Residents have rights. This is the core of the Long-Term Care Ombudsman Program, which is dedicated to advocating for the rights of residents. During this pandemic, we have seen rights in direct conflict with health and safety precautions against COVID-19. Most notably is a resident’s right to have visitors. 

Since March of 2020, visitation guidance has changed several times. Initially, all visitation was completely stopped. Slowly, window visits were introduced, followed by outdoor visitation. Some long-term care (LTC) homes installed safety measures, like plexiglass, to protect residents. For months, visits were conducted in this fashion, with residents talking to loved ones through windows or across a plexiglass divider outside. 

This March, a year after visitation initially stopped, we saw the biggest change to visitation guidance. Not only did LTC homes have to allow indoor visitation, but if the resident is vaccinated, visitors did not need to adhere to social distancing when they were with the resident. After a year of isolation, residents could hug their loved ones. 

Even with these changes, there were still limitations to visits: they had to be scheduled, they had to temporarily stop during outbreak testing, and LTC homes could implement their own restrictions on visit length. Now, with the newest update from the Centers of Medicare and Medicaid Services (CMS), revised November 12, 2021, there is even more freedom with visits.

Changes in the Guidance

This newest revision of the guidance has rolled back some of the previous restrictions. A few of the biggest changes are that LTC homes cannot limit the number of visitors or the length of visits. Additionally, visitors no longer need to schedule their visits.

Who is Required to Follow This Guidance?

This new guidance is from CMS. CMS guidance must be followed by certified skilled nursing facilities and intermediate care facilities. Other levels of care (assisted living facilities and residential care facilities) are required to follow guidance from the Department of Health and Senior Services (DHSS). We expect updated DHSS guidance soon. In the meantime, read our previous blog post about the DHSS guidance from March of 2021.

What Do Visits Look Like Now?

Visits have changed drastically over the past two years. We are finally getting back to what visits looked like pre-pandemic, with a few important caveats. Here is what you can expect:

  • Visitors do not need to schedule visits ahead of time. 
  • Residents can have multiple visitors at one time.
  • LTC homes can no longer limit the length of visits
  • Visits still need to adhere to the core principles of Covid-19 prevention, ensuring that physical distancing can be maintained.
  • If a resident’s roommate is immunocompromised or unvaccinated, it is not recommended that visits occur in the resident’s room, unless the resident is unable to leave their room.
  • For the most part, masks should be worn at all times. If the LTC home is in a low-transmission community, both the visitor and resident are fully vaccinated, and the resident gives permission, masks do not need to be worn while visiting with the resident. However, they should be worn when around other residents and healthcare personnel.
  • Residents currently on transmission-based precautions (TBP), should visit in their room and wear a well-fitting mask when possible.
  • It is highly recommended that visitors get vaccinated, but it is not required. Likewise, LTC homes cannot require that visitors get tested before visiting, but testing is recommended.
  • An outbreak investigation initiates when a new onset of Covid-19 occurs in the LTC home. Visits should still be allowed at this time, but visitors and residents should be made aware of the risks. In this scenario, these visits should occur in residents’ rooms, and visitors should wear masks, regardless of vaccination status.
  • Currently, there are no scenarios related to Covid-19 that will prevent visits from occurring. Some scenarios will limit visitation to residents’ rooms, but visits will still be allowed. 

What to Expect

We know that these past couple of years have been trying for everyone, and LTC residents have suffered more than most, losing rights that they had previously enjoyed. Balancing a resident’s right to have visitors with the right of other residents to be safe from harm has been a challenge. For the health and safety of all residents, visits were canceled and then reintroduced slowly. With the availability of the vaccine and transmission rates decreasing, the risk associated with visits no longer outweighs the resident’s right to have visitors. 

This guidance is new, and some LTC homes might not have adjusted their visitation policies. Even though you don’t need to schedule visits ahead of time, it might be helpful to reach out to your loved one’s nursing home to make sure that they are aware of and adhering to this new guidance. 

If you have questions about this guidance or are having difficulty working with your loved one’s LTC home, reach out to your ombudsman.

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