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DOH Issues Updated ACF Visitation Guidance

The Department of Health (DOH) issued updated visitation guidance for adult care facilities (ACFs) dated June 3rd, which is accessible here. We encourage you to review the guidance carefully but provide a summary of its key aspects below.

  • DOH stresses the responsibility of ACFs to facilitate in-person visitation, consistent with regulations and COVID-19-specific guidance. ACFs should consider how the number of visitors per resident at any one time and the total number of visitors in the facility at any one time may affect the ability to meet infection control standards. Thus, ACFs may want to schedule visits.
  • The guidance reiterates that ACFs can resume interior and exterior construction projects with an approved Resident Safety Plan. It directs ACFs wanting to undertake these initiatives to reach out to their regional office to alert them to the project.
  • The guidance finally provides in writing DOH’s expectation that, in the event of a COVID-19 positive in the facility, the ACF should contact the local health department and follow their direction for next steps. It also requires that ACFs monitor residents in affected units for COVID-19 symptoms at least once per shift and ensure that residents in affected units wear a facemask as tolerated whenever staff enter rooms, refrain from floating staff between units, aim to minimize the number of staff entering rooms where COVID-19 positive residents are located, and cohort positive residents with dedicated staff whenever possible. For residents who initially test negative, follow up with the local health department regarding re-testing if such residents become COVID-19 symptomatic.

Unfortunately, there are some aspects of the guidance that are less clear. The guidance requires the use of face coverings or masks and social distancing in accordance with New York State and/or guidance consistent with vaccination status-applicable guidance per the Centers for Disease Control and Prevention (CDC), which is for the general public. Later in the guidance, it points to Centers for Medicare and Medicaid Services (CMS) nursing home guidance, which then links to this CDC guidance for nursing homes. The mask wearing guidance for the general public is different from that of settings such as nursing homes, so it is unclear which standard DOH is directing ACFs to adopt. Taken together, we interpret this to mean that DOH is permitting fully vaccinated residents to meet with fully vaccinated visitors unmasked and without social distancing if so desired. The federal guidance directs that, in this circumstance, if close contact occurs, it should be limited in duration, and hand hygiene should be performed afterward. A conservative interpretation would suggest that DOH intends that visitors otherwise be masked and keep social distancing when in the presence of other residents or staff. That being said, DOH has yet to confirm these interpretations but has focused on the resident’s right to receive visitors in their response.

It is less clear whether it is required that fully vaccinated residents who can tolerate mask wearing be encouraged to do so when around unvaccinated people or in communal settings. We do believe the Department intends to have staff continue to wear masks regardless of vaccination status.

Again, this guidance is somewhat confusing, particularly since it seeks to “align with” various pieces of federal guidance that themselves are not consistent. If the Department provides us with further clarification on these questions, we will inform members.

The guidance also recommends establishing cohorts of 10 or fewer residents for the purposes of communal dining and activities. It is unclear whether these cohorts can, if fully vaccinated, be less than six feet apart or gather without masks, however. This particular section of the guidance does not reference the federal guidance that would permit this in a group of fully vaccinated residents/staff.

LeadingAge NY has been persistently advocating for the Department to revise their guidance for nursing homes and ACFs to be consistent with federal guidance on visitation, social interaction of fully vaccinated residents, and testing of fully vaccinated workers. In addition, we have continually advocated to reduce the frequency of the burdensome reporting requirements that ACFs and nursing homes must complete daily. While this directive seems to take a step in the right direction, unfortunately there remains confusion. We will provide members with any clarifications we receive and will continue to advocate for more reasonable standards in light of the significant progress made to date.

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