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DHHS Visitation Guidance for Large and Small Residential Facilities
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Guidance for Smaller Residential Settings Regarding Visitation, Communal Dining, Group and Outside Activities
June 26, 2020
We appreciate the efforts of our family care, behavioral health/IDD and Traumatic Brain Injury providers across the state in responding to the COVID-19 Crisis.
Ensuring the health and safety of consumers has been challenging and required tremendous sacrifices on the part of facility management and frontline staff. Residents and families have also been challenged by the inability to have in person visits and participate in outside activities.
Restrictions for residential care facilities were put in place due to vulnerabilities of the population served and the size of these settings. As we move forward, this guidance differentiates smaller facilities from larger residential care facilities.
This guidance applies to
settings with 6 or fewer beds. For example: family care homes, supervised living group homes, and alternate family living arrangements where there is an ongoing need for caution but also a recognition of the differences in smaller family-like settings.
Each facility must have a written plan which outlines their facility's policy on visitation, communal dining, and group/outside activities. If your facility has an Infection Control Plan, these elements can be addressed in that document. The plan needs to include evaluations of the following factors:
- The current COVID status of residents and staff or the presence of any symptoms. a. Visitation, communal dining, or indoor or outdoor group activities should not take place if there are residents with either symptoms or a diagnosis of COVID-19.
- Individual risk factors for complications from COVID-19 (including age and pre-existing conditions), needs, and ability of each resident to safely participate in activities. This includes the residents' ability to abide by infection prevention measures such as hand hygiene, use of cloth face covering, and social distancing.
- The physical layout of the facility and the ability to provide space for social distancing.
- Staff availability for supervision.
- Procedures for conducting daily screening for temperature check, presence of symptoms, and known exposure to COVID-19 of all residents and staff, particularly those returning from extended visits or time outside of the home.
Updated Guidance on Outdoor Visitation for Larger Residential Settings (Adult Care Homes, Behavioral Health/IDD, Intermediate Care Facilities, Psychiatric Residential Treatment Facilities)
June 26, 2020
To prevent outbreaks of COVID-19 in residential care facilities, federal authorities recommended restricting visitation. In addition, visitation to residential care facilities has been prohibited by NC Governor Executive Order except for compassionate care situations.
We recognize that these restrictions have consequences to the overall health and well-being of residents and their families. We also recognize that residential care facilities are at risk of experiencing outbreaks of COVID-19 and the residents of these facilities are often in a high-risk category for serious complications from COVID19. We strongly encourage the continued use of technology to keep connected as much as possible. To balance the needs of families and residents to see each other in person with the need to protect residents from COVID-19, this guidance outlines strict criteria for allowing outdoor visitation.
Current data indicate that risk of transmission in outdoor settings is lower compared to indoor settings. This guidance excludes skilled nursing facilities, including combination skilled nursing/adult care assisted living facilities.
This guidance is for adult care homes, behavioral health/IDD, intermediate care facilities, and psychiatric residential treatment facilities (PRTF) with 7 or more beds. (Facilities with 6 or fewer beds should refer to "Guidance for Smaller Residential Settings Regarding Visitation, Communal Dining, Group and Outside Activities"
available here).
This document provides guidance on outdoor visitation.
Facilities should continue to restrict indoor visitation, communal dining and group activities. Facilities that re-open to visitors in outdoor locations must first meet the following prerequisites:
- Facility must not be listed on the N.C. DHHS COVID website as having an ongoing outbreak.
- Facility has a written testing plan and action plan based on testing in place. Facilities should:
- Pre-identify a community partner or laboratory vendor to conduct testing in the event of a case or outbreak.
- Determine who will write medical orders for residents and staff.
- Determine who will collect specimens.
- The physical layout of the outdoor visitation spaces must allow for appropriate social distancing of at least 6 feet between residents and visitors.
- Any structures built or modifications made to the facility (including any outdoor space) to facilitate visitation cannot violate any N.C. Building Code, Life Safety Code, or any other building safety ordinance. Any modifications to the indoor or outdoor space of a facility to accommodate safe visitation must be pre-approved by the DHSR Construction Section.
From the DHHS/AHEC Webinar TODAY!
COVID-19 Update for Long Term Care Settings, Includes Discussion and Q & A on Visitation Guidance
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Updates and Announcements
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COVID-19 Preventive Materials
Scientific research shows that preventative measures such as hand washing and wearing cloth coverings over the nose and mouth are effective ways to protect ourselves, our loved ones and our communities by lowering risk of exposure to COVID-19.
That's why Governor Roy Cooper announced that coverings over the nose and mouth must be worn when people are in both indoor and outdoor public spaces. This step, in addition to encouraging people to stay six feet apart, wash hands, and stay home when ill, will help us
- protect our families, friends and neighbors from getting seriously ill, and
- restore our economy and get people back to work and get our children back to school.
Growing evidence shows that cloth face coverings, when worn consistently, can decrease the spread of COVID-19, especially among people who are not yet showing symptoms of the virus.
We are writing to you today to ask for your help. We have created resources to empower community partners and small businesses to communicate about the cloth coverings state requirement to protect their loved ones, employees, and customers.
- Social media graphics in English and Spanish answering basic questions about wearing coverings over the mouth and nose. Images used in the graphics reflect the diversity of North Carolina.
- Posters for businesses and community organizations to print and hang that remind people to wear cloth coverings over their nose and mouth and celebrate the commitment businesses in your community have made to protect employees and customers. We encourage you to place the posters in your breakrooms, waiting rooms, building entrances or doors, and other frequented locations.
You can find more information about the new cloth covering
In addition to materials about cloth coverings, the
Prevent and Protect Media Toolkit is full of social media posts and images, infographics, customizable flyers, and more to get the word out about preventative measures (3Ws), testing and contact tracing and help North Carolinians protect themselves and their loved ones against the spread of COVID-19.
We will continue to update the page with new materials, so please check back often. All materials are available in English and Spanish.
Thank you for your continued efforts to work together to slow the spread of COVID-19, and for your commitment to ensuring your community and the communities you serve are informed and supported.
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Governor Cooper Issues a Phase 2 Extension and Executive Order #147
Press Release:
North Carolina Pauses in Safer At Home Phase 2, Adds Statewide Requirement for Face CoveringsAs trends move in the wrong direction, state will not yet move into Phase 3
Governor Roy Cooper and North Carolina Department of Health and Human Services Secretary Dr. Mandy Cohen today announced that North Carolina will remain in Safer at Home Phase 2 for three more weeks. Cooper also announced that face coverings must be worn when people are in public places as officials seek to stabilize concerning trends of increasing viral spread.
Cooper and Cohen were joined by Dennis Taylor, President of the North Carolina Nurses Association and Eugene A. Woods, President and CEO of Atrium Health.
"North Carolina is relying on the data and the science to lift restrictions responsibly, and right now our increasing numbers show we need to hit the pause button while we work to stabilize our trends," said Governor Cooper. "We need to all work together so we can protect our families and neighbors, restore our economy, and get people back to work and our children back to school."
"I know North Carolinians are strong, resilient and care deeply about our communities. We pride ourselves on helping our neighbors. The best way we can do that now is by taking the simple action of wearing a face covering that covers your nose and mouth. If we each do our part, we can get back to the people and places we love," said Dr. Mandy Cohen, NCDHHS Secretary.
Growing evidence shows that cloth face coverings, when worn consistently, can decrease the spread of COVID-19, especially among people who are not yet showing symptoms of the virus. Until now, face coverings had been strongly recommended. Under today's executive order, people must wear face coverings when in public places where physical distancing is not possible.
In addition, certain businesses must have employees and customers wear face coverings, including retail businesses, restaurants, personal care and grooming; employees of child care centers and camps; state government agencies under the Governor's Cabinet; workers and riders of transportation; and workers in construction/trades, manufacturing, agriculture, meat processing and healthcare and long-term care settings.
"Wearing a face covering is an easy thing to do that can make a huge impact for all of us. A major spike in cases would be catastrophic to the system, and without your cooperation, nurses and our fellow healthcare providers will have a harder time caring for sick patients for weeks and months to come," said Dennis Taylor, a nurse, and President of the North Carolina Nurses Association.
"As the leader
of the state's largest health system, I am pro-health and also 100 percent pro-business. In fact, the two are inextricably connected and I'm very proud of the way business leaders and health experts are working together to keep our economy strong," said Eugene A. Woods, President and CEO of Atrium Health. "Medical science says to reduce the spread of COVID-19 masking works, and my sincere hope is that all the people of North Carolina can join forces to make wearing a mask not something we feel we have to do - but something that we want to do to keep each other, our neighbors, our children and our loved ones healthy and safe"
Based on the metrics laid out in April by Governor Cooper and Secretary Cohen, North Carolina is evaluating a combination of the data from the following categories that shows the indicators moving in the wrong direction, causing officials to implement today's pause in Phase 2.
Trajectory in COVID-Like Illness (CLI) Surveillance Over 14 Days
- North Carolina's syndromic surveillance trend for COVID-like illness is increasing.
Trajectory of Lab-Confirmed Cases Over 14 Days
- North Carolina's trajectory of lab-confirmed cases starting to level, but is still increasing.
Trajectory in Percent of Tests Returning Positive Over 14 Days
- North Carolina's trajectory in percent of tests returning positive remains elevated.
Trajectory in Hospitalizations Over 14 Days
- North Carolina's trajectory of hospitalizations are increasing, though we have capacity in our healthcare system.
In addition to these metrics, the state continues building capacity to be able to adequately respond to an increase in virus spread. These areas include:
Laboratory Testing
- North Carolina is averaging more than 17,000 tests a day for the past week and there are more than 500 sites listed on online plus additional pop-up sites.
- North Carolina labs and labs around the country are seeing supply shortages for laboratory chemicals needed to process tests.
Tracing Capability
- There are over 1,500 full-time and part-time staff supporting contact tracing efforts at the local health department level, including the 309 Carolina Community Tracing Collaborative contact tracers. These new hires reflect the diversity of the communities they serve, and 44% are bilingual.
Personal Protective Equipment
- Our personal protective equipment (PPE) supplies are stable.
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President Trump Signs Executive Order Expanding HHS Efforts to Help Foster Children
Read Through Related Statements and Fact Sheets:
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PPP Funds Are Still Available: Paycheck Protection Program Deadline Is June 30
From Forbes: With about a week remaining to apply for a Paycheck Protection Program loan, the Small Business Administration has reinstated its
Lender Match program, which connects small businesses affected by the COVID-19 pandemic with lenders.
The relaunched website enables would-be borrowers to find a
nonbank lender
, including a Community Development Financial Institution (CDFI), Minority Depository Institution (MDI), Certified Development Company (CDC), Farm Credit System lender, microlender or a traditional small bank lender that processes and hand out PPP loans.
"The SBA is focused on assisting eligible borrowers in underserved and disadvantaged communities and connecting them with forgivable PPP loans, especially before the June 30, 2020 application deadline," SBA Administrator Jovita Carranza said in a statement. "As communities begin to carefully reopen across the country, there are still many more opportunities to provide this assistance to businesses who have yet to access these forgivable loans."
The relaunched tool follows passage earlier this month of the
Paycheck Flexibility Act, which smooths the path for small-business owners to qualify for loan forgiveness and increases the deadline to spend PPP funds from eight weeks to 24.
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After significant speculation and discussion (which began almost the moment the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed into law back in March), Congress passed the Paycheck Protection Program Flexibility Act of 2020 (Flexibility Act) and President Trump signed the Flexibility Act into law on June 5, 2020.
The Flexibility Act addresses significant issues with the Paycheck Protection Program (PPP) created by the CARES Act by making many changes to the PPP, some of which apply only to those loans issued going forward and some that apply retroactively to all borrowers. Most of the revisions are borrower-friendly and will be helpful to a borrower trying to maximize the forgiveness aspect of its PPP loan. Below is a highlight of some of the key changes and additions under the Flexibility Act.
The IRS issued proposed regulations under Section 4960 of the Internal Revenue Code of 1986, as amended (the "Code"), which was added as part of the Tax Cuts and Jobs Act. The proposed regulations published in the Federal Register on June 11, 2020, largely follow the IRS interim guidance under IRS Notice 2019-09. However, the IRS made some helpful changes in the proposed regulations which are briefly summarized below.
By way of background, Section 4960 imposes an excise tax equal to the corporate tax rate (21 percent for 2020) on that portion of a covered employee's pay that exceeds $1 million or is treated as an excess parachute payment. More on Section 4960 Excise Tax Here
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Reminder, Please Consider
Supporting
This Important Campaign
Please don't forget that CareForNC is launching a COVID-19 #FacesOfTheFrontline campaign during May and June. We work amongst healthcare warriors every day in our field and we're asking you to send in photos and short videos we can share to help our state and communities see the many faces of frontline workers!
These images will be used in our CareForNC campaign #FacesOfTheFrontline. Make sure you sign up to receive our #CareForNC posts and on our Facebook page so your agencies can repost the CareForNC posts! Be sure to use one or all the hashtags listed below on your agency posts.
- #FacesoftheFrontlines
- #NCHeroes
- #CareforNC
- #TogetherOnTheFrontLine
If you do not have a google account to use the Google drive, you can email your pictures and videos to
carefornc@gmail.com.
Many video attachments may be too large to send via email. In that case, please upload your videos to YouTube privately, Dropbox, or use WeTransfer and send a link to the CareForNC email so we can download the file. Be sure to include:
- Your Name
- Organization Name
- County or Counties You Serve
- Email
- Description of Content
- Any Additional Information
Below are some links to provide you additional information to help you create your own #FacesOfTheFronline posts and for video and picture submissions to CareForNC.
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Thursday: June 25, 2020
CARES Act Provider Relief Fund
Time: 2:00 pm
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Thursday: June 25, 2020
Adapting Community Inclusion to Circumstances of 2020
Time: 2:00 pm thru 3:30 pm
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Thursday: June 25, 2020
Joint NC DMHDDSAS and DHB (NC Medicaid) COVID-19 Update
for NC Providers Webinar
Time: 3:00 pm
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Friday, June 26, 2020
Benchmarks' Membership Webinar
Time: 8:30 am
Meeting ID: 626 815 379
Password: 081879
One tap mobile
+13126266799,,626815379# US (Chicago)
+19292056099,,626815379# US (New York)
(We will NOT be holding a Thursday Child Welfare Webinar this week or next)
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Friday, June 26, 2020
Q&A WEBINAR FOR VAYA HEALTH NETWORK PROVIDERS
Time: 11:00 am thru 12:00 pm
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New: Friday, June 26, 2020
NCDHHS Supported Living Levels 2 & 3: Virtual Stakeholders Engagement Meeting
Time: 1:00 pm thru 3:00 pm
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Monday, June 29, 2020
Family Therapy for Youth with an IDD
Time: 1:00 pm thru 3:15 pm
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New: Monday, June 29, 2020
Joint DMHDDSAS and DHB (NC Medicaid) COVID-19 Update Call
For BH/IDD Consumers, Family Members and Community Stakeholders
Time: 2:00 pm
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Tuesday, June 30, 2020
Identifying and Addressing Traumatic Stress During COVID-19 Pandemic
Time: 2:00 pm thru 4:00 pm
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Wednesday, July 1, 2020
Ongoing Staff Development in Disability Services
Time: 2:00 pm EST
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Monday: July 20, 2020
Meeting number: 730 385 489
You can also dial 173.243.2.68 and enter your meeting number. Or, join by phone: 1-650-479-3207 Access code: 730 385 489
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Please click on each of the following links to view details sent out from each LME/MCO.
Benchmarks' wants to be sure to make the following list handy for our members to visit and suggests a peek at least once per week to find information that may be pertinent to your agency and contracts.
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