) with their visitor.  
    • Residents (or their representatives) and their visitors, who are not up-to-date with all recommended COVID-19 vaccine doses, should be advised of the risks of physical contact prior to the visit.  

Access to the Long-Term Care Ombudsman and Protection & Advocacy Program: 

If an ombudsman or P&A is planning to visit a resident who is in transmission-based precautions or quarantine, or a resident who is not up-to-date with all recommended COVID-19 vaccine doses, in a nursing home where the level of community transmission is substantial or high in the past 7 days, the resident and the ombudsman or P&A should be made aware of the potential risk of visiting, and the visit should take place in the resident’s room.  

Resident Outings: 

When a resident leaves the nursing home, upon their return the nursing home should:  

  • Screen residents for signs or symptoms of COVID-19.  If the resident or family member reports possible close contact to an individual with COVID-19 while outside the nursing home, the resident should be tested, regardless of vaccination status.  If the resident is not up-to-date with all recommended COVID-19 vaccine doses the nursing home should place the resident in quarantine with transmission-based precautions implemented.  
  • A nursing home may opt to test residents, who are not up-to-date with all recommended COVID-19 vaccine doses, without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time, such as over 24-hours.  
  • Nursing homes might consider quarantining residents who are not up-to-date with all recommended COVID-19 vaccine doses, and leave the nursing home if, based on an assessment of risk, uncertainty exists about their adherence or the adherence of those around them to recommended infection prevention measures.  
  • Monitor residents for signs and symptoms of COVID-19 daily.  

FAQ Document:  

Question #7 – Should the nursing home pause communal activities and dining during an outbreak investigation?  

A: If the nursing home is using a broad-based approach for an outbreak investigation, residents who are not up-to-date with all recommended COVID-19 vaccine doses should generally be restricted to their rooms, even if testing is negative, and should not participate in communal dining or group activities until they have met the criteria for discontinuing transmission-based precautions.  In general, residents who are up-to-date with all recommended COVID-19 vaccine doses and resident who had COVID-19 in the last 90 days do not need to be restricted to their rooms unless they develop symptoms of COVID-19, are diagnosed with COVID-19 infection, or the nursing home is directed to do so by the jurisdiction’s public health authority.