COVID-19: Limiting Access to Visitors

Posted on March 10, 2020 by Jonathan Lips

On the heels of the Centers for Medicare & Medicaid Services (CMS) releasing new guidance on visitation in nursing homes, LeadingAge Minnesota urged members to restrict all non-essential visits in nursing homes and adopt the limitation suggestions for other settings such as assisted living and adult day.  

The following information summarizes the new CMS guidance, provides links to resources for guidance in assisted living and adult day settings, and links to a sample resident/family letter, staff letter, visitor/vendor notice and news release.  

CMS Guidance: Restricting, Limiting and Discouraging Visitors

On Monday, CMS released a memo elevating its guidance to actively monitor and restrict visitors in nursing homes. The guidance provided expanded criteria for restricting, limiting or discouraging visitors and individuals, as well as monitoring or restricting staff. While the guidance is intended for nursing homes, some of the information is relevant to all settings across the long-term care continuum.

The guidance advises nursing homes to actively screen and restrict visitation by those who meet the following criteria:

1. Signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath, or sore throat
2. In the last 14 days, has had contact with someone with a confirmed diagnosis of COVID19, or under investigation for COVID-19, or are ill with respiratory illness.
3. International travel within the last 14 days to countries with sustained community transmission. For updated information on affected countries.
4. Residing in a community where community-based spread of COVID-19 is occurring.

CMS also expanded recommendations for limiting or discouraging visitors and monitoring and restricting staff to prevent the spread of COVID-19.

In addition, CMS provided guidance for settings to review and revise how they interact with volunteers, vendors and receiving supplies, agency staff, EMS personnel and equipment, transportation providers, other practitioners (e.g., hospice workers, specialists, physical therapy, etc.), and take necessary actions to prevent any potential transmission.

To read more on the CMS guidance, including recommended preventative measures, see Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing home.

CMS: FAQ - Transfers, Supplies and Accepting COVID-19 Patients/Residents

In the same memo on visitation guidance, CMS also provided answers to frequently asked questions it is receiving on transfers, supplies and whether nursing homes should accept COVID-19 patients. Guidance on these issues is likely to evolve but the March 9 memo from CMS is the most up-to-date resource at this time. Read more at:

Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing home.

Additional Visitor Limitation Guidance and Resources

Shortly after CMS released its memo, the American Health Care Association (AHCA) released a national recommendation to restrict all non-essential visits in skilled nursing settings and offer suggestions for additional limitation of visitors in assisted living settings. We are sharing the two resources below as part of our collective goal to provide consistent and timely information across all providers regardless of association.

• Nursing Home: The guidance includes a recommendation to restrict all non-essential visits, including restricting family visits, school groups, bands, and other outside group activities. It also includes screening checklist for nursing home visitors.
• Assisted Living: The guidance recognizes that assisted living communities vary in size, scope of care, and residents and families' ability to enter and exit the building freely. Therefore, the guidance includes some possible suggestions for the limitation of visitors, including asking residents to encourage their loved ones not to visit, establishing specific visiting hours, limiting the number of entrances, and enacting a sign-in policy for all visitors at a central entry point.

Communicating Visitor Policies to Residents, Families and Staff

It is imperative to keep residents, families and staff informed of any changes in your visitor policy or business operations. Download our Communication Tools - Visitation Policy that includes sample letters for residents, families and staff, sample visitor/vendor notice and a sample news release.