IDH Issues Updated Visitation Guidelines for Long-Term Care Facilities

On October 20, 2020, the Indiana Department of Health (IDH) updated its Visitation Guidelines for Long-Term Care Facilities, which can be found here.  The Visitation Guidelines apply to all long-term care facilities, including nursing facilities and residential care facilities (licensed assisted living communities).

The majority of the updates to the Visitation Guidelines are to the “Continued Infection Prevention” section and incorporate the guidelines from IDH’s updated Infection Control Guidance Standard Operating Procedure.  For IHCA/INCAL’s full summary on IDH’s updated Infection Control Guidance, please click here.

The updated Visitation Guidelines also incorporate the federal Centers for Medicare and Medicaid (CMS) visitation memo, QSO 20-39, stating all long-term care facilities are mandated to provide outdoor visitation, although administrators have the discretion to either continue or prohibit outdoor visitation if the facility is experiencing an outbreak.  Outdoor visits may continue if a HCP tests positive, as long as contact tracing occurs.

In summary, under the updated Visitation Guidelines, all long-term care facilities should continue to offer at least four hours of visitation Monday through Friday and over each weekend (can be a mixture of indoor and outdoor visitation), unless one of the following applies:

• The facility has had a facility-onset COVID-19 case in the past 14 days (an outbreak), as defined by ISDH’s Visitation Guidelines.  However, while indoor visitation must be paused during an outbreak until there have been no new facility-onset COVID-19 cases for 14 days, outdoor visitation should continue during an outbreak.  As stated above, the presence of an outbreak may warrant the discontinuation of outdoor visitation, but facilities are strongly encouraged to contact IDH prior to discontinuing outdoor visitation and document the reasons necessary to pause outdoor visitation.
• The local department of health has otherwise restricted indoor visitation (for the most up-to-date county visitation restriction list, please click here).
• The facility is in county over 10% positivity, per QSO 20-39 (please note, QSO 20-39 does not apply to assisted living communities; for IHCA/INCAL’s summary on QSO 20-39, please click here).

When visitation is occurring, all visitors should be screened and cannot be denied entry unless they fail the COVID-19 screening questions or are unwilling to comply with the visitation requirements (i.e., wearing a mask throughout the visit).  Refusing a test prior to the visitation is not a reason to deny entry.  However, if a visitor agrees to POC testing and the result is positive, the visitor should be denied entry until a confirmatory PCR test is secured.  Facilities should help visitors with a referral to the nearest free Optum or Local Health Department PCR testing site.

 Importantly, if a county is over 10% positivity or a facility is in an outbreak, visitation for compassionate care situations can still occur.  CMS has stated that the term “compassionate care situation” does not exclusively refer to end-of-life situations and does not indicate only family members can visit for these circumstances (i.e., a clergy member offering support may be appropriate in compassionate care situations).  Examples of other types of compassionate care situations include, but are not limited to:

• A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
• A resident who is grieving after a friend or family member recently passed away.
• A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
• A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).