The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) and the Department of Emergency Management (DEM) in Florida have weighed in recently and issued new guidance for skilled nursing and assisted living facilities (ALFs) allowing visitation.
According to CMS Order QSO 20-39-NH, this new guidance permitting general and compassionate care visitation was issued on Sept. 17, 2020, to ensure America’s healthcare facilities are prepared to respond to the coronavirus and protect residents, staff and visitors. The order allows visitation at nursing homes and ALFs unless reasonable clinical or resident safety issues are present and documented.
In Florida, DEM Order No. 20-011, issued on Oct. 22, 2020, amended Gov. DeSantis’s executive order from Sept. 1, 2020, removing restrictions on visitation at skilled nursing facilities, ALFs, and other facilities in Florida for people with developmental and other disabilities for end-of-life situations, as well as visits by those who provide necessary health care to a resident, attorneys and public guardians of residents, and compassionate care visitors. Facilities must comply with these requirements regarding visitation and have all appropriate measures in place to enable visitation.
At the start of the COVID-19 outbreak in March 2020, CMS and the state of Florida provided guidance to facilities on restricting visitation to all visitors and non-essential health care personnel except in compassionate-care and end-of-life situations. The new guidance still focuses on protecting facility residents from COVID-19, yet both the federal and state agencies recognize that the prolonged physical separation from loved ones has taken a physical and emotional toll on residents, including increased risk for depression, anxiety and distress. In addition, residents with cognitive impairment or other disabilities may find visitor restrictions and other changes from COVID-19 confusing or upsetting.
Under the revised guidance, facilities must now permit some general visitation as well as compassionate care visits. Compassionate care visitation includes support to help residents deal with difficult transitions or loss, upsetting events, end-of-life situations, significant changes (such as resident admissions to the facility), the need for assistance, cueing or encouraging eating or drinking, or emotional distress or decline.
The combined provisions from both orders (as summarized by Leading Age Florida and listed below) provide reasonable ways a nursing home or ALF can safely facilitate in-person visitation to address the psychosocial needs of residents and remain compliant with the new orders.
All Visits – Core Requirements
- Outdoor visitation is allowed at all times during visiting hours.
- Facilities must establish a visitation policy.
- Facilities must establish a limit on the number of visitors, length of visits, and visiting hours based on their ability to screen visitors, monitor visits, and the size of the space designated for visiting.
- Facilities must conduct screening based on temperature, signs and symptoms, and exposure to COVID-19.
- Facilities must maintain a visitor sign-in and sign-out log.
- Face coverings or masks and appropriate personal protective equipment (PPE) are required.
- Hand washing and/or use of hand sanitizer is required.
- Social distancing between visitors, residents and staff is required.
- There must be instructional signage throughout the facility and visitor areas.
- Visitor movement within the facility should be limited; visits should be conducted in a designated space if the resident has a roommate.
- Appropriate cleaning and disinfecting of high-touch areas and visitor areas with cleaning and disinfecting between visits is required.
- Facilities should provide training on visitor policies, infection prevention and control, and proper use of PPE, and obtain signature of visitor acknowledging training and receipt of policies.
- Recent test result documentation of visitors may be encouraged, but not required. A facility must pay for testing if it requires for entry.
- Facilities must maintain adequate PPE for staff.
- Facilities may restrict or revoke visitation if, after attempts to mitigate concerns, the visitor is unable to adhere to infection prevention and control requirements or other COVID-19 related policies of the facility.
General visitors may be a friend or family member who visits occasionally, young children or grandchildren accompanied by adults, an out-of-town visitor, or clergy (other than for end-of-life visits or other circumstances which qualify as compassionate care. The general visit requirements are:
- Visitors are not allowed indoors if there is a new onset of a COVID-19 positive case within the past 14 days at the facility.
- Visitors are not allowed indoors if the community positivity rate is greater than 10% based on CMS data (nursing homes only).
- Visitors are not allowed indoors if the facility is conducting testing because of an “outbreak” (nursing homes only).
- Visitors are not allowed if the resident to be visited is COVID-19-positive or in quarantine.
- Visitors must wear face masks and appropriate PPE.
- Social distancing is required with all residents (visitors are not allowed to have physical contact – i.e., hugs – with residents).
- Visitation requires adequate capacity at referral hospitals.
Compassionate Care Visits
Compassionate care visitors include those who meet the requirement to provide support to residents, including emotional support. Compassionate care visits are allowed:
- regardless of community positivity rate;
- regardless of facility onset of COVID-19 positive case(s);
- regardless of whether the resident is COVID-19 positive or in quarantine;
- at all times during visiting hours, including evenings and weekends.
Compassionate care visitors must wear surgical masks and PPE appropriate to health care workers. No social distancing is required with residents for compassionate care visits, meaning visitors can give residents a hug and have physical contact with a resident if they wear appropriate PPE and follow the guidelines (for nursing home residents, touching is only allowed for a “limited” time).
You can get more information on the CMS guidelines here, the revised DEM order here, and download frequently asked questions on visitation here from the Agency for Health Care Administration in Florida on Emergency Order 20-011.
Elder Law Associates PA continues to be a strong advocate for long-term care facility residents, and our attorneys are committed to protecting residents’ rights. If you have a question or concern about a facility where a loved one resides, please contact us today. Our attorneys are available for consultations either in person, over the phone or by video conference. Please call us at 1-800-ELDERLAW or (561) 750-3850 or email Info@ElderLawAssociates.com for more details or to schedule a consultation.