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DOH Issues Holiday Guidance for Nursing Homes and ACFs

On Nov. 24th, the Department of Health (DOH) issued guidance related to nursing home and adult care facility (ACF) residents leaving the building for the holidays. It largely tracks the Centers for Medicare and Medicaid Services (CMS) guidance previously shared with members, with some important mandates, which are noted below. The guidance is clearly meant to discourage residents from leaving the building and contains onerous provisions upon return for any that chose to leave.

  • Residents who leave a facility must:
    • Quarantine or minimize contact to the extent safely possible prior to their return to the facility.
    • Be quarantined on transmission-based precautions upon return to the facility for 14 days.
    • Test negative immediately (within 24 hours) prior to return to the facility.
    • Be tested at least three times during the 14-day quarantine period at the facility, including on the first day (upon return) and the last day that a resident must be quarantined.
  • Facilities must:
    • Develop a plan for the return of residents leaving for home or family visits for social outings. The plan should include a cohorting plan for returning residents, estimating the space, staff, and PPE available.
    • Notify families taking residents out of the facility that residents will not be permitted to return until they present a negative COVID-19 diagnostic test result within the preceding 24 hours.
    • Certify as required by Executive Order 202.77, and Executive Order 202.30 that they have the ability to implement transmission-based precautions for such residents for fourteen days upon return in compliance with NYSDOH guidance and CMS directives.
    • Require the leaving resident and a family or friend to attest in writing that they:
      1. Are aware of the risks involved with taking the resident out of the facility;
      2. Will follow masking, social distancing, and hand hygiene practices pursuant to CDC and DOH directives;
      3. Will notify the facility if the resident becomes ill within one week of leaving the facility;
      4. Will notify the facility if anyone with whom the resident socialized tests positive for COVID-19 or influenza or exhibits symptoms of COVID-19 and influenza within 14 days of the resident’s return to the facility;
      5. Will communicate with the facility about a return date for the resident to the facility in accordance with the facility’s policy; and
      6. Will quarantine or minimize contact (or assist the resident to do so) to the extent safely possible prior to return to a nursing home.
    • Screen and increase monitoring for signs and symptoms of illness upon resident return.
    • Test residents for COVID-19 and influenza if the resident develops signs or symptoms of COVID-19 or influenza or if the resident had a confirmed or possible exposure to COVID-19 or influenza while outside a nursing home or adult care facility.

Shortly after the guidance was issued, LeadingAge NY had a call with representatives from DOH and the Governor’s Office, who clarified that the rules apply to any leave, including a day pass. The rules will apply through the holiday season, which will be at least through New Year’s Day. The leaves included are limited to home or family visitation or for a social outing, meaning the requirements do not apply to medical visits.

LeadingAge NY expressed our concerns with the requirement for a negative COVID-19 test result in order to return. This will likely mean that a daylong visit will need to be an overnight visit due to the inability to get tested on Thanksgiving Day or any other major holiday, especially as there have been significant delays in testing due to increases in demand. Staff said that they would “take our concerns back” but reminded us that this is the guidance as it stands now and must be implemented.