COVID-19 Impact on Visitation and Surveys for Long Term Care and Skilled Nursing

April 1, 2021
April 1, 2021

The long-term care industry is struggling to deal with a variety of issues. Some such as preventing falls and ensuring emergency preparedness have been concerns for these facilities for quite some time; others such as new regulatory oversight and handling the COVID-19 pandemic are new to the mix. The result is that industry leaders are faced with a multitude of new challenges to manage simultaneously. Needless to say, grappling with the pandemic by itself would be more than all-consuming. When we overlay all of these other elements on top of COVID-19, we find many in this industry overwhelmed by the scope and variety of the issues at hand. This article is Part 2 of our attempt to look more closely at some of the serious concerns of organizations across the continuum of care.

Changes Related to COVID-19 Will Impact Surveys and Visitation Policies in the Future

Though COVID-19 transmission represents a major risk for healthcare organizations, it is most dire for long-term care and skilled nursing, “given their congregate nature and resident population served (e.g., older adults often with underlying chronic medical conditions)” (CDC, 2020). Many organizations across long-term care have taken action to limit or prohibit significant visitation. For residents, many facilities have taken action to restrict all visitors. For the foreseeable future, it is likely that any allowed visitors will be screened for illness and that wearing masks and practicing frequent hand hygiene will be encouraged at all times. More importantly, “Visitors are strongly discouraged from visiting patients who are at high risk for severe illness from COVID-19, including patients who are older adults or with an underlying medical condition” (CDC, 2020). As an alternative, the CDC also advises “Facilities should apply alternatives for direct interaction between visitors and patients, including setting up remote communications (e.g., telephone or internet connection) in the isolation area to allow for video or audio calls” (CDC, 2020).

Visitation by healthcare professionals for such purposes as audits and state compliance surveys will also feel the impact of COVID-19 for the foreseeable future. On March 4, 2020, CMS announced that it was “suspending certain non-emergency state survey inspections, allowing inspectors to prioritize the most serious health and safety threats like infectious diseases and abuse” (CMS, 2020). An important component of the suspension is Medicare validation surveys—”In order to decrease burden on facilities so they can focus on infection control matters and ensure State Agency surveyors retain capacity to respond to any potentially emergent concerns, CMS is also temporarily suspending validation surveys of facilities participating in Medicare via accreditation until further notice” (CMS, 2020).

Accrediting organizations with CMS-approved programs are asked to follow this same suspension guidance. Importantly, though CMS offers that the suspension of survey activities is time-limited, the agency admits there is no way to currently know when regular processes will begin again. In addition, it is likely that regular visits to conduct audits and surveys will be governed by far more strict rules and access restrictions than the industry has known.


CDC, “Management of Visitors to Healthcare Facilities in the Context of COVID-19: Non-US Healthcare Settings,”, last reviewed April 13, 2020, Retrieved at
CMS, “Frequently Asked Questions for State Survey Agency and Accrediting Organization: Coronavirus Disease 2019 (COVID-19) Survey Suspension,”, March 13, 2020, Retrieved at

This blog post continues a series based on our article, Top Issues Across the Care Continuum - Part Two, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. An earlier blog post series was based on our article Top Issues Across the Care Continuum – Part One. Subsequent challenges to be examined during this blog post series include:

  • The Abuse Icon on the Nursing Home Compare Website is Problematic for Many Long-Term Care Organizations.
  • Falls with Injury Are a Serious Concern for Long- Term Care Facilities and the People Who Reside in Them.
  • Emergency Preparedness, While Necessary, Is a Burden for Long-Term Care Facilities.
  • Nursing Homes Struggle with the Demands of Required Compliance Surveys and Regulatory Oversight.
  • Long-Term Care Faces Even More Requirements with QAPI Phase 2 and Phase 3 Regulations.

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.