New DOH Nursing Home Visitation Guidance Reduces COVID-19-Free Lookback to 14 Days
On Sept. 15th, the Department of Health (DOH) released new nursing home visitation guidance, effective Sept. 17th, that allows facilities to welcome visitors if they have no "new nursing home onset of COVID-19 in the nursing home" for 14 days. This represents a significant reduction of the 28-day waiting period previously in effect. Notably, the new DOH guidance also uses the "nursing home onset" standard introduced by the Centers for Medicare and Medicaid Services (CMS) in its reopening guidance. Another major change in the guidance is a new requirement that all visitors present a negative COVID-19 test result within the last seven days.
In addition to the 14-day waiting period after a COVID-19 infection in the facility, to qualify for visitation, nursing homes must satisfy specified conditions, including, in summary:
- Compliance with state and federal reporting requirements;
- Submission of a NY Forward Safety Plan here and communication of any changes to the plan, including space(s) to be used (outdoors and indoors) and the number of visitors that could be accommodated with social distancing;
- No staffing shortages based on the staffing plan and National Healthcare Safety Network (NHSN) submissions;
- Access to adequate testing and a testing plan that ensures that all consenting nursing home residents have had a baseline COVID-19 test and the ability to test and re-test all residents upon identification of a case in the facility;
- An arrangement with a laboratory to process SARS-CoV-2 PCR tests with a rapid turnaround time;
- Adherence to written screening protocols.
The number of visitors to the nursing home must not exceed 10 percent of the resident census at any time, and only two visitors will be allowed per resident at any one time. Visitors under age 18 are prohibited. This is in contrast to earlier guidance which allowed visitors under age 18 if accompanied by an adult age 18 or older.
If these conditions are met, nursing homes may allow visitation in accordance with rigorous guidelines. These guidelines include, in summary, the following:
- Visitation should be limited to outdoor areas, but may be permitted in an inside, well-ventilated space with no more than 10 individuals who are socially distant and wearing a mask;
- Visitation is prohibited in resident room or care areas, except for end-of-life visits, parents visiting a pediatric resident in a dedicated pediatric unit or wing, and residents who are bed-bound;
- Visitors, including Long Term Care Ombudsmen, are screened for symptoms and present a negative COVID-19 test result within the last seven days;
- Documentation of visitors' contact information with specified elements is maintained electronically;
- Adequate personal protective equipment (PPE) is made available to ensure that residents and visitors wear a mask or face covering;
- Alcohol-based hand rub is made available;
- A fact sheet regarding requirements of visitors is made available at screening.
If visitation conditions are met, facilities may also allow small group activities with social distancing and no more than 10 residents and staff. Certain "non-essential personnel" are allowed in facilities, subject to the same infection control requirements as staff, including students enrolled in programs to become licensed, registered, or certified health care professionals, provided the nursing home environment is appropriate to the student's education, training, and experience. Construction projects may resume if they impact the lives of residents and were previously approved with a mitigation/prevention plan. Such projects may not resume in a functioning and occupied dedicated COVID-19 unit.
The guidance also notes that nursing homes should continue to refrain from sending residents to non-medically necessary trips outside the nursing home and that communal dining remains suspended.