CMS Changes to Nursing Home Visitation (COVID-19)
Placing your loved ones in nursing homes is difficult but necessary when they need more care than you can provide at home. It’s important to regularly visit your family member once they’ve moved to ensure they’re receiving good care and not facing abuse or neglect.
Visits are also an important way for your elderly loved ones to get the social interactions they need for their mental health. These visitations became impossible during the COVID-19 Pandemic when new rules kept family members out of nursing homes to prevent outbreaks.
The Centers for Medicare and Medicaid Services (CMS) sets guidelines for nursing home visitations. At the height of the pandemic, these guidelines prevented families from visiting their loved ones in nursing homes. Now that vaccines are available and restrictions are easing, the CMS guidelines have been revised to allow more visitation.
Guidelines Prior to COVID-19
The CMS sets standards and guidelines for all nursing homes that receive Medicare or Medicaid funding throughout the U.S. The federal regulations allow all patients to receive the same standard of care and health services no matter where the facility is located. The goal of the regulations is to ensure your loved one is physically safe while residing in a nursing home and receiving adequate care.
They also keep nursing homes accountable for their actions. Nursing homes must follow the regulations to be eligible for funding. If they’re found in violation of any guidelines, they must take corrective action or forfeit these funds. These requirements were first introduced after Medicare was passed in 1965 and were primarily unchanged until the 1980s.
The regulations include:
- The safety and cleanliness of the facility, also known as brick and mortar requirements
- Not permitting abuse of the patients
- Preventing adverse outcomes or avoidable deterioration in the patients
As a result of these regulations, new policies and procedures were implemented. This included having more detailed staffing qualifications, building requirements, and new policies and procedures to treat residents.
Changes to CMS Guidelines in the 1980s
During the early 1980s, concern over the regulation of nursing homes grew, leading to more research and congressional hearings. Initial attempts to change the federal regulations were unsuccessful due to conflicting interests between the nursing home industry, the consumers they served, and state regulations.
The federal government was ultimately able to effect changes in nursing homes by developing a survey process and funding a third-party research study. These reports provided important insight into nursing homes and changes that needed to be made.
Patient care and services survey
Surveys became an important way for observers to evaluate the health status of nursing home patients and the care they received. Previously, only the facility’s procedures and policies were examined. With new surveys, observers interviewed nursing home residents about their care.
Care outcomes were incorporated into the inspection of nursing homes and used to judge the facility’s compliance with CMS guidelines. It formalized and regulated the process to regulate patient care. Surveys are still used today to evaluate care facilities during complaints and recertification.
Study by Institute of Medicine
Legislative changes were difficult to pass because of competing interests between groups. Instead, Congress funded a study by a disinterested third party, the Institute of Medicine (IOM). The study didn’t find any new information but gathered a consensus among experts about further federal regulations.
The IOM study found that regulations on patients’ rights, the quality of care they receive, and their quality of life were needed. Congress used this research to introduce new nursing home regulations, including the Nursing Home Reform Act of 1987. This law introduced nursing home patients’ bill of rights, which formally guaranteed the safety and care of elderly residents.
New Revisions to CMS Guidelines
Since the nursing home patient bill of rights was introduced, no major changes in CMS regulations occurred until the COVID-19 Pandemic. The new CMS changes were designed to address the impacts of COVID-19 on the health and safety of nursing home residents and deal with nursing home complaints and recertifications during this time.
The new CMS guidelines aim to keep the elderly residents of nursing homes safer and prevent future outbreaks of COVID-19 in staff and residents of nursing homes. Residents of nursing homes are more vulnerable to the virus due to their age, declining health, and living in a congregate setting. Initial visitation restrictions kept infection rates down but negatively impacted the mental and social wellbeing of residents.
The CMS reopening guidelines for nursing homes include:
- Criteria to help nursing homes determine when they can relax restrictions without harming patients
- Mitigation strategies to use to lower the risk of infection and spread within their facility
- Phasing in visitation and services
- Creating safer visitation practices
- When surveys for recertification and complaint can resume
States can implement the guidelines statewide, regional, or at the individual facility level. Facilities can only move to the next reopening phase when they meet all the necessary criteria. Before any restrictions are relaxed, all patients and staff have to undergo COVID-19 testing, and the facility must have adequate staffing levels. Other factors influencing reopening include community transmission levels and active cases of COVID-19 in nursing home residents.
The current CMS guidelines say that all nursing homes must, at a minimum, provide:
- The capacity to test any resident or staff member who shows symptoms of COVID-19
- The capacity to test every resident and staffer if a new case of COVID-19 occurs at their facility
- Being able to retest individuals daily for 14 days
- Routine testing for staff members if their regional community transmission rate is high
- Written protocols to follow for screening everyone entering the facility, including residents and staff
- Access to enough personal protective equipment (PPE) for staff, including face masks
- Residents and visitors must wear a face-covering during visitations and maintain social distance
The Latest Updates
The staff at nursing home facilities are now required to get vaccinated against COVID-19. This move protects nursing home residents and staff members from being infected and transmitting the virus to others. Staff vaccinations and infection mitigation efforts are helping keep residents of nursing homes safe as they reopen to visitation.
As of November 2021, visitations to nursing homes are now permitted, but visitors may be asked to undergo COVID-19 testing before their visit. Visitors will also have to follow any facility policies, such as wearing a mask or having outdoor visitations. The CMS doesn’t require visitors to be vaccinated against COVID-19, but they do recommend vaccination for the safety of visitors and residents.
Survey activities of nursing homes have also resumed. State agencies conduct surveys to ensure facilities comply with all CMS guidelines. Surveys are necessary for facilities going through the recertification process and to address complaints made against facilities.
CMS has revised its survey criteria to include infection control and creating temporary guidelines to deal with COVID-19 complaint investigations. Under the latest guidelines, States must perform annual infection control surveys in at least 20% of nursing homes. Nursing homes must undergo recertification surveys within 15 months of their previous one, and agencies must triage nursing home complaints to help address serious problems first.
What the CMS Guidelines Mean for You
Changes made to the guidelines are helping residents and their families restart visitations during the pandemic while keeping residents and staff healthy and safe. Visitations are important for the social and emotional health of your loved one and are a way to hold the facility accountable for the resident’s care.
The increased stress nursing home staff face during the pandemic and the lack of outside visitation create an environment for elder abuse and neglect. Staffing shortages due to illness or vaccine requirements mean the remaining workers have more responsibilities. They may be unable to care for all their patients adequately or may fail to notice problems your loved one is experiencing.
Nursing home residents may have deteriorated faster when visitation was banned because they could not socialize with outside family and friends. Some facilities also restricted the movement of nursing home residents to reduce the spread of the virus, resulting in less socialization between residents. Their emotional or mental health may have suffered as a result.
The current backlog of nursing home complaints and recertification surveys means issues aren’t being addressed quickly, and your loved one may be exposed to staffers or care practices that are harmful. These issues aren’t confined to nursing homes. Other assisted living facilities, including board and care homes, also faced visitation restrictions during the pandemic that could have resulted in the abuse or neglect of your loved one.
How Berberian Ain LLP Can Help
It’s hard to ensure your loved one’s safety when you can’t visit them regularly. Visitor restrictions, staffing shortages, and poor infection control may have negatively impacted the care or security of your family member. Contact a lawyer immediately if you suspect your loved one may have been neglected or abused while residing in a nursing home.
Consider hiring Berberian Ain. Our skilled elder abuse attorneys know how to spot signs of abuse and neglect. We’re experienced in taking powerful facilities to court, and we understand the impact COVID-19 has on nursing home residents. Contact us today for a consultation.