VISITATION POLICY UPDATE
DURING COVID PANDEMIC
UPDATED: 3/11/2021
QSO-20-39-NH (REVISED 3/10/21)
BACKGROUND:
(for the purposes of this policy, “Nursing Home” also applies to the Personal Care units.)
- In March 2020, CMS issued memorandum QSO-20-14-NH providing guidance to facilities on restricting visitation of all visitors and non-essential health care personnel. This led to our “lockdown status” here at Saint John XXIII Home (SJ23).
- In May 2020, CMS released Nursing Home Reopening Recommendations, which provided additional guidance on visitation for nursing homes.
- In June 2020, CMS also released a document on visitation, which expanded on previously issued guidance on topics such as outdoor visits, compassionate care situations, and communal activities. This led to our patio visits and later visits inside within Roncalli Center here at SJ23.
- In September 2020, CMS released (QSO-20-39-NH) COVID VISITATION standards related to; Prevention Core Principals, Indoor visits, outdoor visits, outbreak standards, etc. This document has been our “standard” here at SJ23 since being released.
KEY DEFINITIONS:
- FULLY VACCINATED: Fully vaccinated refers to a person who is ≥ 2 weeks following receipt of the second dose in a 2 dose series, or ≥ weeks following receipt of one dose of a single dose vaccine, per the CDC’s Public Health Recommendations for Vaccinated Persons.
- UNVACCINATED: Individuals who do not meet ALL standards of the FULLY vaccinated definition above.
NEWEST VISITATION UPDATE: (3/10/21)
- In March 2021, CMS released (QSO-20-39-NH revision). This document acknowledges the impact that social isolation may have on the well-being of nursing home residents. It further acknowledges the progress that has been made related to the COVID VACCINATION of residents and staff members of health care facilities. At the time of this release, SJ23 had a resident vaccination rate of >95%.
- VISITATION will now be determined by the following:
- COVID status of the UNIT(s) within SJ23. (Green = visitations)
- Mercer County COVID positivity rate. (under 10%)
- Vaccination % of residents across our campus (greater than 70%)
- Vaccination status of an individual resident (see unvaccinated exceptions).
** Note, CMS has removed the standard of stopping visitation solely due to the Mercer County positivity rate. As well as, implemented standards that may be implemented should an outbreak occur at SJ23, through RISK ASSESSSMENT by unit (nursing home, personal care, special needs).
CORE PRINCIPLES OF COVID-19 INFECTION CONTROL:
MUST CONTINUE to be followed at all times.
- SCREENING: of all who enter SJ23 for signs/symptoms of COVID (temperature and questions/observation for signs of COVID).
- DENIAL OF ENTRY: for those with signs/symptoms or those who have had close contact with someone with COVID infection in the prior 14 days (regardless of the visitors vaccination status).
- HAND HYGIENE: (use of alcohol-based hand rub is PREFERRED).
- FACE COVERINGS: Required at all times regardless of vaccination status. (cover mouth AND nose)
- SOCIAL DISTANCING: at least 6’ between persons.
- VISITOR EDUCATION: signage displayed related to expectations of visitors.
- CLEANING/DISINFECTING: cleaning process of designated visitation areas after each visit.
- PPE USE: proper use of PPE by staff and visitors. (residents recommended to wear mask but not required).
- COHORTING: facility must have a plan in place to respond to COVID cases / COVID care.
- TESTING: Resident and Staff testing must be conducted as per testing requirements based on County positivity and facility positivity rates.
Visitors who are unable to adhere to the core principles of COVID-19 infection prevention should not be permitted to visit or should be asked to leave
INDOOR VISITATION:
SJ23 will permit INDOOR visitation for all residents regardless of vaccination status. At this time, we will continue to offer “visitation stations” within Roncalli Center. We have recreated our “stations” to improve the visitation experience.
Indoor/Outdoor Visitation Standards:
- Visitation will be limited to 2 visitors per resident per visit.
- All visitors will be required to adhere to the CORE PRINCIPLES.
- Residents will be encouraged to wear masks during visits (not required).
We will continue to utilize the “scheduled visits” process to help organize the visits, overcome resident room assignment obstacles and maintain infection control standards. In an attempt to not disrupt meal times, visitations will continue to occur between the lunch and evening meals. We have increased the number of “stations” for visitation, to allow for multiple visits weekly for each resident. In addition, we have removed the “barrier screens” to allow for better communication but still encourage 6’ social distancing. This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated. However, we acknowledge the toll that separation and isolation has taken. We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one. Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor, while wearing a mask and performing hand hygiene before and after the visit. Regardless, visitors must physically distance from other residents AND staff in the facility. Visits can be scheduled by calling 724-981-3200 between the hours of 9am – 9pm. Our goal is to continue to move toward visitation within resident rooms. However, keeping a focus on risk management, we will continue to restrict the location of visitation until the vaccine is more readily available within our community.
OUTDOOR VISITATIONS:
While taking a person-centered approach and adhering to the core principles of COVID-19 infection prevention, outdoor visitation is preferred even when the resident and visitor are fully vaccinated against COVID-19. Outdoor visits generally pose a lower risk of transmission due to increased space and airflow. Therefore, visits WILL be held outdoors whenever practicable. However, weather considerations (e.g., inclement weather, excessively hot or cold temperatures, poor air quality) or an individual resident’s health status (e.g., medical condition(s), COVID-19 status) may hinder outdoor visits. For outdoor visits, SJ23 will utilize the “front porch”, as a safe outdoor space for visitation. When conducting outdoor visitation, all appropriate infection control and prevention practices should be adhered to.
VISITATION EXCEPTIONS:
Circumstances when visitation will be limited due to a HIGH RISK of COVID transmission. The following scenarios will require INDOOR/OUTDOOR visitation to be RESTRICTED:
- For Unvaccinated residents: if the Mercer County COVID positivity rate is greater than 10% AND less that 70% of SJ23 residents are Fully Vaccinated.
- For COVID positive residents: whether vaccinated or unvaccinated, will not be permitted visitors until they have met the criteria to discontinue Transmission-Based precautions.
- For Residents in QUARANTINE: whether vaccinated or unvaccinated, will not be permitted visitors until they have met criteria for release from Quarantine.
- VIRTUAL VISITS: In the event that any of the above situations arise, visitation should be limited to virtual visits, telephone calls and window visits for those residents impacted.
INDOOR VISITATION DURING AN OUTBREAK
This section is a significant deviation from the prior standards
.
An outbreak exists when a new nursing home onset of COVID-19 occurs (i.e., a new COVID-19 case among residents or staff). This guidance is intended to describe how visitation can still occur when there is an outbreak, but there is evidence that the transmission of COVID-19 is contained to a single area (e.g., unit) of the facility. To swiftly detect cases, SJ23 will continue to adhere to CMS regulations and guidance for COVID-19 testing, including routine staff testing, testing of individuals with symptoms, and outbreak testing.
When a new case of COVID-19 among residents or staff is identified, SJ23 will immediately begin outbreak testing and suspend all visitation (except that 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 (units) of SJ23, then visitation can resume for residents in areas/units with no COVID-19 cases. However, SJ23 will suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing. For example, if the first round of outbreak testing reveals two more COVID-19 cases in the same unit as the original case, but not in other units, visitation can resume for residents in areas/units with no COVID-19 cases.
• 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 SJ23 will suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.
While the above scenarios describe how visitation can continue after one round of outbreak testing, SJ23 will continue all necessary rounds of outbreak testing. In other words, this guidance provides information on how visitation can occur during an outbreak, but does not change any expectations for testing and adherence to infection prevention and control practices. If subsequent rounds of outbreak testing identify one or more additional COVID-19 cases in other areas/units of the facility, then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.
NOTE: In all cases, visitors will be notified about the potential for COVID-19 exposure in the facility (appropriate signage regarding current outbreaks within front lobby area), and adhere to the core principles of COVID-19 infection prevention, including effective hand hygiene and use of face-coverings.
VISITOR TESTING and VACCINATION
Visitor testing and vaccination will not take place at SJ23. We do encourage visitors to be tested on their own prior to coming to the facility (within 2-3 days), however, this is not a requirement. Similarly, we encourage visitors to become vaccinated when they have the opportunity. During visits, the “Screening tool” has been updated to include visitor vaccination status. While we would appreciate visitors answering the question, we will not require such as a condition of visitation.
COMPASSIONATE CARE POLICY
The changes made regarding visitation as stated in QSO-20-39-NH does not impact Compassionate Care visitation. See Compassionate Care policy.