With new nursing home guidelines, card games with grandpa are back, regardless of your vaccination status

You can hug your vaccinated grandpa and stay to play cards with him at his nursing home, even if you haven’t been vaccinated, according to new Covid-19 guidance for nursing homes from the Centers for Medicare and Medicaid Services.

The guidance goes into effect immediately.

These recommendations are a little different than the ones released Monday by the US Centers for Disease Control and Prevention for fully vaccinated people in the general population, which allow meeting indoors in small groups without masks or physical distancing — even for the elderly.

Vaccinated or not, nursing home residents are still a fragile patient population, so infection control is important, says CMS. For nursing home residents and visitors, even if vaccinated, CMS still wants people to wear a well-fitted face mask, wash hands and try to keep physically distant, a spokesperson for the agency said in an email. But the new CMS guidelines offer many other new freedoms.

“CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families,” Dr. Lee Fleisher, said on the agency’s website. Fleisher is CMS chief medical officer and director of CMS’ Center for Clinical Standards and Quality. “This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of COVID-19.”

Under the new guidance, visitors don’t need a Covid-19 test result to see family, nor do they need to show proof of vaccination. The guidelines strongly encourage everyone to get vaccinated though.

Visits should be restricted, if the Covid-19 county positivity rate is more than 10% and less than 70% of the residents in the facility were fully vaccinated.

Families should also hold off on visits with residents in quarantine or if they have a positive Covid-19 test.

“Compassionate care” visits, however, are allowed at all times. In this case, the resident’s vaccination status or county’s positivity rate doesn’t matter. A compassionate care visit is when a resident’s health has sharply declined.

The guidance still encourages outdoor visits, since it’s still safest, especially for the unvaccinated. The guidelines also encourage people to keep physical distance when possible.

“There is no substitute for physical contact, such as the warm embrace between a resident and their loved one. Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting facemask,” CMS says on its website. “Regardless, visitors should physically distance from other residents and staff in the facility.”

If there is a Covid-19 outbreak in the nursing home, managers should temporarily suspend visits, test everyone immediately, and confine the case to a single area. Visits can then resume to the rest of the building.

Indoor visits are now allowed for all residents, at nearly all times, regardless of a resident’s or visitor’s vaccination status.

If a resident is fully vaccinated, hugs are back too.

Say goodbye to birthday celebrations through plexiglass

“The goal was always to make sure that the residents have a good quality of life, as well as being safe,” the Trump administration’s CMS Administrator Seema Verma told CNN.

Verma told CNN that as soon as the vaccination efforts started in December, the department started revising visitor guidelines.

“This is one of the issues that I brought up with the transition team, to say, as part of your plan, once you get these vaccinations done, we need to have guidance out quickly, because families are going to want to be reunited with their loved ones,” Verma said.

Nursing home residents have suffered more than most during this pandemic. While residents are less than 1% of the US population, they account for nearly a third of Covid-19 deaths, and because CMS shut nursing homes to visitors to minimize infections, these residents have had to endure it all without in person help from their families.

For nearly a year, birthdays were celebrated through a window or protective plexiglass.

As Covid-19 case numbers in nursing homes plunged 82% between December and February, and after more than 2.6 million residents have been fully vaccinated, CMS decided it was time to bring back visitors, acknowledging closed doors have been hard on everyone.

Safe family visits bring comfort

Both the CMS and CDC recommendations are just guidance, not legally binding. Nursing homes are still at liberty to create their own policies about masks and visitors, but these facilities tend to look to public health agencies for recommendations and are regulated by CMS. And in this case, the associations that work with the elderly are thrilled about the new CMS guidance.

“This exciting news has instilled confidence that we can safely reopen and improve the quality of life for our residents,” the American Health Care Association/National Center for Assisted Living said in an email to CNN.

Christopher Laxton, the executive director for the Society for Post-Acute and Long Term Care Medicine thought the changes were “good stuff.”

“It’s balanced the need to keep residents safe with the need for people to see their loved ones in the nursing home and that has been a really damaging aspect of the pandemic,” Laxton said.

Laxton said family visits bring more than just comfort.

“Families really provide a sort of second line of health and care for these nursing homes. There’s never enough staff, especially now in Covid,” said Laxton. “So having families come and help feed their residents, and engage them in activities, stuff that might ordinarily take a staff person or a couple of (certified nursing assistants) to do, is a huge help.”

While nursing homes have gone to “extraordinary lengths” to support residents Katie Smith Sloan from LeadingAge, the national association of nonprofit providers of aging services, said, “there is no substitute for an in-person visit.”

Smith Sloan added, though, that community spread is still a threat to vulnerable residents. People must do whatever they can to reduce transmission of the coronavirus.

“In short,” she wrote, “vigilance is still required.”