The following answer was provided by CMS on April 24, 2020 in QSO-20-28-NH:

We recognize that restricting visits can be very upsetting to residents and families. In addition to connecting residents with their loved ones, we will be requiring facilities to regularly inform families of the status of any COVID-19 infections in the facility. Facilities may also consider the following alternatives to in-person visits:

1. Offer alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.);
2. Create or increase email listserv communications to update families;
3. Assign staff as primary contact to families for inbound calls, and conducting regular outbound calls to keep families up to date (e.g., a “virtual visitation coordinator”); and
4. Offer a phone line with a voice recording updated at set times (e.g., daily) with the facility’s general operating status, such as when it is safe to resume visits.

Other examples of actions that facilities can take to help families or visitors connect with residents, or be aware of what’s happening inside the facility, include:

• Virtual “office hours”: Host conference calls, webinars, or virtual “office hours” at set times when families can call in, or log on to a conference line, and facility staff can share the status of activities or happenings in the facility. Also, family members can ask questions or make suggestions.
• Update websites: Update the nursing home’s website to share the status of the facility, and include information that helps families know what’s happening in the loved one’s environment, such as food menus and activities that residents can do (while still practicing social distancing, such as crafts or painting).
• Assistive messaging: Staff reading emails from the family to the resident, helping residents send letters, emails or text messages with photos to their family, helping residents talk on the phone or video chat (e.g., Face-Time) with their family, or making e-cards writing or creating paper notes and cards that residents and families can send to each other.
• Nurse staffing information: Post daily nurse (including registered nurses, licensed practical nurses, and nurse aides) staffing information on websites or entrance doors, so families can see the staff available for their loved one. We note that per 42 CFR 483.35(g)(2)(ii)(B), the facility must post this information in a prominent place readily accessible to residents and visitors. Also, per 483.35(g)(3), the facility must, upon oral or written request, make nurse staffing data available to the public for review at a cost not to exceed the community standard.

We urge facilities to take strong efforts to facilitate connections with residents, families, friends, and loved ones. The CDC has also created a sample letter that can be sent to families to help explain the situation. We also encourage families and residents to work with the facility to identify actions that may be helpful to keep residents connected to their friends or loved ones. Resident or family councils can also work with facilities, and the friends and loved ones of residents to keep everyone connected.

Lastly, an important resource is the Long-Term Care Ombudsman Program. During this unprecedented pandemic, the Ombudsman program is reliant on facility staff assistance to obtain contact information of residents and their families. Ombudsman programs are a community resource and their outreach can help to calm fears by providing information and resources to residents, their families and facility staff. CMS encourages nursing homes to communicate regularly with the Ombudsman program and to call on the program when residents and their loved ones have questions or concerns.

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