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COVID-19: Bethesda Policy, Testing and Visitor Updates (11/22/21)


CMS (Centers for Medicare/Medicaid) issued a revised Memorandum (QSO-20-39-HN) revised on 11/12/2021 regarding Nursing Home Visitation – COVID-19.


  • Fully Vaccinated:
    • Refers to a person who is greater than or equal to 2 (two) weeks following a receipt of the second dose in a 2-dose series, or greater than or equal to 2 (two)weeks following receipt of one dose of a single-dose vaccine, per the CDC’s Public Health Recommendations for Vaccinated Persons.
  • Outbreak Testing:
    • In effect when there are any new positive cases in staff or residents. Testing is conducted every 3 (three) to 7 (seven) days until there are no new cases for 14 (fourteen) days.
  • Physical Contact
    • If a resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitted mask and performing hand-hygiene before and after. Regardless, visitors should physically distance themselves from other residents and staff in the facility.

Visitation can be conducted through different means based on a facility’s structure and residents’ needs, such as in resident rooms, dedicated visitation spaces, outdoors, and for circumstances beyond compassionate care situations. Regardless of how visits are conducted, there are certain core principles and best practices that reduce the risk of COVID-19 transmission:

Core Principles of COVID-19 Infection Prevention

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions about and observations of signs or symptoms), and denial of entry of those with signs or symptoms or those who have had close contact with someone with COVID-19 infection in the prior 14 days (regardless of the visitor’s vaccination status)
  • Hand hygiene (use of alcohol-based hand rub is preferred)
  • Face covering or mask (covering mouth and nose)
  • Social distancing at least six feet between persons
  • Instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high-frequency touched surfaces in the facility often, and designated visitation areas after each visit
  • Appropriate staff use of Personal Protective Equipment (PPE)
  • Effective cohorting of residents (e.g., separate areas dedicated to COVID-19 care)
  • Resident and staff testing conducted as required at 42 CFR § 483.80(h) (see QSO-20-38-NH)

These core principles are consistent with the Centers for Disease Control and Prevention (CDC) guidance for nursing homes and should be always adhered to. Additionally, visitation should be person-centered, consider the residents’ physical, mental, and psychosocial well-being, and support their quality of life. The risk of transmission can be further reduced through the use of physical barriers (e.g., clear Plexiglass dividers, curtains). Also, nursing homes should enable visits to be conducted with an adequate degree of privacy. Visitors who are unable to adhere to the core principles of COVID-19 infection prevention should not be permitted to visit or should be asked to leave. By following a person-centered approach and adhering to these core principles, visitation can occur safely based on the below guidance.

Bethesda Home of Aberdeen and Bethesda Towne Square will adhere to QSO-20-39-NH by taking a person-centered approach for the follow visitations:

Outdoor Visitation

  • Outdoor visitation is preferred (weather permitting) via designated areas.

Indoor Visitation (see decision trees below for paths for visitation decisions)

  • Indoor Patio visits
    • May be requested if resident room will not accommodate indoor room visit.
  • Indoor Room visits
    • Starting November 22nd
    • Visitation is no longer set hours; however, visitation cannot take place where large groups gather, including but not limited to Dining Room, Activity rooms, or lounges.
    • Visitors can come multiple times a day and stay as long as resident allows.
    • Families must communicate with each other to not duplicate visit times so Bethesda can still adhere to the Core Principles of COVID-19 Infection Prevention.
    • Number of visitors are not restricted; however social distancing must be maintained.
    • ALL visitors and residents must be always masked (per the Core Principles of COVID-19 Infection Prevention.
    • MUST ADHERE to Core Principles of COVID-19 Infection Prevention.
      • If non-compliance Indoor Visitation will be revoked
    • Visitors must take a direct path to the resident’s room (cannot walk around facility and visit other residents and/or staff).
    • May have physical contact if definition on prior page is met.
    • Meals can be brought in for resident only. Family meals at this time are still prohibited due to the Core Principles of COVID-19 Infection Prevention.
  • Therapeutic Leave
    • Will continue to follow policy on Therapeutic Leave.

Indoor Visitation during an Outbreak

  • When a nursing home onset case of COVID-19 is identified, Bethesda will continue to have indoor visitation.
    • All visitors will be notified upon entry of a potential COVID-19 outbreak and the potential risks of visiting.
    • All visits will be conducted in the resident’s room during an outbreak investigation and all visitors will be expected to maintain face coverings, regardless of vaccination status.