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. 2025 Mar 28:7334648251324269.
doi: 10.1177/07334648251324269. Online ahead of print.

Changes in Federal and State Policies on Visitation Restrictions in Nursing Homes During the COVID-19 Pandemic

Huiwen Xu  1 , John R Bowblis  2   3 , Shuang Li  4 , Jennifer Heston-Mullins  3 , Yong-Fang Kuo  4   5 , James S Goodwin  4   6
Affiliations

Changes in Federal and State Policies on Visitation Restrictions in Nursing Homes During the COVID-19 Pandemic

Huiwen Xu et al. J Appl Gerontol. .

Abstract

Visitation restrictions in nursing homes were a major policy intervention in response to the COVID-19 pandemic. This study conducted a systematic review of the changes in federal and state visitation policies. After the federal recommendations restricting all visitors and non-essential healthcare personnel, 31 states implemented state-wide indoor visitation bans in March and April of 2020. Federal guidance changed in September 2020 and again after the introduction of COVID-19 vaccines in early 2021. State visitation bans were lifted from 6/15/2020 to 11/2/2020, lasting an average of 163 days. When lifting bans, most states required that nursing homes have no resident COVID-19 cases and implement mitigation measures during the visit. Resident COVID-19 infection rates decreased by an average of 7.2 cases per 10,000 residents per week in the six weeks before state bans were lifted (p = .003). Large variations in state bans call for more consistent policy implementation in a future pandemic.

Keywords: COVID-19 pandemic; federal guidance; nursing home; state bans; visitation restriction.

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Conflict of interest statement

Declaration of conflicting interest: Dr. John R. Bowblis provides consulting services to various health care and long-term care stakeholders, including government agencies. Other authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.. Evolution of CMS guidance on nursing home visitations in 2020 and 2021
The memoranda on visitation guidance were obtained from the Centers for Medicare and Medicaid Services (CMS) website. Nursing homes could always restrict visitations, even they met the conditions for reopening. CMS did not make major changes to visitation guidance after 3/10/2021.
Figure 2.
Figure 2.. The duration of nursing home indoor visitation bans by state in 2020
State-wide bans included only directives, not recommendations, applied to the entire state. The start dates of visitation bans in the 31 states were between 3/9/2020 and 4/6/2020, and the end dates were between 6/15/2020 and 3/24/2021. The duration of the bans varied from 61 to 373 days. Hawaii lifted bans on 3/24/2021, after the introduction of COVID-19 vaccines. The x-axis was truncated at 1/1/2021.The remaining 19 states issued recommendations, or partial bans, or had incomplete data to determine bans. The blue vertical line indicates when CMS lifted its guidance on visitation restrictions on 9/17/2020.
Figure 3.
Figure 3.. Trends in COVID-19 infection rates in nursing homes and the community in the 6 weeks prior to and the week of lifting state-wide bans
Nursing home COVID-19 infection rates were calculated as the total number of new COVID-19 cases among all nursing home residents in each state in a week, divided by the total number of residents, scaled to 10,000 residents. Community COVID-19 infection rates were calculated as new COVID-19 cases (excluding nursing home infections) in the community in each state in a week, divided by the number of people in the community (excluding those in nursing homes), scaled to 10,000 population. Data in 24 states that lifted bans between 7/8/2020 and 11/2/2020 were stacked at the index lifting week (week 0). Data were excluded for 6 states (ND, TN, OK, MT, MI, AR) that did not have COVID-19 infection rates for the entire 6-week period prior to lifting bans.
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