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?
- There is no current outbreak in the LTC community, AND they are not currently conducting outbreak testing.
- The core principals of COVID-19 prevention is upheld (face coverings, screening of visitors, hand hygiene, etc.)
- 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.
- Visitors should go directly to the space they visit their loved one, whether that is a resident’s room or a designated visiting area.
- 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.