Nursing Home Bill Mandates Daily Access for Essential Caregivers, Even During Lockdowns, Starting in 2 Years

This new legislation, the Essential Caregivers Act of 2025, is a direct response to the heartbreaking isolation that residents of nursing homes and long-term care facilities faced during the pandemic. Simply put, this bill establishes a fundamental right for residents in Medicare and Medicaid-certified facilities—like skilled nursing homes and intermediate care facilities—to designate at least one “essential caregiver.” If passed, this means that even when a facility restricts general visitation due to a public health emergency, that designated caregiver must still be allowed daily, in-person access.

The Right to Daily Access, No Matter What

For anyone who had a loved one in a nursing home during the COVID-19 lockdowns, this is a massive change. The bill requires facilities to allow the essential caregiver to visit and assist the resident every day, at any time, even if the facility is otherwise closed to visitors (Section 3). This access is designed to ensure that the resident doesn’t suffer the severe health decline from isolation that the bill’s findings cite—things like a 40% rise in reported depression and a 31% increase in pressure ulcers during the last emergency.

The essential caregiver can be designated by the resident, or by their legal representative if the resident has cognitive challenges. This caregiver must agree in writing to follow all facility safety protocols, but here’s the key part: those protocols cannot be more restrictive than what the facility requires of its own staff. This prevents facilities from setting up impossible barriers for family members.

Putting a Hard Cap on Denial

Facilities can’t just decide to shut out the essential caregiver indefinitely. The bill puts strict limits on denial of access during an emergency. A facility can only deny access for an initial period of no more than seven days. They can only extend that denial for one additional seven-day period, and only if the state’s health department signs off on it. That means the total denial of access cannot exceed 14 days during any single emergency period (Section 3).

Crucially, if a resident is in end-of-life care or is experiencing decline or distress (as defined later by the Secretary of Health and Human Services), the facility must allow access, regardless of any other restrictions or denial periods. This guarantees that no one dies alone or without advocacy.

The Appeals Process: Burden of Proof on the Facility

If a facility tries to deny access to an essential caregiver, the bill sets up a fast-track appeals process managed by State survey agencies. If the caregiver is denied access because the facility claims they violated safety rules, the facility must first give a written warning. If the caregiver still fails to correct the issue, the facility can deny access, but they have to send a written explanation within 24 hours.

If the caregiver appeals, the state agency has to start investigating within two business days and make a determination within 48 hours of starting the investigation. This is lightning speed for government bureaucracy. And here’s the kicker: the facility has the burden of proving that the essential caregiver violated the safety agreement. If the facility is found to have wrongly denied access, they face a civil money penalty if they don’t immediately allow access and create a corrective action plan.

The Real-World Trade-Offs

For residents and their families, this bill is a huge win for maintaining dignity and health. It essentially embeds a family advocate into the system, even during the worst crisis. However, it does create new administrative and compliance challenges for nursing homes. They will need to manage these new, non-staff visitors during highly restrictive periods and face potential fines if they mess up the process. The bill also requires facilities to provide “reasonable accommodations” to protect the rights of a resident’s roommate. For instance, if the caregiver is visiting a resident in a shared room, the facility might need to ensure the roommate’s privacy or safety is maintained, which adds a layer of complexity to scheduling and logistics.

Finally, note the timeline: the amendments made by this Act take effect two years after the date of enactment. This two-year runway is intended to give the Department of Health and Human Services time to establish the necessary rules—especially the appeals process—and for facilities to update their emergency protocols.