Policy Update 3/25/21: Based on NYS Department of Health: Health Advisory: Revised Adult Care Facility Visitation

Background information from the 3/25/21 Advisory

New York State guidance has focused on protecting adult care facility (ACF) residents from COVID-19, they recognize that physical separation from family and other loved ones may take a physical and emotional toll on residents and their loved ones. Residents may feel socially isolated, leading to increased risk for depression, anxiety, and other expressions of distress. Residents living with cognitive impairment or other disabilities may find visitor restrictions and other ongoing changes related to COVID-19 confusing or upsetting; and the Department of Health (“Department”) understands that ACF residents value the physical, emotional, and spiritual support they receive through visitation from family and friends. In alignment with the Centers for Medicare and Medicaid Services, the Department is revising the guidance regarding visitation in ACFs during the COVID-19 Public Health Emergency.

  • The information contained in the 3/25/21 directive supersedes and replaces previously issued guidance and recommendations regarding general adult care facility (ACF) visitation and activities, including the guidance issued on March 2, 2021 and the Department’s November 24, 2020 Holiday Guidance.

Harbor View Home for Adults remains committed to the following:

Core Principles

All visitation must be conducted with strict adherence to the Core Principles for reducing the risk of COVID-19 transmission:

  • Screening of 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 denial of 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).
  • Hand hygiene (use of alcohol-based hand rub is preferred).
  • The use of face coverings or masks (covering mouth and nose).
  • Social distancing at least six feet between persons.
  • Instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene). Cleaning and disinfecting high frequency touched surfaces and designated visitation areas in the facility often, and after each visit.
  • Appropriate staff use of Personal Protective Equipment (PPE). Effective cohorting of residents (e.g., separate areas dedicated to COVID-19 care).
  • Residents in isolation or observation, and residents with suspected or confirmed COVID-19 status, irrespective of vaccination status, should not have visitors outside of compassionate care or end-of-life situations.

Limitations

Visitors who are unable to adhere to the core principles of COVID-19 infection prevention will not be permitted to visit or will be asked to leave. Harbor View Home for Adults will document this occurrence in accordance with Title 18 of New York Codes, Rules and Regulations, §485.14(h). Refer to # 14 in this policy for additional details.

As of April 1, 2021, out-of-town visitors traveling from other U.S. states or territories are no longer required to test or quarantine upon arrival in New York State.

Policy

It is the policy of Harbor View Home for Adults to conduct visitation in accordance with the most recent Department of Health guidance regarding adult care facility visitation. Strategies will be updated as more information becomes available and guidance changes.

Conditions for Visitation

  • There have been no orders by local health department or NYS Department of Health to quarantine the community.
  • With the exception of compassionate or end-of-life care visits, to be eligible for visitation, residents must not be in isolation or observation with suspected or confirmed COVID-19 diagnosis.
  • Compassionate care and end of life visitation will be permitted when visitation is not otherwise permitted in accordance with the Department of Health’s current visitation guidance.
  1. Visitation Spaces:

    Harbor View Home for Adults is designating the following spaces for visitation that can maintain socially distancing:

    • Main dining areas
    • Common sitting areas
    • Outdoor areas, garden and patio as weather permits
  2. Private Spaces:

    Harbor View Home clearly identifies private space(s) to be used for visitation when privacy is requested as:

    • Visitation in a private room (if the resident has a private room).
    • Conference rooms
  3. Maximum visitors:
    • The maximum number of visitors at any given time per resident would be 2 and maximum in the building would be 20. The facility may at any time reduce the number of visitors based on its ability manage and to provide oversight. At any one time, the number of visitors will not exceed the number of persons Harbor View Home for Adults staff are safely able to accommodate and supervise to comply with this Health Advisory. This number may vary according to Harbor View Home Community circumstances and time of day.
  4. Supervision of Visitors
    • Harbor View Home for Adults will continue to supervise residents and promote family communications. Staff persons assigned to supervise visits will keep their distance from each visit group to allow for privacy unless assistance is needed. Staff will maintain general awareness that visitors and residents are complying with social distance, face mask and other rules. Any visitor not complying shall be given a warning that further noncompliance will result in loss of their ability to continue the visit or to visit again. Repeated noncompliance should be reported to the administrator.
  5. Infection Control Policies for Visitors
    • Signage is present at all entrances, hallways, by the elevators and at all exit doors providing information on infection control requirements, wearing of masks and handwashing.
    • Visitors are screened for signs and symptoms of COVID-19 at the reception area and are refused access if they exhibit any symptoms or do not pass the screening questions.
    • Screening consists of both temperature checks and asking screening questions to assess potential exposure to COVID-19 which shall include questions regarding international travel or travel to other states designated under the Commissioner’s travel advisory.
      • The facility maintains documentation of the screening questions asked onsite and will make it available upon the Department’s request.
      • All visitors must wear a mask; masks will be provided as needed.
      • All visitors are informed of social distancing requirements.
      • A handout, including infection control and safety is provided to all visitors upon entry.
  6. Covid 19 Cases
    • As per the March 25th, 2021 New York State DOH Health Advisory: Revised Adult Care Facility Visitation, all restrictions are now lifted and Harbor View Home for Adults may now conduct visitation, regardless of new Covid-19 cases for residents or staff in the past 14 days or positivity rates.
  7. Visitors must be 18 years of age or older and must be able to adhere to the core principles of infection prevention and control and established Harbor View Home for Adults policies, and ACF staff are expected to provide regulatorily required supervision and monitoring for all visitors, particularly those who may have difficulty adhering to core principles, such as children once allowed.
  8. Harbor View Home for Adults has policies widely communicated to residents, staff and visitors that limit the number of visitors to 2 per resident at any one time and limit the total number of visitors inside the ACF at any one time to 25.
    • Notifications will be conducted through our robo-call system, posted signage and e-mail, brought to resident council.
    • Harbor View Home for Adults scheduling visits for one hour in duration
  9. Harbor View Home for Adults limits the movements of visitor within the facility to designated areas. Visitors are made aware upon entry that visitation can only take place in the specified designated areas and visitors that violate the rules will be asked to leave.
    • Visits with residents who share a room will not be conducted in the residents’ room.
    • For situations where there is a roommate and the health status of the resident prevents leaving the room, Harbor View Home for Adults will attempt to enable in-room visitation while adhering to the core principles of COVID-19 infection prevention.
  10. Adherence to written screening protocols remain in effect for all staff during each shift, each resident daily, and all persons entering or on the grounds of Harbor View Home for Adults, including visitors, vendors, contractors, and volunteers.
  11. Harbor View Home for Adults policies and procedures have been updated to afford every opportunity for visits in a safe and thoughtful manner per the March 25th, 2021 NYS DOH guidance. Harbor View Home for Adults policies also contemplate the need for adequate supervision and strict adherence to the core principles of infection prevention and control.
  12. Harbor View Home for Adults is not permitting visitors under the age of 10 at this time in order to comply with the core principles of infection presentation control and safety. Visitors between the ages of 10-17 must be accompanied by an adult 18 years of age or older.
  13. Noncompliant visitors: If Harbor View Home for Adults determines that a noncompliant visitor must end their visit or not be allowed a future visit because Harbor View Home reasonably believes the visitor is directly endangering the safety of any resident, Harbor View Home will record and maintain on-site a written statement of the incident including why visitor access was denied or cut short, the date and time and identification of the individual, and make the documentation available upon request to the resident involved and to the person denied visitor access.
  14. Cleaning between and after visits: Assigned staff persons will clean and disinfect high frequency touched surfaces and designated visitation areas on a regular basis and after each visit. Resident rooms where a visit has occurred shall also be cleaned and disinfected after each visit.

  15. Additional resources:
  16. Resources and additional guidance can be referenced at: Centers for Disease Control and Prevention website at https://www.cdc.gov/longtermcare/index.html, and the New York State Department of Health website at https://coronavirus.health.ny.gov/protecting-public-health-all-new-yorkers#long-termcare-facilities.
  17. Additional information:
    • Adequacy of staff: Harbor View Home for Adults will assure the presence of adequate adult care facility (ACF) staff to allow for personnel to help with the transition of residents, monitoring of visitation, compliance with existing regulatory requirements, and cleaning and disinfecting visitation areas after each visit using an EPA approved disinfectant.
    • Signage: Appropriate signage regarding facemask utilization and hand hygiene, and applicable floor markings to cue social distancing delineations must be in place at all times.
    • Screening: Screening for signs and symptoms of COVID-19 prior to resident access.
      • Documentation of screening is maintained onsite in an electronic format and available upon the Department of Health’s request for purposes of inspection and potential contact tracing. Documentation must include the following for each visitor:
        1. First and last name of the visitor.
        2. Physical (street) address of the visitor.
        3. Daytime and Evening telephone number.
        4. Date and time of visit
        5. Email address if available
    • PPE: Adequate PPE is available at Harbor View Home for Adults to ensure residents wear a face mask, or if unable a face covering, during visitation. Visitors must wear a face mask or face covering at all times when on the premises of the ACF and maintain social distancing. The Harbor View Home for Adults maintains an adequate supply of masks on hand for visitors and make available to visitors who lack an acceptable face covering.
    • Hand Sanitizer: Harbor View Home for Adults provides alcohol-based hand rub to visitors or representatives of the long-term care ombudsman visiting residents and those individuals are able demonstrate appropriate us.
  18. Visitation Handout
    • Harbor View Home for Adults has developed a quick, user-friendly fact sheet outlining visitor expectations including appropriate hand hygiene, face masks, face coverings and social distancing. The fact sheet will be provided upon initial screening to all visitors.

Updated based on the March 25th, 2021 guidance.