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Federal officials relax guidance on nursing home visits, citing vaccines and slowing infections

Judie Shape, center, who has tested positive for the coronavirus, blows a kiss to her son-in-law, Michael Spencer, left, as Shape's daughter, Lori Spencer, right, looks on, March 11, 2020, as they visit on the phone and look at each other through a window at the Life Care Center in Kirkland, Wash., near Seattle. In-person visits were not allowed at the nursing home. (AP Photo/Ted S. Warren)

WASHINGTON - Federal health officials Wednesday substantially relaxed the government’s guidelines for seeing nursing home residents in person, saying that vaccinations and a slowing of coronavirus infections in the facilities warrants restoring indoor visits in most circumstances.

The nursing home guidance, the first federal advice on the subject since September, says “outdoor visitation is preferred,” even when a nursing home resident and family or friends are fully vaccinated against the coronavirus, which can cause the disease COVID-19.

But acknowledging that weather or a resident’s poor health might make an outdoor visit impractical, the advice encourages nursing homes to permit indoor visits “at all times and for all residents,” regardless of whether people have been vaccinated, except for a few circumstances.

Those circumstances, federal officials say, include when a resident has not been fully immunized against the virus and lives at a nurse home in which fewer than 70% of those in the facility are fully vaccinated and coronavirus tests in the community show a high rate of local infections - greater than 10% of tests positive.

The eight pages of guidance from the Centers for Medicare and Medicaid Services marks the most recent sign the Biden administration regards the drastic restriction on life in the United States as beginning to slide into the past tense, even as the president and his aides urge Americans to maintain public health precautions for the foreseeable future.

The guidance comes two days after the Centers for Disease Control and Prevention issued separate advice Monday, sketching the outlines of what activities are considered safe for fully vaccinated Americans. That guidance gave such people greater freedom to socialize and engage in some normal daily activity. It said people two weeks past their final shot may visit indoors with unvaccinated members of a single household at low risk of severe disease, without wearing masks or keeping a safe distance.

The two announcements are not outright edicts for the country. They are recommendations, rooted in the best available information about the state of the pandemic and a far-from-complete body of research into what makes sense - all juxtaposed against Americans’ profound weariness with a constricted way of living that is reaching its first anniversary.

Even as appointments to get shots remain in short supply in much of the country, 62.5 million people in the United States have received at least one dose of a vaccine. Two vaccines authorized by the government for emergency use, developed by Pfizer and BioNTech, and by Moderna, require two vaccines. A third more recently allowed, created by Johnson & Johnson, requires a single shot. In all three cases, immunity takes about two weeks to develop once a person has received the final shot.

The nursing home guidance, issued by CMS in coordination with the CDC, acknowledges the pandemic’s harrowing impact on some of the nation’s oldest and frailest people, who make up nursing homes’ populations.

“We acknowledge the toll that separation and isolation has taken,” the document says. “We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one.”

For those reasons, the guidance says, a fully vaccinated nursing home resident “can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.”

Those visitors, the guidance says, should maintain a safe distance from a nursing home’s other residents and its staffers.

The recommendations say “compassionate care visits,” including when a resident is nearing death, should be allowed at all times. They should be permitted even when a resident is unvaccinated, the facility has a coronavirus outbreak, or a community has high infection rates.

Wednesday’s guidance mark the fourth time CMS, the agency within the Department of Health and Human Services that oversees Medicare and Medicaid, has issued pandemic recommendations for nursing homes. The facilities have been intense breeding grounds for COVID-19 among staffers and residents, who live in close quarters. In late November, the pandemic crossed a milestone, having killed 100,000 workers and resident in U.S. long-term care facilities, according to an analysis by the Kaiser Family Foundation, a health-policy research group.

The first CMS nursing home guidance, issued almost a year ago to the day, restricted all visitors and nonessential health workers, except for compassionate care visits, which were to be held in a single, dedicated room. A May update urged caution in reopening nursing facilities, saying they should relax restrictions more slowly than the communities around them, with visits allowed only if a facility had no new cases of coronavirus for four weeks.

The latest guidance says visits can still occur during an outbreak at a nursing home, as long as the virus’s spread appears contained to one area. If tests show no new cases elsewhere in the facility, visits may still take place in the other areas, the recommendations say.

According to an announcement last week by the American Health Care Association, which represents 14,000 nursing homes and other long-term care facilities, coronavirus cases among its members had declined 82% since late December, when there were 30,000 new cases. The seven-day average for nursing home residents in early February, the organization said, was about 6,000.

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