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State Issues New Nursing Home Visitation Guidance

New nursing home visitation guidance was posted to the Governor’s website on Feb. 22nd and distributed by the Department of Health (DOH) with minor revisions on Feb. 23rd. As of the time of this writing, there is no new visitation guidance for adult care facilities (ACFs). The new nursing home guidance takes effect Feb. 26th and:

  • Continues to bar visitors from facilities that have had new onset COVID-19 cases in the past 14 days and facilities conducting outbreak testing, except in compassionate care situations.
  • Bars visitors from facilities in counties with high positivity rates, except in compassionate care situations.
  • Relaxes visitor testing requirements for facilities in counties with low positivity rates.
  • Expands and clarifies compassionate care visitation.
  • Expands visitation in resident rooms.
  • Expands the number of visitors allowed.

Key provisions include the following:

  • Visitation may take place only if there has been no new onset of COVID-19 cases in the last 14 days and the facility is not currently conducting outbreak testing as reported on daily Health Emergency Response Data System (HERDS) survey submissions.
  • Visitation must be “paused” if the COVID-19 county positivity rate, based on the Centers for Medicare and Medicaid Services (CMS) COVID-19 Nursing Home Data site, is high (>10 percent), except in compassionate care situations. Visitor testing is required if the county positivity rate is 5 percent or higher. Specifically, the guidance provides the following directions for each positivity rate band:
    • Low (<5 percent): Visitation should occur according to the core principles of COVID-19 infection prevention and facility policies (beyond compassionate care visits). Visitor testing is strongly encouraged; facilities may utilize rapid testing.
    • Medium (5 to 10 percent): Visitation should occur according to the core principles of COVID-19 infection prevention and facility policies (beyond compassionate care visits). Visitor testing is required. Visitors must present a negative COVID-19 test result from within the past 72 hours, or facilities may utilize rapid testing to meet the testing requirement. Additionally, all visitors must adhere to all infection control practices.
    • High (>10 percent): Visitation must only occur for compassionate care situations according to the core principles of COVID-19 infection prevention and facility policies. Facilities should offer rapid testing whenever possible.
  • The number of visitors to the nursing home must not exceed 20 percent of the resident census at any time.
  • Visitors under the age of 16 must be accompanied by an adult 18 years of age or older.
  • Current COVID-19-positive residents, residents with COVID-19 signs or symptoms, and residents in a 14-day quarantine or observation period remain ineligible for in-person visits.
  • All visits should be held outdoors whenever practicable. Aside from weather considerations (e.g., inclement weather, excessively hot or cold temperatures, poor air quality), an individual resident’s health status (e.g., medical condition(s), COVID-19 status), or a facility’s outbreak status, outdoor visitation should be facilitated routinely.
  • Facilities should accommodate and support indoor visitation, but limit movement in the facility. Visits may take place in resident rooms, except in shared rooms, unless the roommates are spouses. For situations where there is a roommate and the health status of the resident prevents leaving the room, facilities should attempt to enable in-room visitation while adhering to the core principles of COVID-19 infection prevention.
  • Compassionate care visits are permitted, when visitation may not otherwise be permitted, and facilities may waive the negative COVID-19 test requirement for these visits. Compassionate care visits should include:
    • Newly admitted residents with difficulty adjusting to the facility environment and lack of in-person family support.
    • Residents recently grieving the loss of a friend or loved one.
    • Residents who previously received in-person support and/or cueing from family for eating and drinking and are now experiencing dehydration and/or weight loss.
    • Residents who are exhibiting signs and symptoms of emotional distress, including, but not limited to, seldom speaking or crying more frequently (when the resident had rarely cried in the past), refusing to participate in an activity or activities, staying in bed longer than usual, or exhibiting behavior considered abnormal for the individual.
    • Residents who receive religious or spiritual support from clergy or another layperson.

This is not intended to be an exhaustive list. Additional compassionate care situations may be considered by the facility on a resident-specific basis. Testing should be encouraged or facilitated wherever possible.

  • As always, core principles of infection control and prevention must be followed, and facility staff must monitor visitor adherence. The facility must have an easily accessible visitation plan which includes space(s) to be used for visitation (outdoors and indoors) and the number of visitors and residents who could be safely socially distanced within the space(s). The plan must reference relevant infection control policies for visitors.
  • Visitation policies must be adopted and widely communicated to residents, staff, and visitors that limit the number of visitors per resident at one time and limit the total number of visitors in the facility at one time (based on the size of the building and physical space).
  • Facilities may allow for students and trainees enrolled in programs to become licensed, registered, certified, board eligible, or otherwise to complete a program for health care professionals to receive training and otherwise participate in duties relevant to their program.

Please do not hesitate to contact LeadingAge NY with any questions on this guidance.