One of the main purposes of the ombudsman program is to uphold resident rights. During COVID-19 times, however, some of these rights are unfortunately waived. One such right is the right to visitors.

Normally, residents have the right to access, including access to visitors at the time of their choosing. With COVID-19 visitation restrictions put in place, the right to visitors has been severely curtailed, with visitors being restricted except in end of life situations.

New Visitation Guidelines

Until recently, there have been no changes to these restrictions, but last week the Centers for Medicare and Medicaid have put out visitation guidelines for skilled nursing (SNF) and intermediate care facilities (ICF). The most recent guidelines for SNFs and ICFs were released on September 17th. 

On September 22nd, additional guidance from the Department of Health and Senior Services (DHSS) was released. These guidelines provide information about visiting ALFs and RCFs.

While the initial guidelines had a phased reopening plan that allowed for loved ones to visit when the LTC community enters Phase 3, these new guidelines do not distinguish between “essential” visitors and loved ones. 

What Do the Guidelines Mean for Families?

For loved ones of residents in LTC communities, this will depend on the level of care.

What about skilled nursing facilities (SNFs) and intermediate care facilities (ICFs)?

One of the most significant changes is the required visitation. With the prior guidance, SNFs and ICFs had to meet the criteria to have the option to open. They could, however, choose not to open even if they met the requirements. Now, if an SNF or ICF meets the requirements, they must facilitate indoor visitation.

What are the requirements? 

  1. There is no current outbreak in the LTC community, AND they are not currently conducting outbreak testing.
  2. The core principals of COVID-19 prevention is upheld (face coverings, screening of visitors, hand hygiene, etc.)
  3. Visitors are limited to one visitor per resident. The total number of visitors in an LTC community is limited based on the size of the building.
  4. Visitors should go directly to the space they visit their loved one, whether that is a resident’s room or a designated visiting area.
  5. The county in which the LTC community is located is at a low or medium positivity rate. An LTC community may also choose to limit visitation if the adjacent county has a high positivity rate. 

What constitutes a “low” or “medium” positivity rate?

  • Low: less than 5 percent
  • Medium: 5-10 percent
  • High: greater than 10 percent

To confirm that their county has a low or medium positivity rate, an LTC community should contact their county health department. 

What about assisted living facilities (ALFs) and residential care facilities (RCFs)?

The Department of Health and Senior Services (DHSS) released guidance for visiting LTC communities, including ALFs and RCFs, on September 22. DHSS notes that although this guidance is written for LTC communities, all SNFs and ICFs must follow the CMS guidance outlined above. The biggest difference between the DHSS guidance and the CMS guidance is that ALFs and RCFs have the option to open when they meet the criteria; however, they can choose not to allow visitors even if they meet the requirements.

The other key difference between the DHSS guidance and the CMS guidance is DHSS does not consider the county’s infection rate when determining if the LTC community can open. They require that it has been at least 14 days since a facility acquired COVID-19 case has occurred. Facility acquired is defined as a staff member testing positive who has been in the building in the last 10 days or a resident testing positive who is currently residing in the LTC community.

What about outdoor visits?

Whenever possible, all LTC communities should try to facilitate outdoor visits. These visits will depend on the weather, health of residents, and the LTC community’s outbreak status. They are encouraged to provide a space for these visits, such as a patio, tent, or courtyard. To provide LTC communities with the opportunity to facilitate these outdoor visits, Civil Money Penalty (CMP) funds are available for communities to apply for. They can use these funds to purchase the necessary supplies for conducting outdoor visits.

While these new guidelines are a positive step towards homes reopening, visitors should be aware that this change does not mean all homes are suddenly open. LTC communities still need to meet all of the criteria stated in the guidelines and need to confirm their county’s positivity rate with the health department. 

If you aren’t sure whether your loved one’s home is allowing visits, contact them to find out. If you have more questions about these guidelines, reach out to your ombudsman or contact the state ombudsman office at 1-800-309-3282.

Comments

  1. 1
    COVID-19 Update | VOYCE on October 8, 2020

    […] If you would like to know more about the new visitation policy, please see our recent blog post about nursing home visitation! […]

  2. 2
    Dee Porter on November 18, 2020

    My mom is in The Christian Village in Lincoln, Il., and is on hospic care after falling and l fracturing her pelvus.
    Firstly, I have NEVER in my 60 some years seen nurses who care and have so much compassion for their patients. The problem is that there are no where near enough of them. 1 Rn and 1 CNA, occasionally they get lucky and have 2 CNAs for 2 sometimes 3 halls of people. Thats 56 patients on one RN when they only have one hall. Even Superman couldnt keep up with that. At $5000 a month for a non private room, there is NO reason for this.
    They recently had a spike 0f 14 positive COVID patients. I was told I would have to leave. Well, I left, fussing all the way, and called up the chain of command till I got back in. NO ONE should have to die alone. My mother was not positive, and neither am I. She wouldnt be dying if they had enough staff that they could have helpped her to the bathroom.
    Ive been here everyday since the 10th of this month, and yesterday was the first time I saw anyone from house keeping in either of her rooms.
    And they are not allowing hospic in the building. Whats that about? How are they supposed to take care of my mom if they cant see her?
    Who the hec do I turn to? I started with the director if nursing, who is very curt, and does not help at all. I talked to the executive director who took it out on the nursing staff. And believe me when I tell you that they have nurses here that could put many a nurse with half the load to shame.
    What is the state requirement of patient to nurse ratio, or is there not one. Because believe me after seeing the inside of 3 various nursing homes, and seeing how our elderly are treated, it makes me sick.
    Who pocketing the money? Its not the nurses. I think the state needs to come spend a month in this nursing home, and this is by far one of the best . Patients setting in their rooms waiting for 2 hour bed checks that they pray are on time to get a drink, use the restroom, or the Lord knows what else.
    The first home she was in finally closed because they lost all their patients. I would go every evening to see my mom. Sometimes it might be 6 or 6:30 when I got there, and she would be setting in a dark dinning room because,”oops, we forgot her.” Ugh. Then the second where she fell and broke her hip because she would push her call light, and the girls would yell, we are busy. So mom went alone, broke her hip, hit her head, and here we are at The Christian Village, where the staff is so over worked that accidents are waiting to happen.
    Mom again pushed her light 3 different times, the girls would come, tell her they would be back, and never made it. Mom got up to go, this time fallung and fracturing her pelvis. But, we didnt know this until 6 days after she fell because the doctor “video accessed her,” and said she was fine.
    Every day I would come window visit my mom, and she would cry telling me she hurt. They gave her norco, which did nothing. I would call and the nurses would tell me,that she screamed all night. I told them I wanted xrays. 2 days later they were ordered, but not done until the third day after her fall were they done. Two days later I get a call that one of the xrays were back, and it showed nothing. The following evening Mary called and said that she had been in sever pain all day. She asked to send her to the ER, which I of course said, yes, I wanted you to take her the night she fell.
    The doctor ordered a full body scan and said that moms pelvis was fractured, but they really couldnt do anything, so they sent her back with orders for bed rest. Mom called me the next morning crying in pain, they had her up in a chair. I came out to the home, and they suggested we put her on hospic so they could give her stronger pain meds.
    Ive seen a CNA twice, an RN once, and then they said they couldn’t come in. So here I set for the 9th night in a row watching my mom die. She has not eatten since the 10th, and that was a cup of ice cream that it took me all day to get down her. I dont rememder the last time she took a drink. I swob her mouth with water and swabs they gave me.
    She is unable to speak anymore, the only time she makes any sound is when they move her, and she has bed sores. They have changed her once today. Haven’t bothered to even check her since. 2 pm, and its 7:40pm. I have 5 rare diseases that cause me to be laid up for days at a time, but I have given lots of thought to if they would give me the meds, I would take her home with me. At least I would be home, able to eat normal, sleep in a bed, and I could give her the meds, but they wont let that happen. Has to be,an RN. So for those on hospice at home, does a nurse come to their home every two hours to give them meds? Cause if they do, Ill take her home.
    Setting in a chair, watching your mother dye slowly is horrable. I wont leave her because I fear they will just forget about her.
    I have at times, after repeatedly pushing the damn call light, stepped out into the hall and screamed because no one was in sight,”I need pain meds.” Happened again tonight and Craig told me,to push my call light. I told him that I had pushed it 3 times, 3times a cna came in and told me that they would tell the RN. He turned, and yelled down the hall ,can someone help her? The RN came running, gave mom her meds that was at 6:30, havent seen a sole since. Now like I said, they have some amazing nurses here, and they have some who you have to light a fire under, most are amazing, just can’t possibly give the patients care because they have to many.
    It’s now 8:09 p.m. mom should get meds in 22 minutes, a d Ill gaurantee you Ill be yelling down the hall again.
    You know, my moms roommate Marge fell 2 weeks before my mom. They put her to bed. Two days later she died.
    So when does the state step in and force changes? Or is this going to be another, “Honey you need to contact…?” How many will die? They may just be old folks to you, but they are someones mother, sister, aunt, friend. I filed a comolaint with public health. I was told they would have to investigate. Ild be willing to say that not one person from pubkic health has been in here yet.

    Where am I supposed to turn? I dont want anyone else to have to go through this.

    1. 3
      mmoore on November 19, 2020

      Hi Dee,
      First, we’re devastated you and your mom are going through this.
      Laws on staffing levels vary from state to state, but in Illinois, effective January 1, 2014, the minimum staffing ratios shall be increased to 3.8 hours of nursing and personal care each day for a resident needing skilled care and 2.5 hours of nursing and personal care each day for a resident needing intermediate care. (Section 3-202.05(d) of the Act). (https://www.ilga.gov/commission/jcar/admincode/077/077003000F12300R.html)
      However, many states and the federal government have waived a lot of rules due to COVID. Since VOYCE covers Missouri, we’re not knowledgeable enough about Illinois to help you as much as we’d like to.
      However, the Ombudsman for your area is Megan Jizmagian, Regional Ombudsman, 800-842-8538. She should be able to provide you with answers to all your questions.

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