Indoor Visitation During COVID-19

Updated January 12, 2023

Indoor visitation is permitted at all iCare locations without the need for an appointment or any other accommodation. The use of masks is required in common areas of the care center but may be removed in close contact with the individual receiving the visit. Testing of visitors is not required, nor is extensive screening. Outdoor visits are recommended when possible and we ask that you refrain from visiting if you have tested positive, have had close contact with an individual with COVID or have symptoms of any transmissible illness. 

CMS Guidance - September 2022: Nursing Home Visitation

Updated June 13, 2022

At iCare we are working closely and continuously with the Department of Public Health (DPH), taking guidance from the CDC and others, to make our care centers as safe, comfortable, welcoming and effective as possible. We modify and augment our extensive response guide and refine our policies whenever new information becomes available.

It is important to note that the COVID infection rate in Connecticut nursing homes is LESS than the infection rate in the general population. Skilled nursing care centers are a safe place to receive the care you or your loved one need at this time.

Visitation/Communal Activities/Dining are allowed at this time, but may need review when in outbreak mode. See Outbreak Mode for more on this. 

Visitor Testing and Vaccination per CMS QSO 20-39

While not required, we encourage facilities in counties with substantial or high levels of community transmission to offer testing to visitors, if feasible. If facilities do not offer testing, they should encourage visitors to be tested on their own before coming to the facility (e.g., within2–3 days).

CMS strongly encourages all visitors to become vaccinated and facilities should educate and also encourage visitors to become vaccinated. Visitor testing and vaccination can help prevent the spread of COVID-19 and facilities may ask about a visitors’ vaccination status, however, visitors are not required to be tested or vaccinated (or show proof of such) as a condition of visitation. If the visitor declines to disclose their vaccination status, the visitor should wear a face covering or mask at all times.

New Admissions

CDC recommendations support that new admissions that are not up to date with vaccination should be placed on quarantine for 7-10 days. Residents admitted that are up to date with vaccination do not need to be placed on precautions upon admission. The term and guidance on what is considered “up to date” is found on the CDC link dated May 24, 2022. (Definition of up to date: You are up to date with your COVID-19 vaccines when you have received all doses in the primary series and all boosters recommended for you, when eligible).

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html

 All new admissions regardless of vaccination status and those that leave the facility for greater than 24 hours should be tested immediately and if negative again in 5-7 days. The first day of admission to your facility is considered day 0. 

Residents can be removed from Transmission-Based Precautions after day 10 following the exposure (day 0) if they do not develop symptoms. Although the residual risk of infection is low, healthcare providers could consider testing for SARS-CoV-2 within 48 hours before the time of planned discontinuation of Transmission-Based Precautions.

Residents can be removed from Transmission-Based Precautions after day 7 following exposure (day 0) if a viral test is negative for SARS-CoV-2 and they do not develop symptoms. The specimen should be collected and tested within 48 hours before the time of planned discontinuation of Transmission-Based Precautions.

Testing

Staff testing is based on the county COVID-19 level of community transmission. This can be found on https://covid.cdc.gov/covid-data-tracker/#datatracker-home Nursing home data is found by choosing your county, choosing the drop down box that says data type and choosing the option for community transmission. You can hover over the map and see your community transmission rate per your county.

Other circumstances may require additional staff and resident testing.The conditions and rules related to COVID seem to evolve and change almost every day. This is especially true in skilled nursing care centers across the State and country.

However, it is important to note that the COVID infection rate in Connecticut nursing homes is LESS than the infection rate in the general population. Skilled nursing care centers are a safe place to receive the care you or your loved one need at this time.

 

On January 21, 2022, new guidance was issued for visitors to skilled nursing and long term care facilities in Connecticut. This guidance requires proof of vaccination or required COVID testing and use of personal protective equipment. 

Read details and requirements here:

• Making Nursing Home Visitation Safe During the COVID-19 Pandemic (January 21, 2022)
• IMPLEMENTATION GUIDANCE FOR EXECUTIVE ORDER 14B VACCINATION MANDATE FOR STAFF IN LONG TERM CARE FACILITIES

As of this writing indoor and outdoor visitation is open and available at all iCare Health Network care centers, without an appointment. Please note the following:

1. We are committed to facilitating visitation for our residents as this is a vital part of a safe and home like environment. Please don’t hesitate to check with the care center if you are unclear on the requirements of safe visitation.
2. We encourage everyone to get vaccinated immediately. 
3. In regards to large group visits, it is best to call the center and let them know you have a group that would like to visit a specific resident. It is always best in this case to hold your visits outdoors if at all possible. During a spike or peak in COVID cases, especially during Winter, group events may be modified. 

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   Click here for VISITATION INFORMATIONAL POSTER

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Travel Advisories

• International Travel Advisory from the Centers for Disease Control
• Domestic Travel Advisory from the Centers for Disease Control
• Travel Advisory for Connecticut During the COVID-19 Pandemic

Visitation Guidelines – Updated March 15, 2021

Recently the CDC released guidelines identifying lessening restrictions on contact between and facemask use for fully vaccinated persons but the Centers for Medicare and Medicaid Services (CMS) quickly clarified that those guidelines DO NOT APPLY IN HEALTHCARE FACILITIES. Because we are Medicare/Medicaid certified we must follow CMS guidance, and because we are licensed by the CT Department of Public Health (DPH), we must also follow state  laws and regulations and DPH’s guidance.

On March 10, 2021, CMS released revisions to their guidelines on Nursing Facility Visitation, which do affect our visitation and which CT DPH affirmed and supported in a conference call with CT Nursing Facilities. The following is a summary of the the revised visitation guidance, which must be adhered to:

• SCREENING OF VISITORS: We must screen all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions about and observations of signs or symptoms), and we must deny entry of those with signs or symptoms or those who have had close contact with someone with COVID-19 infection in the prior 14 days (regardless of the visitor’s vaccination status). 
• INFECTION PREVENTION MEASURES: We must enforce these standards throughout the facility:
  • Hand Hygiene (use of alcohol-based hand rub) must be done prior to visitation
  • Face covering or mask (covering mouth and nose)
  • Social distancing at least six feet between persons
  • Instructional signage will be posted throughout the facility to provide visitor education on COVID-19 signs and symptoms, infection control precautions, and other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes todesignated areas, hand hygiene)
  • high-frequency touched surfaces in the facility must be cleaned and disinfected in our designated visitation areas after each visit
• LIMITED PHYSICAL CONTACT: If the resident is 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. Regardless, visitors should physically distance from other residents and staff in the facility.
• TYPES OF VISITATION POSSIBLE:  Resident Visitation will be person-centered (based on the individual resident’s circumstances and preferences) and can include the following types of visits, accommodations or required limitations:
  • Outdoor visitation is preferred even when the resident and visitor are fully vaccinated against COVID-19. This is the mode of visitation most preferred by CDC, CMS and DPH as outdoor visits generally pose a lower risk of transmission due to increased space and airflow. Therefore, visits should 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. These type visits can be arranged even if we are in outbreak status.
  • Indoor visitation:
    •  Is allowable  for all residents, except for circumstances when visitation should be limited due to a high risk of COVID-19 such as:
      • if the nursing home’s COVID-19 county positivity rate is >10% and <70% of our residents are fully vaccinated;
      • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the criteria for “recovered”; or
      • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
    • Must be scheduled for a specified length of time in order for us to safely manage the number of visitors per resident at one time and the total number of visitors in the facility at one time
    • Must be conducted in a specified location, such as our designated visitation area or a resident’s room. Visitor movement in the facility must be limited to movement to and from the location of the visit. Visits for residents who share a room should not be conducted in the resident’s room, if possible.
    • Can  still occur when there is an outbreak, if the outbreak is contained to a single area (e.g., unit) of the facility and the visitation is not on the affected unit, but only after a round of outbreak testing as verified that there has been no spread beyond the affected
      unit. If 2 or more units have COVID positive tests, all in-facility visitation (other than compassionate care visits) will be suspended.
  • Compassionate Care Visits:
    • Compassionate Care Visits continue to have few limitations other than the requirements for scheduling,  screening, hand hygiene and proper use of any additional PPE (personal protective equipment) required based on the resident’s COVID status or the circumstances of where the visitation would take place. For compassionate care visits with any resident on precautions, additional PPE may be necessary, for which education on donning and doffing of PPE will be available for any such visitor.
    • Compassionate Care Visits can be arranged for circumstances such as:
      • A resident is assessed as nearing their  end-of-life
      • A resident is having extreme difficulty in adjusting to their admission
      • A resident who is grieving a recent death of  a friend or family member
      • A resident who  is experiencing difficulty with eating or drinking, and had previously been assisted with this by a family caregiver.
      • A resident who is showing untypical signs of withdrawal or other emotionl distress.

• • • PHYSICAL CONTACT DURING COMPASSIONATE CARE VISITS: All visits should be conducted using social distancing; however, if during a compassionate care visit, a visitor and facility identify a way to allow for personal contact, it should only be done following appropriate infection prevention guidelines, and for a limited amount of time. If the resident is 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. Regardless, visitors should physically distance from other residents and staff in the facility.

There is a lot of information here, but as mentioned earlier, iCare centers will approach each visitation circumstance with person-centered consideration, while at the same time taking every necessary measure to protect the safety and well-being of all or residents and staff.  

For more information please contact the iCare Health Network care center directly. Email inquiries can be directed to moc.nheraci@ofni.