***IHCA is aware that the CDC has also issued updated guidance for infection control and long term care on September 10, 2021. IDH has indicated that facilities can follow either IDH or CDC guidance and not be cited for following CDC guidance that differs from current IDH guidance. We expect IDH to update their guidance to conform with CDC guidance the week of September 20.***
This new guidance has also been incorporated into the COVID-19 LTC Toolkit (a link for which can be found on the IHCA’s main COVID-19 page).
The Indiana Department of Health posted an updated as COVID-19 Regulatory Visitation and Activities Guidance. The updated COVID-19 Regulatory Visitation and Activities Guidance also references the updated COVID-19 Clinical Guidance related to treatment of admissions and readmissions. Readmissions are defined as any resident that is out of the facility for greater than 24 hours.
It is critical that facilities read this guidance and compare it to current facility policies. Key areas of this updated COVID-19 Regulatory Visitation and Activities Guidance are:
Resident Rights and Regulations
- Visitation may not be restricted based on vaccination status of the resident or visitor. Full vaccination of visitors is preferred, and vaccination status may be asked, but visitation cannot be restricted.
- Create a safe and accessible spaces for outdoor visitation
- Outdoor visits are not permitted for residents with confirmed COVID-19 infection or in quarantine.
- Must be allowed at all times.
- Length of visitation should not be limited.
- The number of visitors can be restricted to allow social distancing to no fewer than two visitors at a time per resident but must be able to ensure social distancing.
- Privacy curtain should be pulled.
- There should be no limitation of the number of visits a resident can have per day or per week, including the same visitor coming daily.
- Circumstances when visitation should be limited due to high risk of COVID-19 transmission include limiting indoor visitation for:
- Unvaccinated residents, if the LTC facility’s COVID-19 county positivity rate is >10% and <70% of residents in the facility are fully vaccinated.
- Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the criteria to discontinue transmission-based precautions (TBP); or
- Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
- Indoor Visitation During an Outbreak (only pertains to SNF/NFs facilities required to conduct outbreak testing):
- When a new case of COVID-19 is identified, a facility should begin outbreak testing and suspend all indoor visitation immediately (except for compassionate care visits required under federal disability rights law) until at least one round of facility-wide testing is completed. Visitation can resume based on the following criteria:
- If the first round of outbreak testing reveals no additional COVID-19 cases in other areas (e.g., units) of the facility, then visitation can resume for residents in areas/units with no COVID-19 cases. However, the facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing. Visitors who resume visitation in the unaffected areas of the facility should be notified of potential exposure, and signage should be placed in the facility regarding the outbreak in the particular unit.
- If the first round of outbreak testing reveals one or more additional COVID-19 cases in other areas/units of the facility (e.g., new cases in two or more units), then facilities should suspend visitations for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing, meaning every 3-7 days until no new COVID-19 case is identified in a 14-day period.
- Enable visits to be conducted with adequate degree of privacy.
- Continuous observation/supervision of each visitor is not required.
- Visitors should adhere to Core Principals of Infection Control and should be asked to leave otherwise.
- Facilities should limit movement of visitors in the facility.
- Physical touch is allowed for resident, but both resident and visitor should wear a well-fitted face mask, social distance (6 feet between people) and practice hand hygiene before and after the visit.
Compassionate Care Visitation including Essential Family Caregiver (EFC)
- Visitation must be allowed in compassionate care circumstances regardless of the resident’s vaccination status, including during outbreak testing and when the positivity rate is more than 10%, even if the resident is in TBPs (Yellow or Red Zone).
Personal Services, Activities and Communal Dining
- Core principals of Infection control and sources controls should be in place and encouraged.
- Salon: A hairdresser may come into the facility if the hairdresser ears a mask, eye protection when indicated and serves customers following infection control measures below with environmental cleaning of the chair and instruments between clients.
- Residents and hairdresser to wear masks that covers the mouth and nose
- Eye protection should be used when there is risk of splash or spray for the hairdresser.
- Consider fans and fan placement to blow air away from the hairdresser and resident.
- One client at a time inside the salon is recommended unless space accommodates more than one fully vaccinated residents; however, all in the room must wear a mask and residents to maintain social distance.
- Blow dryers should blow away from individuals in the same room.
Pools and Gyms
- Limit use to one individual at a time in the gym or therapy pool if space is small
- Larger gyms may allow more than one individual ( not residing on a yellow or red unit in TBP) at a time if >6 feet is maintained (equipment placement and people), masks are worn, hand hygiene and equipment is cleaned/disinfected between uses. All residents and HCP’s regardless of vaccination status, must wear a mask.
- A newly admitted resident in a 14-day quarantine (yellow zone) because they are not fully vaccinated or a resident in 14-day quarantine in TBP for Asymptomatic COVID-19 is allowed in the gym for medical rehabilitation. Only one resident at a time for this situation and yellow zone required PPE (N95, gown, gloves, eye protection) to be worn by the HCP and the resident to wear a procedure mask and gloves. All equipment to be cleaned and disinfected and the gym to remain empty for an hour afterward before allowing another resident in the gym for therapy.
- Equipment and surfaces should be cleaned with approved antiviral disinfectant after each individual use.
- Masking is not required when a resident is swimming laps is the facility has free standing swimming pools.
- Therapy pets may be brought to the facility and held by residents in the green zone and/or not in TBP.
- Use of hand sanitizer before handling the pets and after is encouraged.
Communal Dining and Activities
- A resident may not participate in communal dining and activities as follows:
- Vaccinated and unvaccinated residents with COVID-19 infection or in TBP because of suspected COVID-19 until they have met criteria to discontinue.
- Facilities in outbreak testing until they have completed one round of testing. (SNF required – Assisted Living is not required) If first round of testing reveals no additional COVID-19 cases in other areas of the facility, then dining and activities may resume for residents in areas with no COVID-19 cases and or in TBP. If the first round of outbreak testing reveal one or more additional COVID-19 cases in other areas of the facility, then communal dining and activities should be halted in all areas of the facility.
- Communal dining and activities can occur under these conditions:
- Facilities can adhere to physical distancing, such as being seated at least 6 feet apart.
- Dining area is environmentally cleaned before and after each group comes to the area.
- Residents should be offered hand hygiene before and after activities and dining. o Residents should not share food, drinks, or other personal items during dining.
- Caregivers in the dining area should wear masks and perform hand hygiene before assisting residents with eating and between each resident that they assist.
- Caregivers should perform hand hygiene after leaving the resident’s room if assisting him/her there.
- Facilities can allow church services indoors with social distancing and masks.
- Encourage medium and large services to be held outdoors.
- Singing is a high risk activity and requires a well-fitted mask and distancing greater than 6 feet.
- Indoor singing is not prohibited
- Outdoor entertainment is encouraged as weather permits.
- Indoor entertainment with social distancing, masks and core principals of infection prevention.
- Shouting and singing should be avoided with indoor entertainment.
- For residents attending medical appointments and routine and preventive care outside of the facility, the following is recommended:
- Provide the resident with a surgical mask to wear while attending the appointment and performing hand hygiene before and after the appointment.
- Review core principals of Infection Control often and answer any questions the resident has.
- It is not recommended to place the resident in transmission-based precautions upon return to the facility but monitor the residents for signs and symptoms of COVID-19 per protocols for all other COVID naïve residents in the facility and consider frequent COVID testing for screening for residents who go in and out of the facility routinely.
- Consider offering a private room or a semiprivate room with a roommate who has not had high exposure risk for COVID 19 for those residents that leave the facility for dialysis.