Centers for Disease Control and Prevention (CDC) revised Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination and guidance on international and domestic travel on April 27. These changes have significant impact on nursing home operations and are supported by Centers for Medicare and Medicaid Services (CMS), who have updated relevant guidance to be consistent with CDC’s recommendations.

Travel

CDC continues to recommend delaying all travel, both international and domestic, until fully vaccinated. Fully vaccinated individuals are no longer required to quarantine upon return from international or domestic travel. Fully vaccinated travelers do not need to be tested upon return from travel. Fully vaccinated international travelers will require a negative test to enter the United States and should be tested within 3-5 days upon return from international travel. Unvaccinated travelers must test 1-3 days prior to both international and domestic travel and within 3-5 days upon return from international and domestic travel. Unvaccinated travelers should also quarantine for 7 days after travel and should avoid individuals who are at increased for severe illness for 14 days after travel. This means that unvaccinated staff may be restricted from work for 14 days after travel.

Visitation

Visitation may take place without masking and without social distancing under the following circumstances:

• Both the resident and the visitor(s) are fully vaccinated.
• The resident and visitor(s) are alone in the resident’s room or a designated visiting space where no one else is present.
• If a resident or any of the resident’s visitors are not fully vaccinated, masking and social distancing should be maintained throughout the visit. If the resident is fully-vaccinated but the visitor is not, the resident may choose to have close contact with the visitor while continuing to mask throughout the visit. 
• The visitor must mask and social distance from all other residents, staff, and visitors while in the nursing home.
• Nursing homes are not expected to obtain proof of vaccination of visitors, such as photo copies of vaccination cards. Asking a visitor about vaccination status is sufficient for determining masking and social distancing protocols during the visit. 

Activities and Dining

Activities and dining may take place without masking and without social distancing under the following circumstances:

• All individuals present in the activity or dining area, including all residents, staff, and visitors, are fully vaccinated.
• If any individuals are present in the activity or dining area that are not fully vaccinated, masking and social distancing should be maintained throughout the activity and dining (masks may be removed when actively eating) for all individuals regardless of vaccination status.
• Vaccination status should be determined in a way that maintains the individual’s privacy and dignity. CDC recommends asking residents, staff, and visitors to sign up for activities / dining ahead of time so that vaccination status can be determined and appropriate decisions made. If vaccination status is unknown, protocols for “unvaccinated” individuals should be followed.
• Nursing homes are permitted to “cohort” activities and dining according to vaccination status. If choosing to do so, the nursing home must continue to comply with Resident Rights requirements.
• Staff may additionally follow the above guidance on masking and social distancing when in break rooms or in-person meetings. If all individuals present are fully-vaccinated, all individuals may forego masking and social distancing.

Testing

Testing protocols in response to outbreak and in response to symptomatic residents and staff have not changed. Expanded screening testing protocols (routine staff testing according to county positivity rate) have been changed to allow fully vaccinated, asymptomatic staff to be exempted from routine staff testing.

CMS has updated memos QSO-20-38-NH and QSO-20-29-NH to be consistent with these recommendations from CDC. CMS advises that in the event of an outbreak investigation from state or federal surveyors, the nursing home will be expected to explain how they ensure adherance to CDC recommendations.