COVID-19: Updated Visitor Restrictions in Nursing Homes and Adult Care Facilities

On March 13, the NYS Department of Health (DOH) and the Centers for Medicare & Medicaid Services (CMS) released additional guidance and restrictions on visitors to nursing homes amid the novel coronavirus (COVID-19) crisis. Notably, the DOH guidance also extends these restrictions to adult care facilities and overrides the previous March 11 guidance pertaining to nursing homes and adult care facilities.

According to the DOH, all nursing homes and adult care facilities are required to comply with the following:

1. All visitation is suspended except when medically necessary or in imminent end-of-life situations.
2. All health care personnel and other facility staff are required to receive health checks at the beginning of each shift.
3. All health care personnel and other staff must wear a facemask when within six feet of residents.

In regards to the DOH’s suspension of all visitation in nursing homes and adult care facilities, limited exceptions include instances where the visitation is medically necessary and when the visitors are family members of residents in imminent end-of-life situations or those providing Hospice care. The DOH guidance describes “medically necessary” as instances where a visitor is essential to the patient’s care or is providing support in imminent end-of-life situations. In addition to this restriction on visitors, facilities are required to implement the following DOH and CMS guidelines:

1. Visitors who are permitted to enter the facility are required to receive health screenings as if they are health care staff.
2. Visitors with symptoms of respiratory infection (fever, cough, shortness of breath, sore throat) should not be permitted to enter the facility at any time, even in end-of-life situations.
3. The duration and number of visits should be minimized.
4. All visitors must perform hand hygiene and wear a facemask while in the facility and should only be permitted to visit the resident’s room.
5. Facilities should suggest refraining from physical contact with residents and others.
6. Facilities must provide other methods for meeting the social and emotional needs of residents, such as video calls.
7. Signage must be posted notifying the public of the visitation suspension.
8. Facilities must proactively notify residents’ family members and other visitors of the visitation restriction through multiple channels, including, signage, calls, letters, emails, or recorded messages for receiving calls.

Notably, while the CMS guidance states permitted visitors must be limited to the resident’s room and any other room designated by the facility, the DOH guidance limits visitation to only the resident’s room. Importantly, the CMS has stated nursing homes will not be deemed out of compliance with its visitation requirements in the event a state implements restrictions that exceed those provided by the CMS. In these instances, surveyors may still enter the facility, but the facility will not be cited for failing to comply with visitation requirements.

In addition to the restrictions on visitors, facilities are also required to perform health screenings on health care personnel and other facility staff at the beginning of each shift. This requirement applies to all personnel entering the facility, regardless of whether they are providing direct care to residents. The facility staff performing the health screenings are required to wear facemasks, and all health care personnel or other staff with symptoms or a fever of 100° F or higher are to be sent home. Additionally, any health care personnel or other staff who develop symptoms or a fever while in the facility should be immediately sent home. The CMS guidance instructs facilities to follow the guidelines for restricting access issued by the Centers for Disease Control and Prevention (CDC) and recommends documenting the health screening, including temperature and the absence of other symptoms.

The DOH has also issued guidance pertaining to adult care facilities’ and residents’ access to the community. Specifically, in areas of high concentrations of positive COVID-19 cases, facilities should encourage residents to remain at home. In the event residents access the community and community transmission is recognized in the area where the adult care facility is located, the facility is required to have staff available to screen residents for symptoms or potential exposure. Finally, the DOH’s guidance also provides required actions for facilities for both confirmed and suspected cases of COVID-19.

In addition to the above requirements, the CMS has also issued updated guidance on suggested practices for nursing homes. According to these guidelines, nursing home facilities should:

1. Cancel communal dining and group activities (both internal and external)
2. Implement active screening of residents and staff for fever and respiratory symptoms
3. Identify staff that work at multiple facilities and actively screen and restrict them as needed
4. Advise visitors and others entering the facility to monitor for signs and symptoms of respiratory infection for at least 14 days after exiting the facility and, if symptoms occur, to immediately notify the facility of when the individual visited, the residents they were in contact with, and the locations they visited in the facility

As the COVID-19 crisis continues to evolve, nursing home and adult care facilities and other providers should continue to review guidance from the DOH, CMS, and CDC.

If you have any questions regarding the content of this alert, please contact Dena DeFazio, associate, at ddefazio@barclaydamon.com or another member of the firm’s Health Care & Health and Human Services Practice Area.