As discussed in CMS Guidance on Visitors in Long-term Care Facilities, visitation restrictions due to the COVID-19 pandemic have been especially challenging for residents in skilled nursing, rehabilitation, and assisted living facilities. While these measures have been effective in controlling the spread of the virus, they have also left facility residents feeling lonely and isolated as a result.
Recognizing the harmful mental and physical effects of prolonged isolation on long-term care facility residents, CMS released updated guidance in September 2020 that encourages facilities to resume visitation without jeopardizing residents’ health. Here are five ways long-term care facilities can safely facilitate visits while protecting the health and safety of residents and staff.
Implement disease prevention protocols
Resuming visitation will have a positive impact on residents at long-term care facilities, but in order to resume visitation safely, facility staff and leadership will need to be especially vigilant in adhering to CDC disease prevention guidelines. (CMS guidance is consistent with CDC guidelines.)
Long-term facilities resuming visitation should, without exception, implement the following:
- Screening of all facility visitors for COVID-19 signs and symptoms, including temperature checks and questions about signs or symptoms
- Placement of hand sanitizing stations (preferably with alcohol-based hand sanitizer) throughout the facility
- Requiring face covering or, at minimum, well-fitting masks covering the mouth and nose
- Requiring social distancing of at least six feet between persons
- Regular cleaning and disinfecting frequently-touched surfaces in the facility often
- Appropriate staff use of PPE
CDC guidelines also recommend assigning one or more individuals with training in infection control to manage the facility’s Infection Prevention & Control (IPC) program. If no staff members are trained in infection control, they can take a certification course in Infection Prevention.
Educate visitors on the risks
After an extended period of being unable to visit loved ones, facility visitors may need to be reminded of the unique risks COVID-19 poses — not just to their family member or friend, but to all facility residents and staff. Because the symptoms of COVID-19 can be indistinguishable from those of the common cold — especially to an otherwise healthy younger adult — the CMS guidance from September suggests placing “instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms.” While the desire to see loved ones is understandable, visitors should be encouraged to stay home until they are clear of any symptoms.
Furthermore, staff should feel empowered to remind and correct visitors who may not be following visitation requirements properly. Common mistakes are incorrectly wearing masks, not maintaining six feet of distance, and not washing or sanitizing hands frequently. If a visitor frequently disregards and ignores visitation requirements, staff may consider denying entry to the visitor to protect the residents.
Establish designated visiting areas
Long-term care facilities should consider establishing designated visiting areas. When weather permits, CMS guidance suggests establishing these visitation areas outside to further reduce transmission risk:
Facilities should create accessible and safe outdoor spaces for visitation, such as in courtyards, patios, or parking lots, including the use of tents, if available. When conducting outdoor visitation, facilities should have a process to limit the number and size of visits occurring simultaneously to support safe infection prevention actions (e.g., maintaining social distancing). We also recommend reasonable limits on the number of individuals visiting with any one resident at the same time.
For many facilities, outdoor visitation is not feasible, especially in colder months. In that case, facilities should designate an area indoors that can be accessed by visitors using the fewest possible routes. The area should be arranged so visitors can interact with their loved ones while still maintaining social distance.
Long-term care facilities are encouraged to use their best judgment when considering exceptions, especially when a resident’s health or mobility issues make it difficult to leave their room. Where possible, however, limiting the number of areas visitors can access makes it easier for facility staff to keep those areas clean and disinfected, as well as ensure visitors are maintaining social distancing.
Monitor positivity rate in the facility and surrounding areas
If there have been any new COVID-19 cases in the facility in the last 14 days, visitation is not recommended. However, visitation can still be allowed in facilities with existing COVID-19 cases, as long as residents with COVID-19 have been effectively cohorted (i.e., a separate area of the facility has been established solely for the purpose of COVID-19 care).
Careful monitoring of COVID-19 cases in the surrounding areas where visitors are most likely to originate is also recommended. The updated CMS guidance suggests the following metrics for adjusting visitation policies:
- Low/Medium (up to 10% positivity rate): Visitation should be allowed, provided the facility adheres to the above guidelines.
- High (>10% positivity rate): Visitation should only be allowed in compassionate care situations, and COVID-19 prevention guidelines should be strictly followed.
It’s important to note that the criteria for “compassionate care” visits was expanded in the latest CMS guidance. The new criteria includes residents who were living with family prior to admittance and are struggling with the new environment, residents who have recently experienced the loss of a friend or family member, and residents displaying marked changes in behavior; e.g., sudden emotional outbursts in a resident who is normally composed.
As COVID-19 presence in your community or facility changes, it’s important to communicate changes to your visitor policy with the family of residents. Providing frequent updates will help assure those who trust your facility to care for their love ones that you’re doing all you can to protect them.
In cases where hosting visitors becomes too much of a risk, consider alternate solutions for connecting your residents with their loved ones. Video calls and conferences work well, and creating a simple sign-up form online can help your staff facilitate these digital connections.
Use software solutions to streamline visitation
Software solutions can help to safely facilitate visitors in skilled nursing, rehabilitation, and assisted living facilities. These solutions allow facility management to create a uniform visitor check-in process that is safe, fast, and secure, allowing visitors to spend more time with their loved ones.
Visitor tracking is an important consideration, especially in long-term care facilities where visitors will be primarily indoors. Visitor management software allows staff and management to keep an accurate count of facility visitors at any given time, which makes it easier to identify peak visiting hours and stagger visits to ensure there is enough space for visitors to follow social distancing requirements. Visitor management solutions can also be used to flag visitors who fail to follow facility guidelines for disease prevention.
symplr Visitor Management offers these features (and many others), making it an ideal solution to help long-term care facilities protect their residents and staff as they reopen to visits from family and friends of residents.