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Essential Family Caregiver Program – Implementation Required

Posted Jul 2, 20214 min Read

Regulatory & Clinical

During the 2021 legislative session, Senate Enrolled Act 202 was passed to require nursing facilities and licensed assisted living communities (collectively, long-term care facilities) to implement an Essential Family Caregiver (EFC) program when visitation is limited or restricted during a declared disaster emergency or public health emergency.  On July 2, 2021, the Indiana Department of Health (IDH) issued a Toolkit for long-term care facilities to implement an EFC program during this public health emergency when visitation is limited or restricted, and any future disaster or public health emergencies when visitation is limited or restricted.

  • The Toolkit can be accessed here, and an informational PowerPoint can be accessed here.  The Toolkit includes guidelines for implementing an EFC program, as well as sample forms and checklists.

Long-term care facilities should begin working to create and maintain an EFC program immediately and inform residents and their designated representatives of the EFC program when implemented.  For those long-term care facilities that have already implemented an EFC program, please review the Toolkit to ensure your program is in compliance with IDH’s guidelines.  The Toolkit is similar to IDH’s previous voluntary EFC program, but most notably under the Toolkit, each resident may have two (2) EFCs designated.  Facilities that already have an EFC program in place are encouraged to notify residents and their designated representatives when any changes to the program are made.

Highlights of the EFC program under the Toolkit are as follows:

  • Overview:  All long-term care facilities must allow a resident, or the resident’s designated representative (if the resident has been deemed incapacitated or is a resident of a memory care unit), to designate at least two (2) individuals to serve as EFCs for declared disaster or public health emergencies when visitation is limited or restricted.
    • In other words, the resident, or the resident’s designated representative, may choose to only designate one (1) individual to serve as an EFC but is permitted to designate up to two (2) individuals.
    • If more than one (1) EFC is designated, the resident, or the resident’s designated representative, shall determine the identity of the primary EFC to serve as the main point of contact for communication and care coordination related to the EFC program.
  • EFC Requirements:  An EFC must be at least 18 years of age, and he/she must have provided care and support to the resident on a routine basis, about twice a week on average, prior to the visitation limitations or restrictions.  For newly admitted residents, a person who provided care to them before their admission would also be able to apply as an EFC.
  • EFC Designation Process:  The facility’s administrator, or his/her designee, shall have the discretion to determine whether to designate an individual as an EFC and must approve or deny the applicant within seven (7) calendar days of receipt of the application, in consultation with facility staff who provide care to the resident.
  • EFC Denials:  If a facility denies an application, the reason for denial must be provided in writing to the applicant.  It is the sole burden of the facility to provide justification for denial of the application. The applicant may then request in writing that the administrator reconsider designating the applicant as an EFC.  An individual whose application is still denied after reconsideration may report the denial in writing to IDH or LTC Ombudsman if the individual believes that the denial is not justified.
  • EFC Plans:  The facility is required to develop an individualized resident EFC plan that is maintained in the resident’s file (electronic or paper) and provided to all parties.  This plan must be person-centered and include the following components for each designated EFC:
    • Hours of visitation and the duration of the visits.
    • Specify the responsibilities of all parties (i.e., the care to be provided by the EFCs).  Please note, the care provided can help supplement but should not replace the care provided by the facility.
    • Include indoor and outdoor visitation, and virtual visitation for when the caregiver is unable or prohibited to enter due to illness.
    • Reflect the preferences of the resident and caregiver, and be in accordance with existing state/federal guidelines for visitation.
  • Restrictions:  The facility may restrict an established plan of visitation by an EFC if the individual violates the visitation rules or has a positive screening / test. An individual with a positive screening / test should be permitted to return based on state and federal guidelines (i.e., similar to Return to Work guidelines for health care personnel).

Any questions about the EFC program can be directed to, Zach Cattell at or Lori Davenport at