Happy senior couple on the bench

Senior living industry groups said they are hopeful that the visitation rules for nursing homes released Wednesday by the Centers for Medicare & Medicaid Services will spur states to make similar recommendations for assisted living communities soon.

“We have heard from our members, who have expressed great frustration with the lack of updated guidance from the states, especially as most residents are now vaccinated and the level of risk significantly decreased. Current rules do not appropriately reflect the benefits of the vaccine that should create more flexibility relative to visitation policies,” American Seniors Housing Association President David Schless told McKnight’s Senior Living. “The risks associated with isolation can be devastating to residents, and all efforts to create the right balance of well-being and safety should be pursued. We have been encouraging states to adjust their state assisted living visitation rules to reflect this balance and hope this action from CMS will encourage states to take similar action as soon as possible.”

Feb. 23, ASHA had sent a letter to National Governors Association Chair Gov Cuomo (D-NY) and Vice Chair Asa Hutchinson (R-AR) and all governors across the United States encouraging them to ease visitation restrictions in senior living communities in the coming weeks.

CMS said that COVID-19 vaccinations and a decrease in infections and deaths led to the issuance of its new guidelines. The guidance, released in conjunction with the Centers for Disease Control and Prevention, calls for limitations on visits in nursing homes to be put in place for:

  • Unvaccinated residents, if the COVID-19 county positivity rate is greater than 10% and less than 70% of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions; or
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

The CMS recommendations came just days after the CDC issued guidance for non-healthcare settings. Wednesday, the CDC updated its guidance for healthcare settings as well.

“We are asking that states consider the CDC’s guidance and move swiftly to allow visitation as appropriate and where restrictions still remain,” Argentum President and CEO James Balda said. “At Argentum, we will continue to work closely with our members and state partners to encourage state agencies to take these actions, as well.”

The CMS guidelines were issued exactly a year after Argentum announced the cancellation of its 2020 Public Policy Institute & Fly-In due to the coronavirus.

Wednesday, Balda noted that resident vaccination rates “continue to be impressive across the industry,” with more than 95% of providers surveyed reporting an uptake rate of 81% to 100%.

“There’s no doubt that the well-being of senior living residents depends largely on engagement with family members and loved ones,” he said. “And while our communities have worked tirelessly to keep residents engaged through innovative activities during the pandemic, there’s certainly no substitute for long-awaited visitation.”

The CMS and CDC healthcare setting guidance also came exactly a year after the American Health Care Association and National Center for Assisted Living had announced its own guidance calling for assisted living communities and nursing homes to limit access to only those individuals who are critical to the operational or care needs of their buildings in order to prevent “dire consequences” that could result from a coronavirus outbreak. Vaccination would not begin until December, with nursing home and assisted living residents and staff members in the top priority group to be vaccinated.

Wednesday, as the pandemic and vaccination continued, AHCA / NCAL President and CEO Mark Parkinson called for public health officials to continue to prioritize new and current long-term care residents and staff members for the shots so that visits are possible.

“A steady, ongoing allocation of vaccines to long-term care will also help ensure we continue to build upon the progress we have already made in reducing COVID in long-term care,” he said.

Vaccine prioritization for long-term care was the subject of a letter that Parkinson, Balda, Schless and LeadingAge President and CEO Katie Smith Sloan sent on Wednesday to Cameron Webb, M.D., White House senior policy adviser for COVID-19 equity.

“It is not enough to leave the allocation, access and delivery decision-making to individual states,” they wrote in the letter. “State health departments are understandably focused on more broad-scale rollout of vaccines to all older people, and soon, all adults. We must not lose focus on the most vulnerable elders.”

Some states, such as Kentucky, Michigan, New York, Oklahoma, South Carolina, Tennessee and Vermont, already have made announcements related to the lifting of state-level restrictions in long-term care settings.