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DOH Issues New Visitation Guidance for ACFs

The Department of Health (DOH) has issued revised visitation guidelines for adult care facility (ACF) and assisted living settings. A few notable changes or clarifications are as follows. Members should review the Dear Administrator Letter (DAL) carefully for full details:

  • DOH has clarified that residents should continue to wear masks in common areas. This issue is under review, and we may see new guidance on this soon.
  • ACFs may not limit the number of visitors a resident can have at any one time, or the frequency or length of visits for residents, or require advance scheduling of visits. However, the ACF must ensure that physical distancing can be maintained, and, to the extent possible, facilities should avoid large gatherings during which a large congregation of individuals in the same space cannot maintain physical distancing.
  • All who enter, with the exception of emergency personnel responding to an emergency, must be screened.
  • If a resident’s roommate is unvaccinated or immunocompromised (irrespective of vaccination status), then visits should not be permitted in the resident’s room, if possible.
  • All residents and visitors should wear face coverings or masks and physically distance, particularly if either is at increased risk for severe disease or unvaccinated.
  • While not recommended, residents who are on transmission-based precautions (TBP) or quarantine can receive visitors. Parameters are provided in the DAL.
  • Unvaccinated residents may choose to have physical touch based on preferences and needs. In such instances, the facility must advise the resident and their visitor of the risks of such contact prior to the visit.

With regard to outings, communal activities, and dining, the Department directs ACFs to place a resident who is unvaccinated or not fully vaccinated in quarantine if they had close contact with someone who is COVID-positive. Ultimately, the ACF should contact the local health department and follow directions for next steps, and the resident should be placed on TBP if they become symptomatic.

In the circumstance that a resident leaves the facility for 24 hours or more, the guidance directs ACFs to the Centers for Disease Control and Prevention's (CDC) Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes: Create a Plan for Managing New Admissions and Readmissions. Members are encouraged to review the CDC guidance carefully, particularly as it may change. However, as of this date, it recommends that residents who are not up to date with all recommended COVID-19 vaccine doses and are new admissions and readmissions be placed in quarantine, even if they have a negative test upon admission, and should be tested as described below. Additional key points from the CDC guidance are summarized below.

Facilities located in counties with low community transmission might elect to use a risk-based approach for determining which of these residents require quarantine upon admission. Decisions should be based on whether the resident had close contact with someone with SARS-CoV-2 infection while outside the facility and if there was consistent adherence to infection prevention control practices in health care settings, during transportation, or in the community prior to admission.

In general, residents who are up to date with all recommended COVID-19 vaccine doses and residents who have recovered from SARS-CoV-2 infection in the prior 90 days do not need to be placed in quarantine, but should be tested as described below. Quarantine might be considered if the resident is moderately to severely immunocompromised.

In most circumstances, quarantine is not recommended for residents who leave the facility for less than 24 hours (e.g., for medical appointments, community outings with family or friends) and do not have close contact with someone with SARS-CoV-2 infection. Quarantining residents who regularly leave the facility for medical appointments (e.g., dialysis, chemotherapy) would result in indefinite isolation of the resident that likely outweighs any potential benefits of quarantine.

The testing guidance states: Newly-admitted residents and residents who have left the facility for >24 hours, regardless of vaccination status, should have a series of two viral tests for SARS-COV-2 infection; immediately and, if negative, again 5-7 days after their admission.

Please let us know what questions you have regarding this new guidance.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828