In accordance with the most recent Centers for Medicare and Medicaid Services (CMS) revision dated 11/12/21 and the New York State Department of Health (NYSDOH) revision dated 11/16/21, visitation is permitted for all residents, at all times.
Previous guidance from CMS and the NYSDOH was focused on protecting Nursing Home residents from Covid-19. The facilities and regulatory agencies recognize that physical separation from family and loved ones has taken a physical and emotional toll on residents and their loved ones. We understand that Nursing Home residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends.
Due to the increasing numbers of vaccinated residents, many of whom have opted for booster vaccinations and the employee mandate to be vaccinated in a healthcare setting, CMS and the NYSDOH feel it is safe to open up visitation.
There are still concerns associated with visitation regarding the few unvaccinated or when the county’s Covid-19 level of community transmission is substantial or high. Infection Prevention and Control recommendations and guidance must still be adhered to in order to maintain the safety and well-being of our residents/patients, visitors and staff.
Due to the changes in Visitation Guidance, visitation is now allowed for all residents, at all times. The frequency and length of visits, the number of visitors, and advanced scheduling of visitation has been eliminated but visitors must follow the Core Principles of Infection Control when in the facility.
Infection Prevention Core Principles:
- Visitors who have had a recent positive viral test for Covid-19, have symptoms of Covid-19, or currently meet the criteria for quarantine (due to exposure or travel) should not enter the facility.
- Visitors will have their temperature taken and a healthcare screening will be performed. Upon completion, all visitors will sign the visitor log and receive a visitor sticker.
- After completion of the screening process, visitor’s will be directed to the resident’s room. If the resident’s roommate is immunocompromised or unvaccinated, you may be asked to visit in an alternate area. (Outdoor visitation is always preferred due to decreased risk of transmission (weather permitting), the unit must be notified that you are taking the resident outside and visit must occur on premises where permitted)
- Visitors are not permitted to stroll through the facility, as per Infection Control directives
- Visitors are encouraged to become vaccinated and should carry their vaccination card with them. Visitors who are unvaccinated are encouraged to obtain a negative test (2-3 days prior to their visit)
Please adhere to the following Infection Control Protocols during your visit:
- All visitors must wear an appropriate facemask or facial covering at all times, regardless of vaccination status when on facility premises. Visitors are encouraged to arrive with their own facemask. Residents, if capable, shall also wear a facemask or facial covering.
Additional Personal Protective Equipment (PPE) may be required for Covid positive or Covid suspected residents
- Although there is no limit for number of visitors at any given time, social distancing of 6 feet must be adhered to during the visit. Please limit the number of visitors to a number that permits social distancing.
- Visitors will be required to sanitize their hands with facility provided sanitizer before the visit begins and upon conclusion of the visit.
Additional Facility Protocols:
- The facility is responsible for intermittently monitoring adherence to Infection Control Protocols during your visit. “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 the facility. (as per CMS/NYSDOH)”
- Instructional signage shall be displayed within the facility regarding Covid-19. A Visitor Fact Sheet is available at the front desk entrance.
- Cleaning and disinfecting of high frequency touched areas often as per protocol. Cleaning of visitation area after each visit.
- Appropriate staff use of PPE and Hand Hygiene
- Effective cohorting of residents (separate areas dedicated to Covid-19 care)
- Resident and staff testing as required by regulation
Please note: In accordance with regulation and resident’s rights, the resident has the right to make choices about his/her life in the facility that are significant to the resident. Residents may deny or withdraw consent for a visit at any time. Therefore, if a visitor, resident, or their representative is aware of the risks associated with visitation, and the visit occurs in a manner that does not place other residents at risk, the resident must be allowed to receive visitors as he/she chooses.
Facilities shall not restrict visitation without a reasonable clinical or safety cause consistent with current CMS/NYSDOH regulations and guidance.
Visitation During an Outbreak:
An outbreak exists when a new nursing home onset of Covid-19 occurs, one new Covid-19 case among residents or staff.
While it is safer for visitors not to enter the facility during an outbreak investigation, visitors must still be allowed in the facility. Visitors should be made aware of the potential risk of visiting during an outbreak investigation and adhere to the core principles of infection prevention. If residents or their representatives would like to have a visit during an outbreak investigation, the should wear face coverings or masks during visits, regardless of vaccination status, and visits should ideally occur in the resident’s room. Social distancing (6 feet) shall also be maintained.
Compassionate Care Visits:
Compassionate Care visits are allowed at all times. Under previous regulations and guidance, there were some scenarios where residents should only have compassionate care visits. However, visitation is now allowed at all times for all residents. IN the event a scenario arises that would limit visitation for a resident (i.e. resident is severely immunocompromised and the number of visitors the resident should be exposed to needs to be kept to a minimum), compassionate care visits would still be allowed at all times.
Resident Outings/Leaving the Facility for Visitation:
Facilities must permit residents to leave the facility as they choose. Should a resident choose to leave, the facility should remind the resident and any individual accompanying the resident to follow all recommended infection prevention practices including wearing a face covering or mask, social distancing, and hand hygiene and to encourage those around them to do the same.
Upon the resident’s return, nursing homes should take the following actions:
- Screen residents upon return for signs and symptoms of Covid-19
- If the resident or family member reports possible close contact to an individual with Covid-19 while outside of the nursing home, test the resident for Covid-19, regardless of vaccination status. Place the resident on quarantine if the resident has not been fully vaccinated
- If the resident develops signs or symptoms of Covid-19 after the outing, test the resident for Covid-19 and place the resident of Transmission-Based Precautions, regardless of vaccination status.
- A nursing home may also opt to test unvaccinated residents without signs or symptoms if they leave the facility frequently or for prolonged length of time, such as over 24 hours.
- Facilities may consider quarantining unvaccinated residents who leave the facility if, based on an assessment of risk, uncertainty exists about their adherence or the adherence of those around them to recommended infection prevention measures.
- Monitor residents for signs and symptoms of Covid-19 daily
Note: Residents who leave the facility for 24 hours or longer should generally be managed as a new admission or readmission as recommended by the CDC’s” Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes”. Please note there are exceptions to quarantine, including fully vaccinated residents.
Communal Activities and Dining:
While adhering to the core principles of Covid-19 infection prevention, communal activities and dining may occur. Book clubs, crafts, movies, bingo, exercise, etc. are all activities that can be facilitated with alterations to adhere to the guidelines for preventing transmission. The safest approach is for everyone to wear a face covering or mask while in communal areas of the facility.
Entry of Healthcare Workers and Other Providers of Services:
All healthcare workers must be permitted to come into the facility as long as they are not subject to a work exclusion or showing signs or symptoms of Covid-19. In addition to healthcare workers, personnel educating and assisting in resident transitions to the community should be permitted entry consistent with this guidance. EMS personnel do not need to be screened, so they can attend to an emergency without delay. All staff, including individuals providing services under arrangement as well as volunteers, should adhere to the core principles of Covid-19 infection prevention and must comply with Covid-19 testing requirements.
Access to the Long Term Care Ombudsman:
CMS requires that a Medicare and Medicaid certified nursing home provide representatives of the Office of the State Long Term Care Ombudsman with immediate access to any resident. If the ombudsman is planning to visit a resident who is in quarantine or on transmission-based precautions, or an unvaccinated resident in a nursing home in a county where the level of community transmission is substantial or high in the past seven days, the resident and the ombudsman should be made aware of the potential risk of visiting, and the visit should take place in the resident’s room. Representatives of the ombudsman office shall adhere to the core principles of Covid-19 infection prevention.
If the resident or the Ombudsman program requests alternative communication in lieu of an in person visit, the facility must, at a minimum, facilitate alternative communication, such as phone or other technology.
Nursing homes are also required to allow the Ombudsman to examine the resident’s medical, social, and administrative records as authorized by State Law.
Federal Disability Rights Laws and Protections and Advocacy Programs:
As per regulatory directives, the facility must allow immediate access to a resident by any representative of the protection and advocacy systems, as designed by the state, and as established under the Developmental and Disabilities Assistance and Bill of Rights (DD Act), as well as the Protection and Advocacy Program for those with Mental Illness (P&A for Mentally Ill Individuals Act). Representatives of the P&A programs are permitted access to all facility residents, which includes “the opportunity to meet and communicate privately with such individuals regularly, both formally and informally by telephone, mail, and in person.
If the P&A Program is planning to visit a resident who is in quarantine or on transmission-based precautions, or an unvaccinated resident in a nursing home in a county where the level of community transmission is substantial or high in the past seven days, the resident and the P&A representative should be made aware of the potential risk of visiting, and the visit should take place in the resident’s room. Representatives of the P&A Program office shall adhere to the core principles of Covid-19 infection prevention.
State Survey Agencies and CMS are ultimately responsible for ensuring surveyors are compliant with the applicable expectations. LTC facilities are not permitted to restrict access to surveyors based on vaccination status, nor ask a surveyor for proof of his/her vaccination status as a condition of entry. If the facility has any questions, they should call their local State Survey Agency.