CMS Update to Nursing Home Visitation Memorandum

The holidays are fast approaching, and residents and family members will want to make plans soon to spend time together.  With the strict restrictions of 2020 loosening somewhat, this holiday season will likely be a very busy season for both nursing facility visits, and for resident outings.

On November 12, 2021, CMS revised its Nursing Home Visitation Memorandum, QSO-20-39-NH that was initially issued on September 17, 2020. QSO-20-39-NH REVISED (

Under the initial Memorandum, CMS had authorized certain situations in which Nursing Home visitations could be restricted by facilities in order to prevent the spread of COVID-19.  According to the updated Memorandum issued on November 12, 2021, facilities must now allow residents to receive visitors without restriction. 

With that being said, all visitors to a Nursing Home should still adhere to the Core Principles of COVID-19 Infection Prevention.  Visitors who are positive for COVID-19, who have symptoms of COVID-19, or meet the criteria for quarantine should not be permitted to enter the facility.  All other visitors must be permitted to enter the facility.  Additionally, facilities must allow for indoor visitation at all times for all residents.  Facilities can no longer limit the number of visitors or require advance scheduling of visits for residents.  All visits should still be conducted in a manner that complies with the Core Principles of Infection Prevention.

While not recommended, residents who are on COVID-19 transmission-based precautions or quarantine can also receive visitors.  In these situations, visits should occur in the resident’s room, and the resident should wear a well-fitting face mask.  Additionally, indoor visits must be permitted during a facility COVID-19 outbreak investigation.  An outbreak investigation is initiated when a new nursing home onset of COVID-19 occurs (i.e., a new COVID-19 case among residents or staff).  Visitors should be made aware of the risks of visiting and precautions necessary to visit the resident. Facilities may provide well-fitting PPE to these visitors, but it should be noted that facilities are not required to provide PPE to visitors.

While facilities may ask visitors about their vaccination status, visitors are not required to be tested or to provide proof of vaccination as a condition of visitation.  If a visitor declines to disclose vaccination status, that visitor should wear a face covering at all times while inside the facility.

The CMS memorandum also addresses the issue of resident outings.  Facilities must permit residents to leave the facility as they choose.  Facilities should remind residents, and those who are accompanying them, to follow all recommended infection prevention practices.  Upon the resident’s return, nursing homes should take the following actions:

  • If the resident or the resident’s family member reports a possible close contact with COVID-19, test the resident for COVID-19, regardless of vaccination status, and place the resident on quarantine if they have not been vaccinated.
  • If the resident develops symptoms of COVID-19 after the outing, test the resident for COVID-19 and place the resident on transmission-based precautions, regardless of vaccination status.

As a final note, the CMS Memorandum states that facilities are not permitted to restrict access to surveyors based on vaccination status, nor are they permitted to ask a surveyor for proof of vaccination status as a condition of entry.

If you have any questions regarding nursing facility visitation or would like to discuss the Memorandum’s impact on your policies or operations, please do not hesitate to contact us at 717-620-2424 or via email.

David C. Marshall –

Jennifer Russell –