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Visitor Policy Good Samaritan Nursing & Rehabilitation Care Center

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In accordance with the most recent “Health Advisory: Skilled Nursing Facility Visitation” dated March 25, 2021, the New York State Department of Health will continue to permit outside visitation (weather permitting) and limited indoor visitation and activities, if the Nursing Facilities meet specific benchmarks and develop a visitation plan. Additional requirements and restrictions have been added.

The information contained in the directive supersedes and replaces previously issued guidance and recommendations regarding general nursing home visitation and aligns with CMS and CDC guidelines. The guidance does not change the nursing home’s responsibility to continue ongoing resident and family communication or the availability of virtual visits, whenever possible. It does not change the previous guidance regarding visitation for medically necessary or end-of-life services.

Beginning March 29, 2021, nursing homes may expand visitation and/or activities under the revised guidance if able to continue following the core principles of infection control and prevention, under the following conditions:

  • The Nursing Facility is in full compliance with all state and federal requirements, state Executive orders and guidance, state reporting requirements including COVID-19 focus surveys, daily HERDS and  staff testing surveys, and federally required weekly submission of COVID-19 data to the National Healthcare Safety Network (NHSN)
  • The Nursing Facility has written protocols to separate residents into cohorts of positive, negative, and unknown as well as separate staffing teams to work with positive COVID-19 residents and non-positive residents. If any facility is unable to meet these requirements, the nursing facility shall transfer the residents to an alternate facility that is able to meet this criteria.
  • The operator or designee must retain a copy of the revised facility’s visitation plan at the facility where it is easily accessible and immediately available upon request of the Department of Health or Local Health Department. The plan must clearly articulate the spaces to be used for visitation (indoors and outdoors) including the number of visitors and residents which could be safely socially distanced within the spaces. The plan must reference relevant infection control policies for visitors.
  • Visitors must be able to adhere to the core principles, including infection control policies, and staff are expected to provide monitoring for those who may have difficulty adhering to core principles.
  • Facilities must have policies widely communicated to residents, staff, and visitors that limit the number of visitors per resident at one time (based on the size of the building and physical space). The facility will schedule visits for a specified length of time to help ensure all residents are able to receive visitors. Visits will be limited to 60 minutes and visitors limited to two per resident.
  • Facilities should limit movement within the facility, including limiting visitors from walking around different halls of the facility. Visitors will be guided directly to the designated visiting area.
  • Adherence to written screening protocols for all staff during each shift, each resident daily, and all persons entering the facility or grounds of the nursing facility, including visitors, vendors, students and volunteers.
  • The number of visitors to the nursing home will be limited to the facility’s ability to maintain social distancing between residents and visitors and the number of visitors and time allocated to visitation should take into consideration that many residents and their loved ones will want to avail such visits.
  • 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. Every effort will be made to accommodate visits through electronic devices and alternative visitation techniques.
  • The facility must use the CMS COVID-19 county positivity rate, found on the Nursing Home Data site as additional information to determine how to facilitate indoor visitation. Indoor visitation may commence except during the following circumstances when visitation should be limited due to a high risk of COVID-19 transmission (exception-compassionate care visits will be permitted at all times as deemed necessary by the care plan team)

Indoor visitation will be limited for:

    • Unvaccinated residents if the nursing homes county Covid-19 positivity rate is >10% and <70% of the 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 Transmission-Based Precautions; OR
    • Residents in quarantine, whether vaccinated or unvaccinated, until they have met the criteria for release from quarantine.

NOTE: Visitation will not be permitted on the nursing units unless the care plan team deems it would be in the best interest of the resident/patient.

  • In the event of an outbreak (One new case of Covid-19 among staff or residents), indoor visitation may be temporarily suspended.
  • A copy of the Nursing Facility’s formal visitation plan is posted to their public website and broadcasted via email or social media to provide visitors with clear guidelines for visiting and to announce if visitation is paused.

 

VISITATION GUIDANCE

Visitation will be limited to 4 residents at any given time in each area and visitors will be limited to two visitors per resident to ensure social distancing and compliance with the core principles of infection prevention guidelines and COVID-19 directives. Visitation is by appointment only.

Visitation can be conducted through different means based on the facility’s structure and residents’ needs such as dedicated visitation spaces (outdoors and indoors), resident rooms for compassionate care or for residents unable to be moved to a dedicated visitation space. Regardless of how visits are conducted, there are certain core principles and best practices to reduce risk of Covid-19 transmission including but not limited to:

  • Screening of all who enter the facility for signs and symptoms of Covid-19 (temperature checks, questions and observations of signs and symptoms) Visitation will be denied for anyone displaying signs or symptoms or those who have had close contact with someone with a Covid-19 infection in the past 14 days (regardless of vaccination status)
  •  Documentation of screening must be maintained onsite in an electronic format and available upon request by the NYS Department of Health for purposes of inspection and potential contact tracing. Documentation must contain the following:
      1. First and Last Name of the Visitor
      2. Physical (street) address of the visitor
      3. Daytime and evening phone number
      4. Date and time of visit
      5. Email address, if available
  • Hand Hygiene (use of alcohol based hand rub is preferred)
  • The use of face coverings or masks (covering mouth and nose)
  • Social distancing at least 6 feet between persons
  • If the resident and visitor are fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitted face mask and performing hand hygiene before and after. Visitors should physically distance from other visitors, residents and staff in the facility.
  • Instructional signage throughout the facility and proper visitor education on Covid-19 signs and symptoms, infection control precautions and other applicable facility practices (e.g. use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often and designated visitation areas after each visit
  • Appropriate staff use of Personal Protective Equipment (PPE)
  • Effective cohorting of residents (e.g. separate areas dedicated to Covid-19 care)
  • Resident and staff testing conducted as required

 

OUTDOOR VISITATION:

While taking a person-centered approach and adhering to the core principles of COVID-19 infection prevention, outdoor visitation can be conducted in a manner that reduces the risk of transmission. Outdoor visits pose a lower risk of transmission due to increased space and airflow. All visits shall 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 conditions, COVID-19 status), or a facility’s outbreak status, outdoor visitation should be facilitated routinely.

Outdoor Visitation Areas: North and South Patio Areas

INDOOR VISITATION

Facilities should allow for visitation at all times and for all residents (regardless of vaccination status) except for a few circumstances when visitation should be limited due to a high risk of Covid-19 transmission (exception-compassionate care visits should be permitted at all times). These scenarios include limiting indoor visitation for:

    • Unvaccinated residents if the nursing homes county Covid-19 positivity rate is >10% and <70% of the 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 Transmission-Based Precautions; OR
    • Residents in quarantine, whether vaccinated or unvaccinated, until they have met the criteria for release from quarantine.

 

Indoor Visitation Areas: North and South Dayrooms

 

 

INDOOR VISITATION DURING AN OUTBREAK

An outbreak exists when a new nursing home onset of Covid-19 occurs (One new case among staff or residents). Visitation can still occur when there is an outbreak, but there is evidence that the transmission of Covid-19 is confined to a single area (e.g. unit) of the facility. Nursing homes must continue to comply with CMS regulations and guidance for Covid-19 testing including routine staff testing, testing of individuals with symptoms, and outbreak testing. Nursing homes must also comply with NYS executive orders, regulations and applicable Department guidance governing testing.

 

When a new case of Covid-19 among residents or staff is identified, nursing homes should immediately begin outbreak testing and suspend all visitation (except that which is required under federal disability rights law) until at least one round of facility-wide testing is completed. Visitation can resume based on the following criteria:

  • If the first round of outbreak testing reveals no additional Covid-19 cases in other areas (e.g. units) of the facility, then visitation can resume for residents in areas/units with no Covid-19 cases. The facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing
  • If the first round of outbreak testing reveals one or more additional cases of Covid-19 cases in other areas/units of the facility (e.g. new cases in two or more units), then facilities should suspend visitation for all residents (vaccinated and unvaccinated) until the facility meets the criteria to discontinue outbreak testing.
  • If subsequent rounds of outbreak testing identify one or more additional Covid-19 cases in other area/units of the facility, then facilities should suspend visitation for all residents (vaccinated and unvaccinated) until the facility meets the criteria to discontinue outbreak testing.

 

Note: In all cases, visitors should be notified about the potential for Covid-19 exposure in the facility (e.g. appropriate signage regarding current outbreaks), and adhere to the core principles of Covid-19 infection prevention, including effective hand hygiene and use of face coverings or masks.

VISITOR TESTING AND VACCINATION

While visitor testing and vaccination can help prevent the spread of Covid-19, visitors shall not be required to be tested or vaccinated (or show proof of such) as a condition of visitation. This also applies to representatives of the Office of the State Long-Term Care Ombudsman and protection and advocacy systems.

The facility encourages visitors to be tested on their own prior to coming to the facility (e.g. within 2-3 days). The Department of Health encourages visitors to become vaccinated when eligible.

POTENTIAL VISIT RELATED EXPOSURES

Consistent with NYS DOH policy, if a visitor to a nursing home tests positive for SARS-CoV-2 by a diagnostic test and the visit to the nursing home occurred from two days before the visitor’s symptom onset (or in the 2 days before the date of collection of the positive sample for visitors who remained asymptomatic) to the end of the visitor’s isolation period, there is potential for exposure.

Exposures among visitors and residents should be evaluated using community tracing guidelines, meaning exposure is defined by the proximity of the individuals and duration of the visit (contact within 6 feet and duration of 10 minutes or more) regardless of PPE or face covering used by the visitor or resident.

 

The following should be evaluated to determine the appropriate follow-up when there is identification of a visitor who tests positive for Covid-19. If the following are confirmed by the facility:

  • The visit was supervised by an appropriate facility staff member, and
  • The visit was conducted in a common area or outdoor area that does not require the visitor to enter a resident unit; and
  • The visitor complied with all Covid-19 precautions including hand hygiene and appropriate use of a face mask or face covering; and
  • The visitor and the resident maintained at least 6 feet of distance from each other for the entire duration of the visit; and
  • The visitor maintained at least 6 feet of distance from all visitors, residents, and staff for the entire duration of the visit.

 

Then, the appropriate action should be taken with respect to residents only. If all of the above are confirmed, the resident who received the visit should be placed on a 14 day quarantine in a single room in the designated observation area using Contact plus Droplet precautions and eye protection. The resident should be monitored for symptoms and have temperature checks every shift. Testing for SARS-CoV-2 should be considered for greater assurance of the resident’s Covid-19 status every 3-7 days for at least 14 days.

If all of the above cannot be confirmed by the facility, the nursing home should proceed as they would after identification of a Covid-19 positive staff member, including contact tracing to determine extent of exposure within the facility. On affected units (or entire facility depending on the amount of contact), the facility should initiate testing every 3 to 7 days among staff or residents until testing identifies no new cases of Covid-19 infection for a period of at least 14 days since the most recent positive result, use of transmission based precautions and testing for influenza.

Facility staff who are exposed according to CDC HCP exposure guidance should be furloughed.

If contacts include other visitors, those visitors should be considered exposed if contact was within 6 feet for more than 10 minutes to the Covid-19 positive visitor regardless of PPE or face covering worn.

Facility staff or visitors who identified as exposed at the facility should be reported by the facility to the local health department where the individual resides.

COMPASSIONATE CARE VISITS:

This guidance further clarifies that Compassionate Care Visits are permitted when visitation may not otherwise be permitted in accordance with the NYSDOH’s current visitation guidance, and the facilities may waive the requirement of a visitor presenting a negative COVID-19 test prior to the commencement of such visit under any of the following circumstances.

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.

The situations above are 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 whenever possible.

ACCESS TO THE LONG-TERM CARE OMDUDSMAN

Nursing homes are reminded that regulations at 42 CFR § 483.10(f)(4)(i)(C) require that a Medicare and Medicaid- certified nursing home provide representatives of the Office of the State Long-Term Care Ombudsman with immediate access to any resident. During this PHE, in-person access may be limited due to infection control concerns and/or transmission of COVID-19, such as the scenarios stated above for limiting indoor visitation; however, in-person access may not be limited without reasonable cause. CMS requires representatives of the Office of the Ombudsman to adhere to the core principles of COVID- 19 infection prevention as described above. If in-person access is deemed inadvisable (e.g., the Ombudsman has signs or symptoms of COVID-19), facilities must, at a minimum, facilitate alternative resident communication with the ombudsman, such as by phone or through use of other technology.

Nursing homes are also required under 42 CFR § 483.10(h)(3)(ii) to allow the Ombudsman to examine the resident’s medical, social, and administrative records as otherwise authorized by State law.

FEDERAL DISABILITY RIGHTS LAWS and PROTECTIVE & ADVOCACY PROGRAMS

Section 483.10(f)(4)(i)(E) and (F) requires the facility to allow immediate access to a resident by any representative of the protection and advocacy systems, as designated by the state, and as established under the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (DD Act), and of the agency responsible for the protection and advocacy system for individuals with a mental disorder (established under the Protection and Advocacy for Mentally Ill Individuals Act of 2000).

Protection and Advocacy programs authorized under the DD Act protect the rights of individuals with developmental and other disabilities and are authorized to “investigate incidents of abuse and neglect of individuals with developmental disabilities if the incidents are reported to the system or if there is probable cause to believe the incidents occurred.” 42 U.S.C. § 15043(a)(2)(B). Under its federal authorities, representatives of Protection and Advocacy programs are permitted access to all facility residents, which includes “the opportunity to meet and communicate privately with such individuals regularly, both formally and informally, by telephone, mail and in person.” 42 CFR § 51.42(c); 45 CFR § 1326.27.

Additionally, each facility must comply with federal disability rights laws such as Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA). For example, if a resident requires assistance to ensure effective communication (e.g., a qualified interpreter or someone to facilitate communication) and the assistance is not available by onsite staff or effective communication cannot be provided without such entry (e.g., video remote interpreting), the facility must allow the individual entry into the nursing home to interpret or facilitate, with some exceptions. This would not preclude nursing homes from imposing legitimate safety measures that are necessary for safe operations, such as requiring such individuals to adhere to the core principles of COVID-19 infection prevention.

Any questions about or issues related to enforcement or oversight of the non-CMS requirements and citations referenced above under this section subject heading should be referred to the HHS Office for Civil Rights, the Administration for Community Living, or other appropriate oversight agency.

 

SURVEY CONSIDERATIONS

Federal and state surveyors are not required to be vaccinated and must be permitted entry into facilities unless they exhibit signs or symptoms of COVID-19. Surveyors should also adhere to the core principles of COVID-19 infection prevention and adhere to any COVID-19 infection prevention requirements set by state law.

 

ENTRY OF HEALTHCARE WORKERS AND OTHER PROVIDERS OF SERVICES     

Health care workers who are not employees of the facility but provide direct care to the facility’s residents, such as hospice workers, Emergency Medical Services (EMS) personnel, dialysis technicians, laboratory technicians, radiology technicians, social workers, clergy, etc., must be permitted to come into the facility 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 after being screened.

EMS personnel do not need to be screened, so they can attend to an emergency without delay. Nursing homes are reminded that all staff, including individuals providing services under arrangement as well as volunteers, should adhere to the core principles of COVID-19 infection prevention and must comply with COVID-19 testing requirements.

Using a person-centered approach when applying this guidance should cover all types of visitors, including those who may have been previously categorized as “essential caregivers.”

CONSTRUCTION PROJECTS

The NYSDOH will not allow the resumption of any renovation or construction project, even if previously approved by the NYSDOH (including revised mitigation/prevention plan regarding testing, PPE, screening, social distancing) if it is in or adjacent to a functioning and occupied dedicated COVID unit.

COMMUNAL DINING AND ACTIVITIES

Communal dining and activities may occur while adhering to the core principles of COVID-19 infection prevention. Residents may eat in the same room with social distancing (e.g., limited number of people at each table and with at least six feet between each person). Nursing homes should consider additional limitations based on status of COVID-19 infections in the facility and the size of the room being used and the ability to socially distance residents (e.g. limit to 10 residents and staff in smaller spaces.

Additionally, group activities may also be facilitated (for residents who have fully recovered from COVID-19, and for those not in isolation for observation, or with suspected or confirmed COVID-19 status) with social distancing among residents, appropriate hand hygiene, and use of a face covering (except while eating). Nursing homes may be able to offer a variety of activities while also taking necessary precautions. For example, book clubs, crafts, movies, exercise, and bingo are all activities that can be facilitated with alterations to adhere to the guidelines for preventing transmission.

 

 

 

If the Facility falls out of compliance with requirements/guidelines specified within this policy and/or the Health Advisory, the Nursing Facility shall immediately halt visitation and inform the NYS Department of Health. The NYS Department of Health can halt visitation at the nursing facility at any time due to community or facility spread of infection, or when the Department identifies that the facility has failed to comply with the guidelines of the Health Advisory.

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