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

UPDATE (5/24/21) Starting May 29, 2021, the Arizona State Veteran Homes will allow residents to participate in home and community visits with a responsible party.

Home Visits/Community Visits with Responsible Party

• Residents, regardless of their vaccination status, are able to go on home visits with their family.
• Families will need to inform the facility of the visit in advance so the resident is ready.
• The family member will be screened upon arrival to ensure no COVID-19 symptoms are present.
• The family will be provided with an education packet with information regarding COVID-19 signs and symptoms, preventing COVID-19, safe practices, contact tracing and vaccine information.

Requirements/Protocols for Home Visits/Offsite Visits

1. Visitor will inform the facility that they will be taking their loved one home for a visit.
2. Upon arriving to the facility the visitor will go to the main desk and inform staff they are here to pick up their loved.
3. The visitor will be screened to ensure they are free of COVID-19 signs and symptoms prior to taking the resident from the facility.
4. The visitor will also be provided with an education packet from the employee at the screening station.

While visitation is allowed seven days a week, all home and community visits must be scheduled Monday through Friday from 8 a.m. - 2 p.m. and at least 24 hours in advance of the requested visit with a resident.

To schedule a home or community visit with a resident, call the specific Arizona State Veteran Home.

Arizona State Veteran Home - Phoenix: Brittany Tashner 602-248-1560 or Carrie Boston 602-351-6879

Arizona State Veteran Home - Tucson: 520-638-2150

Read the full visitation policy below

Policy Statement:

Our facilities follow current CMS/CDC guidelines and recommendations for prevention of COVID-19 during visitation within our facility.

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 and home visits. 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 facility for signs and symptoms of COVID-19 and recent exposure to a person with COVID-19 infection
  • Persons with signs and symptoms or with close contact to a person with COVID-19 infection in the last 14 days should be denied entry regardless of the visitor’s vaccination status
• Performing hand hygiene with soap and water or alcohol-based hand rub
• Wearing a face covering or mask while in the facility
• Practicing physical distancing of at least 6 feet between people
• Cleaning and disinfecting of high frequency touched surfaces in the facility often, and designated visitation areas after each visit
• Requiring appropriate staff use of Personal Protective  Equipment (PPE)
• Conducting effective cohorting of residents ( e.g., separate areas dedicated for COVID-19 care)
• Posting instructional signage throughout the facility and visitor education on COVID-19 signs/symptoms, proper facility procedures, and infection control precautions
• Testing residents and staff for COVID-19 infection as described in CMS testing guidance

These core principles are consistent with the Centers for Disease Control and Prevention (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 Type In-Person Visitation Permitted Based on Resident Transmission Based Precaution (TBP) for COVID-19 and Facility Outbreak Status Grid as our way to determine how the facility will facilitate visitation:

Facilities will accommodate and support outdoor visitation and indoor visitation as long as there has been no new onset of COVID-19 cases and the facility is not conducting outbreak testing.  If there is an outbreak, outdoor and indoor visitations will resume when the facility after the first round of facility-wide testing has been completed.

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

Outdoor Visitations

• Outdoor visits will be allowed for all residents regardless of vaccination status, except in the following circumstances when visitation should be limited due to high risk of COVID-19 transmission.
  • Residents with confirmed COVID-19 infection, regardless of vaccination status, until they have met the criteria to discontinue COVID-19 isolation;
  • Residents in quarantine, regardless of vaccination status, until they met criteria for release from quarantine.
• Outdoor visitation is preferred even when the resident and/or visitor are fully vaccinated against COVID-19. Outdoor visits generally pose a lower risk of transmission due to increased airflow and ability to more easily socially distance greater than 6 feet. Therefore, outdoor visits will be prioritized whenever practical.
  • Considerations about whether an outdoor visit is practical for a resident include:
    • Weather (e.g., inclement weather, excessive hot/cold temperatures, poor air quality)
    • The individual resident’s health status (e.g., medical conditions, COVID-19 status)
• During outside visits, the facility will:
  • Provide an accessible and safe outdoor space for the visits (e.g., courtyards, patios, parking lots, including the use of tents when available.
  • Continue to follow the core principles of COVID-19 infection prevention, with the following caveat for physical contact between a resident and their visitor(s):
    • Residents who are fully vaccinated can choose to have close contact (including touch) with their visitor(s) while wearing a well-fitting facemask and performing hand hygiene before and after.
    • Regardless, visitors should always physically distance from other residents and staff in the facility

Note: residents who are on transmission-based precautions for COVID-19 (regardless of vaccination status) should only receive visits that are virtual or through windows, unless a compassionate care situation is identified. This restriction on visitation will be lifted once transmission-based/isolation precautions are no longer required, and routine visits may be conducted.

Indoor Visitations

• Indoor visitations will be allowed for all residents regardless of vaccination status, except in the following circumstances when visitation should be limited due to high risk of COVID-19 transmission.
  • Unvaccinated residents, if the nursing home’s COVID-19 county positivity rate is >10% and <70% of the residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, regardless of vaccination status, until they have met the criteria to discontinue COVID-19 isolation;
  • Residents in quarantine, regardless of vaccination states, until they met criteria for release from quarantine
  • Facilities during an outbreak (please see the Indoor Visitation during an Outbreak section for more information).
• During inside visits, the facility will:
  • Continue to follow the core principles of COVID-19 infection prevention, with the following caveat for physical contact between a resident and their visitor(s):
    • Residents who are fully vaccinated can choose to have close contact (including touch) with their visitor(s) while wearing a well-fitting facemask and performing hand hygiene before and after.
    • Regardless, visitors should always physically distance from other residents and staff in the facility.
  • Facilities will schedule staggered visits and limit the number of visitors per resident to two visitors at any given time. Facilities will limit the number of residents with visitors at any given time. Facilities will limit a maximum of one resident and two visitors in resident and designated visitation rooms.
  • Facilities will 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.
  • Facility will conduct visits for a resident with a roommate in an area outside of the resident’s room, if possible.
    • For situations where there is a roommate and the health status of the resident prevents leaving the room, the facility will attempt to enable in-room visitation while adhering to the core principles of COVID-19 infection prevention.

Note: residents who are on transmission-based precautions for COVID-19 (regardless of vaccination status) should only receive visits that are virtual or through windows, unless a compassionate care situation is identified. This restriction on visitation will be lifted once transmission-based/isolation precautions are no longer required, and routine visits may be conducted.

Indoor Visitation during an Outbreak

Per CMS, an outbreak exists when a new nursing home onset COVID-19 case occurs. This means a new COVID-19 case is identified among residents or staff. Depending on the extent of the outbreak (i.e., whether COVID-19 transmission is contained to a single area of the facility), visitation may still be allowed. To swiftly detect new cases and understand the extent of potential transmission in a facility, the facilities will continue to follow CMS COVID-19 testing guidance, including routine staff testing, testing individuals with symptoms, and outbreak testing.

• When a new case of COVID-19 is identified among residents or staff, the facility will immediately:
  • Begin outbreak testing.
  • Suspend all visitation (except that required in the Compassionate Care and Other Universally Required Visitation) until at least first round of facility-wide testing has been completed.
• Visitation can then resume based on the results of the first round of facility-wide outbreak testing:
  • If no additional COVID-19 cases are detected in other areas (e.g., units) of the facility
    • For residents in areas/units without COVID-19 cases (regardless of vaccination status)
      • Routine visitation can resume
    • For residents in areas/units with ≥1 COVID-19 outbreak case(s) identified (regardless of vaccination status)
      • Routine visitation should be suspended until the facility meets criteria to discontinue outbreak testing (i.e., when testing identifies no new cases of COVID-19 infection in staff or residents for at least 14 days from the most recent positive result).
    • Example scenario:
      • After an outbreak case (i.e., a new case in a staff member or resident) is identified, the first round of outbreak testing revealed two more COVID-19 cases in the same unit as the original case, but not in other units. Visitation can resume immediately for residents in areas/units with no COVID-19 cases identifies.
    • If one or more additional COVID-19 case(s) is identified in other areas/units of the facility (e.g., one or more area/unit outside the area/unit where the original outbreak case was identified):
      • Routine visitation should be suspended for all residents (regardless of vaccination status) in all areas/units of the facility until the facility meets criteria to discontinue outbreak testing (i.e., when testing identifies no new cases of COVID-19 infection in staff or residents for at least 14 days from the most recent positive result).
• When visitation occurs while a facility is in outbreak status
  • Visitors should be notified about potential for COVID-19 exposure in the facility (e.g., appropriate signage regarding current outbreak).
  • The facility should continue to adhere to the core principles of COVID-19 infection prevention, including effective hand hygiene and use of face coverings.

Note: residents who are on transmission-based precautions for COVID-19 (regardless of vaccination status) should only receive visits that are virtual or through windows, unless a compassionate care situation is identified. This restriction on visitation will be lifted once transmission-based/isolation precautions are no longer required, and routine visits may be conducted.

Outbreak Testing Reminder:

Regardless of whether visitation is allowed while, a facility is in outbreak status, the facility will continue all necessary rounds of outbreak testing.

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.

Home Visits/Community Visits with Responsible Party

• Residents, regardless of their vaccination status, are able to go on home visits with their family.
• Families will need to inform the facility of the visit in advance so the resident is ready.
• The family member will be screened upon arrival to ensure no COVID-19 symptoms are present.
• The family will be provided with an education packet with information regarding COVID-19 signs and symptoms, preventing COVID-19, safe practices, contact tracing and vaccine information.

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 16 years of age.
5. Only true service animals are allowed during an indoor visit.
6. A screening will be completed on all visitors to ensure they are free of signs and symptoms of COVID-19.
7. Residents will wear a surgical mask (when safe).
8. Visitors will be required to wear a surgical mask provided by the facility. Face shields will be available if requested.
9. Gowns and gloves are not mandatory, however could be provided if needed.
10. 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.
11. Usage of public restrooms will not be permitted.
12. Hydration systems for outside visitations will not be provided due to the need for masks to be worn at all times.
13. Hand sanitizer will be provided.
14. A minimum distance of 6 feet will be required for residents and their visitors from other residents and staff within the facility.
15. The facility will maintain a visitor log for contact purposes.
16. If visitors are unable to adhere to the requirements/protocols, the visitation will be ended and the visitor may not be permitted to return for subsequent visits.
17. All designated visiting areas will be cleaned and sanitized in between each visit.

Requirements/Protocols for Home Visits/Offsite Visits

1. Visitor will inform the facility that they will be taking their loved one home for a visit.
2. Upon arriving to the facility the visitor will go to the main desk and inform staff they are here to pick up their loved.
3. The visitor will be screened to ensure they are free of COVID-19 signs and symptoms prior to taking the resident from the facility.
4. The visitor will also be provided with an education packet from the employee at the screening station.

Staff Responsibilities

1. Schedule visit with visitor(s).
2. Explain our requirements/protocols with the visitor(s) during the scheduling of the visitation.
3. Staff will ensure hand sanitizer is available at the visitation tables.
4. Staff will ensure the requirements/rules will be made available at each visitation table.
5. On the day of the visit staff will ensure the resident washes and/or sanitizes his/her hands.
6. Provide the resident with a surgical mask (when safe).
7. Escort the resident to the designated visiting area.
8. A designated staff member will provide the necessary screening for the visitor(s) in order for visitation to occur.
9. Staff will direct the visitor(s) to hand sanitize.
10. Staff will provide the visitor(s) with a surgical mask. Face shields will be available if requested.
11. Staff member will monitor the visits from afar to ensure proper protocols are being followed.
12. Following visitation, the resident will be escorted back within the facility to their room.
13. Housekeeping will be called to clean and sanitize the visitation area for next visit.

Visitor(s) Responsibilities

1. Schedule a day and time for visitation.
2. Follow the requirements/protocols for visitation.
3. Sanitize their hands prior to screening process.
4. Go through the screening process.
5. Wear a surgical mask at all times. Face shields will be available if requested.
6. Stay at least six feet apart from other residents and staff.
7. 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 was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of family support.
  • 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).
• Will always be allowed for all residents, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or a facility’s outbreak status.
• Can be conducted by family members, as well as by any individual that can meet the resident’s needs (e.g., clergy or lay persons offering religious and spiritual support).
• Will be conducted using the core principles of COVID-19 infection prevention, with the following caveats for physical contact between a resident and their visitor(s):
  • Residents who are fully vaccinated can choose to have close contact (including touch) with their visitor(s) while wearing a well-fitting facemask and performing hand hygiene before and after
  • For residents who are not fully vaccinated, if a facility and a visitor can identify a way to allow for personal contact, it should be done following appropriate infection prevention guidelines, and for a limited amount of time.
  • Regardless, visitors should always physically distance from other residents and staff in the facility.

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 COVID-19 after being screened.
  • Caveat: EMS personnel do not need to be screened, so they can attend to an emergency without delay.

State Long-Term Care Ombudsman

• 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 resident.
• 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.
• During this Public Health Emergency, in-person access may be limited due to infection control concerns and/or transmission of COVID-19, such as the scenarios outlined in the Outdoor, Indoor and Indoor Visitation During an Outbreak sections; however, in-person access may not be limited without reasonable cause.
  • If in-person access is deemed inadvisable (e.g., the Ombudsman has signs and symptoms of COVID-19), facilities must, at a minimum, facilitate alternative resident communication with the ombudsman, such as by phone or through the use of other technology.
• Representatives of the Office of the Ombudsman Health are not required to be tested or vaccinated as a condition of visitation and must follow the core principles of COVID-19 infection prevention while in the facility.

Federal Disability Rights Laws and Protection & Advocacy (P&A) Programs

• 483.10(f)(4)(i)€ 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).
  • P&A programs authorized under DD Act protects 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 P&A 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 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.
• 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.
• Such individuals are not required to be tested or vaccinated as a condition of visitation and must follow the core principles of COVID-19 infection prevention while in the facility.

Federal and State Surveyors

• Federal and state surveyors are not required to be vaccinate and must be permitted entry into facilities unless they exhibit signs and symptoms of COVID-19.
  • For concerns related to resident communication with and access to persons and services inside and outside the facility, surveyors should investigate for non-compliance at 42 8 CFR § 483.10(b), F550.
  • For concerns related to a facility limiting visitors without reasonable clinical and safety cause, surveyors should investigate for non-compliance at 42 CFR § 483.10(f)(4), F563.
  • For concerns related to ombudsman access to the resident and the resident’s medical record, surveyors should investigate for non-compliance at 42 CFR §§ 483.10(f)(4)(i)(C), F562 and 483.10(h)(3)(ii), F583.
  • For concerns related to lack of adherence to infection control practices, surveyors should investigate for non-compliance at 42 CFR § 483.80(a), F880.
• Surveyors are not required to be tested or vaccinated as a condition of visitation and must follow the core principles of COVID-19 infection prevention while in the facility.

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:  F550, F563, F562, F583, F880

Other References:

www.cdc.gov

www.cms.gov

Maricopa County Department of Public Health – CMS Long-term Care Facility Guidance on Visitation During COVID-19

Arizona Department of Health Services – COVID-19 Guidance for Visitation at Congregate Settings for Vulnerable Adults and Children

Related Documents: CMS Memorandum Summary September 17, 2020 / CMS Memorandum Summary September 17, 2020 revised 3/10/2021

Created Date: 09/29/2020, updated 10/23/2020, 11/9/2020, 3/19/2021