Lifting Federal Visitation Restriction and COVID-19 Infections in Nursing Homes

Abstract

Objectives: Early in the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recommended restricting visitors from entering nursing homes as a precaution. The restriction was lifted on September 17, 2020. This study examines whether COVID-19 infection rates among residents increased after the lifting of the federal restriction, providing indirect evidence on the impact of introducing visitation restrictions.

Design: We used a difference-in-differences event-study framework to compare changes in nursing home COVID-19 infection rates in the 4 weeks before (August 23, 2020-September 13, 2020) vs. 8 weeks after (October 4, 2020-November 22, 2020) the lifting of the federal visitation restriction.

Setting and participants: The study cohort included 4823 nursing homes in the 19 treatment states that never had state-level visitation bans and 1654 nursing homes in the 8 control states that implemented state bans but lifted their bans by August 2020. The control group theoretically had the ability to allow visitation before the lifting of the federal restriction.

Methods: Our primary outcomes were weekly nursing home COVID-19 infection rates among residents and community-adjusted resident infection rates. The policy change was the lifting of federal visitation restriction on September 17, 2020. All analyses control for other facility characteristics that may impact COVID-19 spread in nursing homes.

Results: Nursing home infection rates closely mirrored the trend in community COVID-19 infections. Our regression analyses found no statistically significant increase in nursing home infection rates (ß = 2.4; 95% CI, -6.4 to 11.2) or the community-adjusted infection rates (ß = -5.2; 95% CI, -10.9 to 0.5) associated with the lifting of the federal restriction.

Conclusions and implications: Lifting the federal visitation restriction had a negligible impact on nursing home infection rates. Policymakers and nursing home administrators should only consider implementing visitation restrictions under extreme circumstances.

Keywords: COVID-19 infections; Federal visitation restriction; difference-in-differences; nursing homes.