Let’s take a moment to review the new PA and NJ Long Term Care Visitation Guidelines that have been established post COVID. It has been a very difficult eight plus months for both loved ones and residents of long-term care communities (LTC), referring to residents in assisted living, personal care homes and nursing homes). Social isolation has taken an extreme toll on the residents. During the past few months, many family members have taken advantage of outside visits with residents. However, as the weather turns colder and with the holiday season forthcoming, many families are concerned about the ability to continue to visit their loved one, particularly via an inside visit in long-term care settings.
Below is the most recent update on long-term care visitations guidelines developed by the federal government, the State of New Jersey, and the Commonwealth of Pennsylvania. Please note these guidelines are likely to be amended as the situation changes locally and nationally. We will continue to update these guidelines as needed.
On September 17th, 2020, the Centers for Medicare & Medicaid Services (CMS) released a memo significantly easing LTC visitation restrictions. The new guidance permits outdoor visitation, indoor visitation, and compassionate care visits and lays out a framework for those visits. CMS notes that this guidance replaces all previous guidance.
Highlights of the September 17, 2020 Long Term Care Visitation Guidelines memo include:
Visitation should be person-centered, consider the resident’s physical, mental, and psychosocial well-being, and support their quality of life.
Facilities should ensure visits are conducted with privacy.
Certain core principles apply to all types of visits. Among others, these include screening, hand hygiene, face covering or mask, and social distancing.
Visits to nursing homes should be outdoors whenever practicable. Facilities should facilitate outdoor visits routinely except under certain circumstances.
Facilities should create accessible and safe outdoor spaces and a process to limit the number of visits and people visiting any one resident.
• Facilities should support indoor visitation adhering to the following guidelines:
o No new onset of COVID-19 cases in the last 14 days; facility not conducting outbreak testing.
o Only compassionate care visits if the county positivity rate is greater than 10%.
o Visitors must follow the core principles.
o Facilities should limit number of visitors per resident at one time; total number of visitors in the facility at one time; and movement in the facility.
You can read the full CMS memo HERE
Please note each state’s guidelines should be in compliance with CMS guidance.
Revised NJ Long-Term Care Visitations Directives
On October 20, 2020, the NJ Department of Health issued revised directives effectively immediately to allow expanded indoor visitation in LTC communities. Additionally, the revised regulations will permit use of cheaper and faster test kits to screen guests for COVID-19.
The new directive calls for indoor visitation by appointment to be permitted in every phase. The updated directive brings New Jersey in line with the CMS guidelines.
Visitors must be screened and masked and meet any other infection control guidelines. They and the residents will also be required to acknowledge they are aware of the potential exposure of COVID-19.
Any facility with an active outbreak of COVID-19 will remain under maximum restrictions, the directive stated.
Please note if a LTC community has or had within the past 14 days just one case of COVID-19, or if a facility chooses to not implement the directive due to the county case count or other implementation challenges, visitation, indoor or outdoor may be restricted.
You can read the revised NJ Directive HERE
Pennsylvania Long-Term care Visitation Guidelines
Pennsylvania, as of November 2, 2020, has not updated its guidance to come into compliance with the above CMS Memorandum. However, the Pennsylvania Department of Health has stated that all PA LTC communities must follow CMS guidance. Below are the PA visitation guidelines:
Core Visitation Principles
1. A facility’s Visitation rules are based on the structure of that facility and its residents’ needs. This includes availability of dedicated visitation areas and outdoor spaces.
2. Visitor screening includes temperature check, visual observations, and questionnaire.
3. Facility makes alcohol-based hand sanitizer readily available.
4. Facility requires facemasks at all times.
5. Facility requires 6-foot social distancing.
1. Compassionate Care Visits. Under Pennsylvania compassions care a family member may be considered a member of the “care team” for a loved one whose condition is deteriorating. The family caregiver can be permitted in the facility if the family member tested negative within the last seven days.
2. Outdoor Visits.
a. Preferable because of lower transmission risk.
b. Visitors must maintain social distance.
3. Indoor Visits.
a. Generally, limits are set by the facility and based on building size and physical spaces. Further, facility may choose to schedule visitation times and manage length of visits to
(1) manage the number of visitors at one time and
(2) assure all residents have equal access to visitors.
b. Facilities may limit visitor’s freedom of movement.
c. Facilities may permit in room visitation if the resident cannot leave room for health reasons. In this circumstance all precautions must be taken. Additional precautions may be added if resident is in a shared room.
d. If COVID-19 activity is considered “high”, the facility should limit visitation to compassionate care only.
1. Medical Outings. The resident may choose between facility’s transport or a family member if no known transmission risk, based on facility’s screening and testing protocols exists. Family members should adhere to masking, hand sanitation, and social distancing.
2. Non-Medical Outings: Each facility is responsible for creating a policy in this regard, considering the infection prevention and control precautions, resident’s vulnerability, and duration of the time away from the building.
Note: If the resident visits another state, a 14-day quarantine may be recommended.
Here is the most recent Directive issued by the PA Department of Health HERE
Should you have any questions regarding these visitation guidelines, please feel free to contact Rothkoff Law Group, an Elder Care Law Firm.