CMS Response to Inquiry Regarding Screening of Nursing Home Volunteers and Contractors:

Thank you for your recent inquiries related to the screening of nursing home volunteers and contractors. Our regulations differentiate between volunteers that provide care and services to residents and volunteers who socialize with residents.

In the case of volunteers and contractors who provide care and services (e.g., conducting laboratory/radiology services, transporting residents, assisting with eating/dining) and therefore, act as agents of the facility, the facility cannot engage those with adverse actions related to abuse, neglect, exploitation, misappropriation of property, or mistreatment, as described in 42 CFR 483.12(a)(3) [Tag F606]. Also, the facility’s policies and procedures must address how pre-screening occurs for prospective volunteers and contractors [42 CFR 483.12(b)-Tag F607].

The facility should require these individuals to be subject to the same scrutiny prior to placement in the facility, whether screened by the facility itself or a third-party agency. The facility should maintain documentation of the screening that has occurred.

We do believe that local organizations and entities can help enhance the quality of life in a nursing home through volunteer activities as it allows residents to be connected to the community. It is recognized that many groups volunteer at nursing homes intermittently, such as groups representing a religious organization or a corporation that may lead an activity with the residents. In these cases, the volunteers are considered to be “visitors” to the nursing home. CMS does not expect a nursing home to develop and implement policies and procedures to screen these individuals, or generally, any visitor who does not provide direct care to residents. However, we would expect that the facility’s policies related to visitor access include safety restrictions such as denying access or providing limited and supervised access to a visitor who has been found to be abusing, exploiting, or coercing a resident or who is suspected of abusing, exploiting, or coercing a resident until an investigation into the allegation has been completed. Also, visitors must not interfere with the exercise of resident’s rights, e.g., as outlined at 42 CFR 483.10, including the resident’s right to privacy and confidentiality and the resident’s right to self-determination.