Thursday, June 25, 2020
Visitation guidance updated by DHS
DHS Visitation Guidance for AL Communities
DHS has released the following updates for Assisted Living visitation during the COVID-19 Pandemic. The following information was provided by DHS. WALA recommends that you carefully read through this guidance and contact us if you have questions.
Purpose
To provide guidance to assisted living facilities regarding safer visits to residents during COVID-19. This guidance is intended for facilities with no known or suspected COVID-19 cases. The guidance includes preventative measures to reduce the chances of the introduction of COVID-19 into the facility, while mitigating the unintentional consequences of social isolation from family and loved ones. For purposes of this document, facilities include community-based residential facilities, licensed adult family homes, and residential care apartment complexes.

Rationale
COVID-19 is a serious viral infection and based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19 (HHS, 2020). This increases the need for vigilance in avoiding the introduction and transmission of COVID-19 into congregate living settings, such as assisted living facilities. 
Safe visiting practices are already in place in assisted living facilities but are designated for “compassionate care situations” such as end-of-life visits. Recommended infection prevention and control practices can provide an opportunity for expanded visitation for residents, specific to their person-centered plan, while maintaining the goal of avoiding introduction and/or transmission of COVID-19 to our most vulnerable citizens.

Guiding Principles
This guidance is intended for assisted living facilities that are able to develop and implement a Safer Visiting Policy, that includes effective infection prevention and control measures and addresses the psychosocial needs of the resident. Facilities’ practices must be consistent with current CDC and local/tribal public health departments. (See  Key Strategies to Prepare for COVID-19 in Long-Term Care Facilities (LTCFs) (link is external) ;  CDC Assisted Living Guidance (link is external)

Physical distancing and use of cloth face coverings have proven to be a significant infection prevention and control practice to prevent the spread of COVID-19. These can be accomplished by providing a 6-foot distance or other barriers between individuals, and ensuring that all individuals wear either a face mask or cloth face covering.

However, there are valid concerns that may prevent an individual from wearing one safely. Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the covering without assistance. Medical considerations, including respiratory conditions, as well as traumatic personal experiences, mean some individuals are not able to wear a face covering safely. Wearing a cloth face covering may be dangerous or stressful for individuals with disabilities and young children. Individuals may also fear racial profiling or discrimination based on wearing—or not wearing—a face covering. Access to clean, multiple, or appropriate face coverings may also be a barrier. 

Similarly, facilities should consider the unique needs of people who are hard of hearing when developing and implementing policies to adopt the use of cloth face coverings. 

Screening of visitors and staff have shown to provide an early detection and surveillance method to impede the spread of COVID–19 in assisted living facilities. This screening allows for the prohibition of individuals entering assisted living facilities with even minor changes in health status.

Education of residents and families is important to ensure all parties understand the need to follow infection prevention and control practices.

Education should include: 

Recommendations for Safer Visits

  • Each facility should develop a procedure that takes into consideration the recommendations for infection prevention and control measures and management of safer visits, as desired or needed by residents. 

  • Assisted living facilities should develop policies on visitation based on the following considerations: 
  • Expressed or observed desires and needs of the individual resident for whom visits are being considered.
  • Current CDC guidance, local/tribal public health requirements and based on care team review.
  • Safe visits are listed in a hierarchy of most safe visits to least safe visits as follows:
  • Virtual visits, such as Skype, Zoom, etc.
  • Outside visits, maintaining physical distancing and face covering. If inclement weather is present, the outside visit should be rescheduled rather than moving the visit into the facility.
  • Inside visits if dedicated room is available and only if the resident is unable to visit virtually or by an outside visit. 
  • Resident room visits if the resident has single room and only if the resident is unable to visit in any of the above-noted ways.

  • Care team (as required under applicable regulations that must include the resident or resident’s surrogate decision maker) determines the safest type of visit based on resident’s need and/or desire.


  • Infection prevention and control measures should include: 
  • Screening prior to visitation for any COVID-19 symptoms.
  • CDC guidance for COVID -19 symptoms(link is external) according to current federal, state, or local public health guidelines. 
  • Implement active screening of visitors for fever and respiratory symptoms.
  • Actively take their temperature and document the presence of a fever and respiratory symptoms including: new or worsening cough, unexplained muscle weakness or pain, and sore throat.
  • If screening discovers signs and symptoms for fever and respiratory infection, visitation should be cancelled. The visitor should self-isolate at home and inform their medical provider.

  • Limit the distance a visitor travels in the assisted living facility. This may be accomplished by:
  • Having a separate visiting room close to the entrance that is disinfected between each visit.
  • Developing paths that avoid walking through care areas.
  • Asking visitors to avoid interacting with anyone other than the resident they are visiting.
  • Ensure physical distancing between the visitor and resident by designating a 6-foot distance, such as using plexiglas barriers, outdoor visits with 6-foot distance, placing taping or signage to identify 6-foot clearances. Consider environmental changes such as hard surface furniture with 6-foot spacing and removing all extraneous items such as magazines and books from visiting areas. 
  • Ensure visitor and resident complete frequent hand hygiene by using hand sanitizer with at least 60% alcohol before, during, and after their visit.
  • Ensure visitor and resident are using source control measures such as cloth face covering or face mask for the entire visit, even if social distancing. Ensure visitor and resident use cloth face coverings and/or PPE as required per facility policy and resident need.
  • Between each visit, the visitation area must be disinfected according to current guidelines(link is external)

  • Administrative controls to monitor compliance and provide instruction:
  • The assisted living facility should continually review its visitation policy based on local transmission of COVID-19 and adjust as needed to ensure maximum protection for residents. This includes temporarily stopping all inside visitation when a COVID-19 case is identified in a staff member or resident. 
  • Consider prescribing date and time limitations on the number of visitors in the setting at any one time, limit the number of visitors per resident and limit length of the visit. 
  • The visits should occur at scheduled times when there are adequately trained staff available to provide education on COVID-19 mitigation procedures and facility expectations. 
  • The length of visits should be established by the assisted living facility policy to ensure continuous compliance with infection prevention and control procedures. 
  • The facility should develop and implement an ongoing self-monitoring system to ensure staff, residents, and visitors are complying with all procedures for safer visitations. 
  • The facility should revise visitation plans based on resident responses, the facility’s data, the facility’s and the local community’s COVID-19 status, and current local, state and federal guidelines.

  • Visitor and resident education shall be conducted prior to each visit and include: 
  • Facility’s procedure for visitation. 
  • Screening process for COVID-19 symptoms per CDC guidelines(link is external)
  • Education to self-monitor after the visit for 14 days and report any symptoms of illness to the assisted living facility immediately as well as notifying their Medical Provider, if they have one, and local/tribal Public Health Department. 
  • Reminder that subsequent visits must be pre-arranged and will not occur if the setting experiences any incidence of COVID-19.

Assisted living facilities will need to determine whether they can follow these guidelines to ensure they can provide safer visitations. Due to PPE availability, staffing patterns, and facility lay-out and/or location, every facility may not be able to meet the guidance requirements necessary to offer all of the safer visit options, nor will the options available at each facility necessarily be available at all times.

References


You can read DHS guidance in it's entirety by clicking the link below and scrolling to the heading "  Safer Visits in Assisted Living Facilities "