COVID-19, Types of Visitation: Arizona State Veteran Homes

Policy Statement: 

Our facilities follow current Centers for Medicare & Medicaid Services (CMS)/Centers for Disease Control and Prevention (CDC) guidelines and recommendations for prevention of COVID-19 during indoor and outdoor visitations.

 

Policy Interpretation and Implementation: 

Visitation will be conducted through different means based on a facility’s structure and residents’ needs, such as window visits, outdoor dedicated visitation spaces, indoor dedicated visitation spaces and compassionate care situations. Regardless of how visits are conducted, there are certain core Principles and best practices that reduce the risk of COVID-19 transmissions:

 

Core Principles of COVID-19 Infection Prevention

  • Screening of all who enter the screening area for signs and symptoms of COVID-19(e.g., temperature checks, questions or observations about sign and symptoms), and denial of entry of those with signs and symptoms

  • Hand Hygiene (use of alcohol-based hand rub is preferred)

  • Face covering or mask (covering mouth and nose)

  • Social distancing at least six feet between persons

  • Instructional signage throughout the facility and proper visitor education on COVID-19 sign and symptoms, infection control precautions, 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 for COVID-19 care)

  • Resident and staff testing conducted as required by 42 CFR 483.80(h)

These core principles are consistent with the CDC guidance for nursing homes and should be adhered to at all times. Additionally, visitation will be person-centered, will consider the residents’ physical, mental and psychosocial well-being, and support their quality of life. The facilities will enable visits to be conducted with an adequate degree of privacy. Visitors who are unable to adhere to the core principles of COVID-19 infection prevention will not be permitted to visit and will be asked to leave.

 

The facilities will use the COVID-19 county positivity rate found on the Arizona Department of Health Services COVID-19 Nursing Home Data website (www.azdhs.gov) as our way to determine how the facility will facilitate visitation:

  • Low (<5%) = Visitation should occur according to the core principles of COVID-19 infection prevention and facilities policies (beyond compassionate care visits)

  • Medium ( 5% - 10% ) = Visitation should occur according to the core principles of COVID-19 infection prevention and the facility policies (beyond compassionate care visits)

  • High (>10%) = Visitation should only occur for compassionate care situations according to the core principles of COVID-19 infection prevention and facility policies

Facilities will accommodate and support outdoor visitation and indoor visitation as long as there has been no new onset of COVID-19 cases in the last 14 days and the facility is not conducting outbreak testing.  If there is an outbreak, outdoor and indoor visitations will resume when the facility has been cleared of COVID-19 for 14 days.

 

Outdoor Visitations

  • While taking a person-centered approach and adhering to the core principles of COVID-19 infection prevention, outdoor visitation is preferred and will be conducted in a manner that reduces the risk of transmission.

  • Outdoor visits pose a lower risk of transmission due to increased space and better airflow.

  • Therefore, visits will be held outdoors whenever practicable.

 

Indoor Visitations

  • Will occur in a designated area within each facility.

  • Visitors must be able to adhere to the core principles of symptom screening on entry including handwashing/hand sanitizing, appropriate use of PPE and other infection control protocols. Facility staff must provide monitoring for those who may have difficulty adhering to the core principals.

  • Visitors should be instructed to wear their own mask/face covering upon arrival to and throughout the facility. If they do not have a face covering, they should be offered a mask or face covering, as supplies allow.

  • Facilities must comply with all public health investigation and contact tracing processes to ensure that potential exposures between visitors and residents or facility staff are promptly addressed.

  • Facilities will schedule staggered visits and limit the number of visitors per resident to two visitors at any given time. Facilities should limit the number of residents with visitors at any given time to five residents. Facilities should limit a maximum of one resident and two visitors in resident and designated visitation rooms.

  • Facilities should limit movement within the facility to the maximum extent possible. For example, visitors should not walk around different halls or other areas of the facility.

  • Visitors will be escorted to the designated visitation area once they have completed their screening requirements.

  • Facilities must exclude visitors with a known exposure to COVID-19 in the past 14 days (i.e., people in quarantine), and visitors who are confirmed or presumptive COVID-19 cases who meet criteria for isolation.

  • Facilities must keep a log of all visitors to the facility (indoors and outdoors). Facilities must capture the name, address and phone number of visitors to facilitate potential contact tracing efforts.

NOTE: 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.

 

Requirements/Protocols for Outdoor and Indoor Visits

  1. Visitor will need to schedule a day and time for each visit. At this time, the visiting policy will be reviewed with the visitor, so they are aware of the proper procedures that need to be adhered to.

  2. Each visit will last up to 30 minutes.

  3. Visits will be limited to two visitors per visit.

  4. Visitors must be at least 18 years of age.

  5. The visitor will provide the facility with a negative COVID-19 test less than 48 hours old.

  6. The visitor will sign an attestation that they have isolated from the time their test was completed and their visit. Also noting they are aware of the requirements/protocols of visiting.

  7. A screening will be completed on all visitors to ensure they are free of signs and symptoms of COVID-19.

  8. Residents will wear a surgical mask (when safe) and a face shield.

  9. Visitors will be required to wear a surgical mask and face shield.

  10. Gowns and gloves are not mandatory, however could be provided if needed.

  11. Food and drinks are not allowed during the visit. If food is brought in for the resident, it will need to be given to security. The container will be wiped down and dated. Once this is completed, it will be taken to the resident’s room.

  12. Usage of public restrooms will not be permitted.

  13. Hydration systems for outside visitations will not be provided due to the need for masks to be worn at all times.

  14. Hand sanitizer will be provided.

  15. A minimum distance of 6 feet will be required for residents and their visitors.

  16. The facility will maintain a visitor log for contact purposes.

  17. If visitors are unable to adhere to the requirements/protocols, the visitation will ended and the visitor may not be permitted to return for subsequent visits.

  18. All designated visiting areas will be cleaned and sanitized in between each visit.

 

Staff Education

  • Staff will be educated on the requirements/protocols of outdoor and indoor visitations.

  • Staff will be trained on how to approach non-compliant visitors. Any non-compliance with the requirements/protocols will result in staff immediately terminating the visit for all parties.

  • If a visitor is non-compliant with protocol, and the visitation is ended by staff, the visitor is to leave the premises immediately.  If the visitor becomes agitated or confrontational staff are to immediately seek assistance from the security guard to have the visitor removed from the property.

  • Staff should always remain 6 feet from the visitor(s) to promote safety from COVID-19 and if a visitor(s) becomes violent.

 

Staff Responsibilities

  • Schedule visit with visitor(s).

  • Explain our requirements/protocols with the visitor(s) during the scheduling of the visitation.

  • Staff will ensure hand sanitizer is available at the visitation tables.

  • Staff will ensure the requirements/rules will be made available at each visitation table.

  • On the day of the visit staff will ensure the resident washes and/or sanitizes his/her hands.

  • Provide the resident with a surgical mask (when safe) and face shield.

  • Escort the resident to the designated visiting area.

  • A designated staff member will provide the necessary screening for the visitor(s) in order for visitation to occur. This staff member will also take a copy of the visitor’s negative COVID-19 test, review the requirements/protocols and have the visitor(s) sign an attestation regarding the requirements/protocols.

  • Staff will direct the visitor(s) to hand sanitize.

  • Staff will provide the visitor(s) with a surgical mask and a face shield.

  • Staff member will monitor the visits from afar to ensure proper protocols are being followed.

  • Following visitation, the resident will be escorted back within the facility to their room.

  • Housekeeping will be called to clean and sanitize the visitation area for next visit.

 

Visitor(s) Responsibilities

  • Schedule a day and time for visitation.

  • Follow the requirements/protocols for visitation.

  • Sanitize their hands prior to screening process.

  • Go through the screening process.

  • Provide a facility with a copy of a negative COVID-19 that is 48 hours or less from the time of their visitation.

  • Sign an attestation that they reviewed the requirements/protocols and they are aware that if at any time they break protocol they will be told their visitation is over and they need to leave the property.

  • Wear a surgical mask and face shield at all times.

  • Stay at least six feet apart from their loved one during the visit.

  • If they bring any food for the resident, it needs to be in a proper container that can be cleaned and properly dated. This container will need to be given to the security guard at the front desk.

 

Compassionate Care Visits

  • While end-of-life situations have been used as examples for compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life situations. Here are some other examples:

  • A resident who is grieving after a friend or family member recently passed away.

  • A resident who needs cueing and encouragement with eating or drinking, previously provided by the family and/or caregiver(s), is experiencing weight loss or dehydration.

  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).

  • Allowing a visit in these situations would be consistent with the intent of, “compassionate care situations”. Also, in addition to family members, compassionate care visits can be conducted by any individual that can meet the resident’s needs, such as clergy or lay persons offering religious and spiritual support. This is not an exhaustive list, and other valid compassionate care situations may be identified.

  • Lastly, at all times, visits should be conducted using social distancing and use of appropriate PPE. Through a person-centered approach, facilities should work with residents, families, caregivers, resident representatives, and the Long-Term Care Ombudsman program to identify the need for compassionate care visits.

 

Required Visitation: We believe the guidance above represents reasonable ways facilities can enable in-person visitation. Except for ongoing use of virtual visits, facilities may still restrict visitation due to COVID-19 county positivity rate, the facility’s COVID-19 status, a resident’s COVID-19 status, visitor’s symptoms, lack of adherence to proper infection control practices, or other relevant factors related to the COVID-19 public health emergency.

NOTE: Residents who are on transmission-based precautions for COVID-19 should only receive visits that are virtual, through windows, or in-person for compassionate care situations, with adherence to transmission-based precautions. However, this restriction should be lifted once transmission-based precautions are no longer required per CDC guidelines, and other visits may be conducted as described above.

 

Health Care Workers and Other Service Providers: 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 show signs or symptoms of COVID19 after being screened.

NOTE: EMS personnel responding to an emergent situation should not be screened so they can attend to an emergency without delay. All facility 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 administrative rules for COVID-19 Testing in Licensed Assisted Living Facilities, Nursing Facilities and Residential Care Facilities.

 

Access to the Long-Term Care Ombudsman: In-person access may be limited due to infection control concerns and/or transmission of COVID-19; however, in-person access may not be limited without reasonable cause. If in-person access is not advisable, such as the Ombudsman having 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 Protection & Advocacy (P&A) Programs: Facilities must 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).

 

Important Links:

COVID-19: Arizona State Veteran Home Update

 

Holiday Visitation Guidance: Arizona State Veteran Homes

 

References  

OBRA Regulatory Reference Numbers: §483.80(a) Infection prevention and control program.

Survey Tag Numbers: F880

Other References: www.cdc.gov / www.cms.gov

Related Documents: CMS Memorandum Summary September 17, 2020

Created Date: 09/29/2020, updated 10/23/2020, 11/9/2020

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