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IDH Releases Updated Guidelines on Visitation, New Admissions, Excursions and More for LTCFs - IHCA

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IDH Releases Updated Guidelines on Visitation, New Admissions, Excursions and More for LTCFs

Posted Apr 7, 20218 min Read

Regulatory & Clinical
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Please Note:  On April 7, 2021, this article was updated to reflect recent changes to the Visitation Guidelines, which now specify that fully vaccinated residents may participate in excursions over 24 hours in duration without having to be placed in transmission-based precautions for 14 days upon return if they remain asymptomatic and did not engage in high-risk exposure during the excursion that was over 24 hours in length.  The updated Visitation Guidelines also clarify that visitation for compassionate care visits includes Essential Family Caregivers, and such visits should continue even if indoor visitation is otherwise restricted, regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak, even if the resident is in transmission-based precautions (i.e., Yellow or Red Unit).“

On March 16, 2021, the Indiana Department of Health (IDH) issued updated Visitation Guidelines, which largely track with CMS’s recently revised QSO 20-39, a summary of which can be found here.  While CMS’s revised QSO 20-39 only applies to nursing facilities, IDH’s updated Visitation Guidelines apply to both nursing facilities and residential care facilities/assisted living communities (collectively “long term care facilities”) and are effective immediately.  The guidance also addresses changes to quarantine for new admissions that are fully vaccinated or within 90-days of having recovered from COVID-19.  The guidance also discusses core principles of infection control, excursions and in-facility activities.

Regarding visitation, and similar to CMS QSO 20-39, under IDH’s updated Visitation Guidelines, visitation is required at all times.  However, IDH’s Visitation Guidelines make clear that long-term care facilities should:

  • Create a policy for normal visitation hours, length of visits, the number of visitors per resident, and the number of visitors at any one time; and
  • Work with residents if any visitors are not available during normal visitation hours to ensure proper accommodations are provided, consistent with resident preference.

Further highlights of IDH’s updated Visitation Guidelines are as follows:

  • Indoor Visitation:  While outdoor visitation is still preferred, indoor visitation should occur for all residents (regardless of vaccination status), except as follows:
  • If the county in which the nursing facility is located is above 10% positivity and less than 70% of the residents are vaccinated, then visitation should be limited for unvaccinated residents until the county is below 10% positivity once again;
  • Visitation should be limited for residents with a confirmed COVID-19 infection, whether the resident is vaccinated or unvaccinated, until the resident meets the criteria to discontinue transmission-based precautions;
  • Visitation should be limited for residents who are in quarantine, whether the resident is vaccinated or unvaccinated (i.e., a new admission in a Yellow Unit who is unvaccinated, or a new admission in a Yellow Unit who is vaccinated but was a close contact of a COVID-positive individual); and/or
  • An outbreak has occurred, as outlined further below.
  • Please Note:  Importantly, visitation for compassionate care visits, which includes Essential Family Caregivers, should continue even if indoor visitation is otherwise restricted, regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak, even if the resident is in transmission-based precautions (i.e., Yellow or Red Unit).
  • Scheduling Visitation:  Like with QSO 20-39, under IDH’s updated Visitation Guidelines, visitation is required at all times (the previous version of IDH’s Visitation Guidelines required eight (8) hours of visitation daily).  However, IDH’s Visitation Guidelines make clear that long-term care facilities should create a policy for normal visitation hours, length of visits, the number of visitors per resident, and the number of visitors at any one time to protect the health and security of residents and staff.  Long-term care facilities should work with residents if any visitors are not available during normal visitation hours to ensure proper accommodations are provided, consistent with resident preference.  Whenever possible, long-term care facilities are also encouraged to allow up to one (1) or two (2) hours and two (2) visitors per resident. 
  • In-Room Visitation:  While visits in designated visitation areas are still encouraged, in-room visits may occur in long-term care facilities for any reason while adhering to the core principles of COVID-19 infection prevention.  Long-term care facilities are not required to perform continuous supervision of each visitor.  If a long-term care facility has reason to believe that a visitor may not adhere to core principles of infection control, then the facility may choose to employ periodic and frequent, or continuous, observation/supervision of the visitor.  Communication by the long-term care facility to the visitor(s) and resident(s) concerning the reasons for observation/supervision is strongly encouraged. 
  • Physical Contact:  For those residents who are fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.  However, visitors should continue to physically distance from other residents and staff in the facility. 
  • Outbreaks:  When one (1) new facility-onset COVID-19 case among residents or staff is identified, as defined by IDH’s Visitation Guidelines, the nursing facility should immediately begin outbreak testing and suspend all visitation (except that required under federal disability rights law, which is by definition a compassionate care visit), until at least one (1) 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/units of the facility, then visitation can resume for residents in those areas/units with no COVID-19 cases.  The facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing, meaning testing every three (3) to seven (7) days until no new COVID-19 case is identified for a 14-day period.  In such a circumstance, visitors should be notified of their potential exposure to COVID-19 (i.e., when visiting residents on the non-affected units), and signage should be placed regarding the outbreak in the particular unit.
    • If the first round of outbreak testing reveals one (1) or more additional COVID-19 cases in other areas/units of the facility (i.e., new cases in two (2) or more units), then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing, meaning testing every three (3) to seven (7) days until no new COVID-19 case is identified for a 14-day period.
    • As a reminder, IHCA/INCAL’s Outbreak Toolkit can be here, and IHCA/INCAL’s article on routine and outbreak testing can be found here.

The guidance also addresses the following: 

  • New Admissions:  Based on the CDC’s updated Healthcare Infection Prevention and Control Recommendations in Response to the COVID-19 Vaccination, new admissions who are fully vaccinated or are COVID-recovered in the past 90 days are not required to be placed in transmission-based precautions for 14 days upon admission.  However, fully vaccinated residents who are new admissions and a close contact of a COVID-positive individual should be placed in transmission-based precautions for 14 days.
  • Excursions: Both vaccinated and unvaccinated residents are not required to be placed in transmission-based precautions for 14 days upon return from an excursion, if the excursion is less than 24 hours of duration and provided that proper precautions with physical distancing, hand hygiene, and mask wearing are taken during the excursion.  Further, fully vaccinated residents may participate in excursions over 24 hours in duration without having to be placed in transmission-based precautions for 14 days upon return if they remain asymptomatic and did not engage in high-risk exposure during the excursion that was over 24 hours in length.    However, the Visitation Guidelines do make clear excursions should be paused during outbreak testing. 
  • Entertainers and Church Activities:  Facilities can allow church services and entertainers outdoors with social distancing and masks according to the core principles of infection prevention.  When conducting church services or entertainers indoors, shouting or singing should be avoided due to potential aerosol and droplet projection. 
  • Infection Control:  Long-term care staff should continue to adhere to the core principles of infection prevention as outlined in IDH’s Visitation Guidelines and COVID-19 LTC Facility Infection Control Guidance Standard Operating Procedure, including wearing face shields when within six (6) feet of a resident and participating in screening daily.  Visitors should also continue to be screened and prevented from entering a facility if they are exhibiting signs or symptoms or if they were a close contact of a COVID-positive individual in the past 14 days.  A sample employee screening form can be found here, and a sample visitor screening form can be found here.

About the Author

Laura Brown, Director of Legislative and Legal Affairs