DOH Updates Nursing Home Visitation Guidance to Align with CMS and CDC Guidance
On July 8th, the Department of Health (DOH) released updated nursing home visitation and social interaction guidance that aligns with Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidance and clarifies certain issues that have been subject to various interpretations by regional office personnel.
Key Changes
Key elements of the new guidance that differ from prior guidance are:
- If both the resident and their visitor(s) are fully vaccinated, and the resident and visitor(s) are alone in the resident room or designated visitation room, the resident and visitor may choose to have close contact (including touch) without a mask or face covering.
- In an outbreak, only indoor visitation is suspended.
- Residents who are on transmission-based precautions (TBP) for confirmed or suspected COVID-19 or an exposure to COVID-19 as defined by the CDC should only receive visits that are virtual, through windows, or in person for compassionate care situations. In other words, residents who are placed on TBP only because they live on a unit where an infected resident or staff member lives or works, but who have not been exposed as defined by the CDC, may receive visitors outdoors.
- Communal dining may occur without the use of face coverings or physical distancing if all residents are fully vaccinated. If there are unvaccinated residents also dining in the communal dining area, all residents must wear face coverings when not eating, and unvaccinated residents should physically distance from others.
- Group activities may occur without the use of face coverings or social distancing if all residents participating are fully vaccinated. If any residents who are not fully vaccinated are participating, all residents must wear a face covering, and unvaccinated residents should physically distance from others.
Core Principles of Infection Control Continue
The new guidance supersedes and replaces prior guidance. It continues to require adherence to core principles of infection prevention to reduce the risk of COVID-19 infection, including, among others, screening of all who enter the facility for signs and symptoms of COVID-19 and denial of entry of those with signs or symptoms or those who have had close contact with someone with COVID-19 in the prior 14 days, hand hygiene, and use of masks and social distancing in accordance with CDC guidance. Visitors who are unable to adhere to the core principles of COVID-19 infection prevention should not be permitted to visit or should be asked to leave. As under the prior guidance, facilities are encouraged to offer COVID-19 testing to visitors or to suggest that they be tested prior to visiting; however, facilities may not require testing or vaccination as a condition of visitation.
Indoor and Outdoor Visitation and Outbreaks
The new guidance maintains a preference for outdoor visitation, but also continues to require indoor visitation except for:
- Unvaccinated residents if the nursing home’s COVID-19 county positivity rate is >10 percent AND <70 percent of residents in the facility are fully vaccinated;
- Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue TBP; OR
- Residents in quarantine, whether vaccinated or unvaccinated, until they have met the criteria for release from quarantine.
The new guidance continues to require the suspension of visitation indoors in affected units during a contained outbreak and facility-wide when the outbreak affects more than one unit. However, as noted above, it clarifies that outdoor visitation may continue even during an outbreak, and even for residents of affected units, except for residents who are on TBP for confirmed or suspected COVID-19 or an actual exposure to COVID-19.
Scheduling Visits and Roommates
The new guidance also continues to require facilities to consider how the number of visitors may affect the ability to adhere to infection prevention practices and encourages facilities to consider scheduling visits in order to permit adherence to infection prevention principles, ensure that all residents are able to receive visitors, and support respect for resident privacy when residents share a room. If possible, when residents share a room, visits should not be conducted in the resident’s room. However, when the health status of the resident prevents leaving the room, the guidance instructs facilities to attempt to enable in-room visitation while adhering to infection prevention principles.
Personal Caregiving and Compassionate Care Visitation
The new guidance clarifies that under the personal caregiving visitation regulations for nursing homes, facilities must have policies and procedures in place regarding personal caregiving visitors, including those who provide compassionate caregiving. However, since there is no state public health emergency at this time, facilities are not required to activate personal caregiving policies. Compassionate caregiving is still required under federal guidance, regardless of general visitation restrictions.
Other Required Visitors and Health Care Providers
In addition to compassionate care visitors, certain other visitors must be allowed entry into facilities regardless of general visitation restrictions. Representatives of the long term care ombudsman and representatives of protection and advocacy systems for people with disabilities must be allowed immediate access to facilities, unless there is an infection control concern. Health care workers who are not employees of the facility but provide direct care to residents, including social workers and clergy, must be permitted to enter facilities as long as they are not subject to a work exclusion due to an exposure to COVID-19 or showing signs or symptoms of COVID-19. Federal and state surveyors must also be permitted access to the facility and are not required to be vaccinated.
Communal Dining and Group Activities
As noted above, facilities may offer communal dining without the use of face coverings or physical distancing if all residents are fully vaccinated. If there are unvaccinated residents in the communal dining area, all residents must wear face coverings when not eating, and unvaccinated residents should physically distance from others. Group activities may occur without the use of face coverings or social distancing if all residents participating are fully vaccinated. If any residents who are not fully vaccinated are participating, all residents must wear a face covering, and unvaccinated residents should physically distance from others.
The guidance directs facilities to the CMS visitation guidance and the CDC's Updated Healthcare Infection Prevention and Control Recommendations in Response to Vaccination for additional information.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838