Governor's Task Force on the Safe and Limited
Re-opening of LTC Facilities Completes their Work -- Governor to Sign Recommendations
The Governor’s Task Force on the Safe and Limited Re-Opening of Long- Term Care Facilities completed drafting recommendations for safe visitation last week and they are now headed to the Governor’s office for his approval.
FSLA was honored to serve on the task force advocating for residents, staff, administrators and families across the entire state.
The following is a summary of the Task Force recommendations. FSLA would like to thank the Governor, the members of the Task Force, AHCA Secretary Mary Mayhew, Surgeon General Scott Rivkees, DOEA Secretary Richard Prudom, Alzheimer's Association VP of Public Policy, Michelle Branham, Caregiver Mary Daniel and all Assisted Living Providers for their hard work.
Please consider using the following information to draft your Visitation Policies and Procedures and DOWNLOAD a copy of the following document to provide copies to your staff.
The Task Force focused on the following:
1. Safely allowing essential caregivers to visit long-term care facilities;
2. Safely allowing compassionate care visits in long-term care facilities; and
3. Visitation options including indoor and outdoor visitation.
Essential Caregivers (EC)
- Provide healthcare services and/or assistance with activities of daily living to help maintain or improve the quality of care or quality of life of a facility resident
- Care or service provided by the essential caregiver is included in the plan of care or service plan for the resident
- Activities of daily living include bathing, dressing and eating -- but does not include grooming
Compassionate Care Visitors (CC)
- Allowed on a limited basis as an exception to restricted visitation Intended to provide emotional support to help a resident face a hard situation
- Examples: End of life, major upset, difficult transition or loss
Essential and Compassionate Care: Facility Requirements
- Establish policies and procedures for how to designate and use an EC and allow CC visits
- Identify those who provided EC before the pandemic or have asked to provide since, consult with resident or representative for concurrence
- Allow resident to designate 2 ECs and CCs and allow no more than one EC or CC per visit; Intermediate Care Facilities (ICF) and APD licensed Group Homes may allow two ECs or CCs at one time.
- Facility shall set a limit on the total number of visitors allowed in the facility based on the ability of staff to safely screen and monitor visitation
- Develop a schedule – work with resident and EC/CC to define an agreeable schedule
- Provide infection prevention and control training, including proper PPE use, hand hygiene and social distancing; Designate key staff to support infection control training of Caregivers
- Allow evening and weekend visits to accommodate work or childcare barriers
- Maintain visitor log for signing in and out
- No visits if the resident is quarantined or if the resident is positive for COVID-19 or symptomatic, unless the visit is for compassionate care
- The facility may restrict or revoke if the EC/CC fails to follow infection prevention and control requirements or other COVID-19 related rules of the facility after attempts to mitigate concerns
Essential and Compassionate Caregiver Requirements
Personal Protective Equipment (PPE)
- EC/CC: Wear a surgical mask and other PPE as appropriate for the care provider; PPE for EC should be consistent with CDC guidance for healthcare workers
- EC/CC: Be trained on infection prevention and control, use of PPE, use of masks, hand sanitization and social distancing
- EC/CC: Sign acknowledgement and adhere to training
Testing and Symptoms
- EC/CC: Comply with facility-provided COVID-19 testing if offered; Facility use of testing must be based on current CDC and FDA guidance
- EC/CC: Inform the facility if they develop a fever or symptoms consistent with COVID-19 within 14 days of a visit
While in Facility
- EC/CC: Provide care or visit in the resident’s room, or in facility-designated areas within the building
- Maintain social distance of at least 6 feet with staff and other residents - limit movement in the facility
General Visitation: Facility Requirements
- 14 days with no new facility onset of resident or staff COVID-19 cases, excluding dedicated units/wings accepting COVID-19 cases from the community
- Sufficient staff to support management of visitors
- Adequate PPE
- Adequate cleaning/disinfecting supplies
- Referral hospitals have capacity
- Schedule visitors by appointment; monitor for adherence to proper use of masks and social distancing
- Notify residents, their representatives and recurring visitors of any changes in the visitation policy
- Continue with visitor screening, i.e., temperature checks and symptom/exposure screening questions
- Designate key staff to support infection control education of visitors including, PPE, use of masks, proper hand hygiene, social distancing and visitation policies
- Facility may perform testing
- Facility use of testing must be based on current CDC and FDA guidance
- Maintain a visitor log for signing in and out
- Visit spaces must be cleaned and disinfected between visitors and contain handwashing or sanitation stations
- Visitors must be 18 years or older at this time (the task force may revisit this provision at a later date)
- Allow residents to designate up to five visitors
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Facility shall limit the number of visitors per resident to no more than two visitors per visit
- Facility shall set a limit on the total number of visitors allowed in the facility based on the ability of staff to safely screen and monitor visitation
- Facility shall limit the length of visits, days, hours, number of visits per week by one visitor
- Restrict visitation for any resident in isolation for suspected or confirmed COVID within the facility
- For indoor visitors, facilities can create indoor spaces for residents in a room that is not accessible by other residents, or in the resident’s private room if the resident is bedbound and for health reasons cannot leave their room
General Visitation: Outdoor Visitation
- Facilities are strongly encouraged to provide outdoor Visitation
- Facilities can create outdoor visitation spaces for residents that are protected from weather elements, such as porches, courtyards, on patios, or other covered areas
- Protection from heat and sun is essential. Cooling devices may be required to maintain safe temperatures
General Visitation: Visitor Requirements
- Infection Control: Properly wear a face mask and other necessary PPE and perform hand hygiene
- Policy Consent: Sign a consent form noting understanding of visitation policies
- Fever/ Symptom: Inform the facility if they develop a fever or symptoms consistent with COVID-19 within 14 days of a visit
- While in Facility: Visit in the resident’s room or in facility-designated areas and maintain social distance of at least 6 feet with staff and residents – limit movement in the facility
- Exception to Social Distancing: A visitor may be closer than 6 feet to the resident who they are visiting if they comply with CDC PPE requirements for healthcare workers.
Process Upon Identification of New COVID-19 Cases
- Indoor and Outdoor visitation is prohibited until the facility achieves a continuous 14-day period without the facility-onset of a resident or staff COVID-19 case (if staff person was in the facility in the 10 days prior to the positive test).
- Any facility that has a resident test positive for COVID-19, or a staff tests positive for COVID-19 if the staff person was in the facility in the 10 days prior to the positive test, must immediately cease all indoor and outdoor visitation.
- Essential Caregivers and Compassionate Caregivers are still permitted.
Beauty Salons and Barbers
- Beauty salons and barbers help improve resident morale and quality of life. Hair salons may resume providing services to residents with precautions in place.
- Criteria for facilities to resume beauty salon and barber services:
- 14 days with no new onset of resident COVID-19 cases
- Barbers and hairdressers providing services must wear a surgical mask, gloves and perform hand hygiene and follow the same requirements as essential caregiver visitors
- Residents receiving services must wear face masks
- Waiting customers shall follow social distancing guidelines
- Only residents of the facility are allowed in hair salon for services; no services can be provided to outside guests
- Services may not be provided to any resident in isolation for suspected or confirmed COVID-19
- Providers must properly clean and disinfect equipment between residents
Resident Absence for Medical Appointments
Residents leaving the facility/group home temporarily for medical appointments must wear a face mask at all times if tolerated and be screened upon return to the facility. Eye protection should be encouraged.
Healthcare Provider Visits
- Healthcare providers serving residents in the facility/group home must comply with CDC requirements for PPE, must be screened prior to entry, must comply with all infection control requirements of the CDC
- The resident receiving the healthcare services should wear a facemask during the service if tolerated
- Medical appointments should be scheduled through the facility/group home to comply with the facility/group home’s ability to ensure appropriate screening and adherence to infection control requirements
Conclusions
The Task Force made the following recommendations to Governor DeSantis:
- Allow visitation in long-term care facilities for Essential Caregivers and Compassionate Care visitors. These individuals provide important care and support to residents of long-term facilities; without their involvement these residents are at risk of unnecessary decline.
- Encourage long-term care facilities to allow general resident visitation outdoors and allow indoor visitation if the facility meets certain indicators of low virus risk.
- Each visitation scenario must be accompanied by facility policies and procedures that support the safety of all residents and visitors including appropriate training and mandatory use of masks and other infection control protections, screening, and visitor scheduling and management.
Complaint Process
- For concerns regarding a health care facility in Florida, consumers, patient advocates and practitioners may file a complaint with the Agency for Health Care Administration
- Complaints can be filed anonymously
- However, please be sure to include sufficient information, such as the patient/resident name, date(s) of events, and any other specifics pertinent to the complaint, to allow proper assessment of concerns.
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You may file a complaint with the Agency by calling our toll-free Complaint & Information Call Center at 1-888-419-3456, or by completing our online complaint form at: http://apps.ahca.myflorida.com/hcfc.
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Please refer to the Agency’s Consumer Complaint website for additional information at: http://ahca.myflorida.com/Contact/call_center.shtml
- The Long-Term Care Ombudsman Program is a volunteer-based advocacy organization seeking to improve long-term care facility residents' quality of life and care. Investigates complaints made by or on behalf of residents. All investigations are confidential and provided at no charge
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You may also file a complaint with the Long Term Care Ombudsman at 888-831-0404, http://ombudsman.myflorida.com/Complaint.php
Resources
Notes and Handouts from Previous Meetings
