Indoor/Outdoor Visitation Policy

Revision Date: 03/13/2022
POLICY:
The facility recognizes that physical separation from family and other loved ones take a physical and emotional toll on residents and their loved ones. The facility aims to ensure residents and their visitors have safe, protected, and monitored indoor /outdoor visitation during the COVID-19 pandemic crisis, and ensure an adequate degree of privacy for residents and their visitors. Outdoor visitation is still preferred over indoor when possible.
PURPOSE:
To provide a visitation program that is safe, minimizing the risk of COVID-19 transmission and as well considering the residents’ physical, mental and psychosocial well-being.
PROCEDURES:

Prior to initiating indoor visitation

  • Prior to initiating indoor visitation, residents, family members and resident representatives will be informed of the precautions being taken to keep residents safe. The notification will include:
  • A description of the symptom screening process.
  • All terms of indoor and outdoor visitation, including mask and social distancing requirements, how to summon facility staff if needed, and what will cause a visitor to be denied entry.
  • Steps visitors must take before, upon arrival, and during their visit.

When indoor visitation begins:

  • The facility will limit indoor visitors to people who can comply with mask social distancing requirements, and facility’s infection prevention principles.
  • Residents or their visitors, who are not up to date with all their recommended COVID-19  vaccine doses would be advised of the risks of physical contact prior to visit.
  • Children under the age of 18 visiting the facility must always be accompanied by a guardian and must be able to comply with face mask and social distancing requirements.
  • Due to the congregate setting and architectural structure of the facility, there are difficulties in maintaining social distancing, and for these reasons a maximum of 4 visitors will be allowed at one time for any given resident. If any group of visitors is larger than 4, they will have to take turns of no more than 4 at a time. The facility may consider small gatherings of up to 10 people for special events or occasions.
  • The facility will permit visitors who reside either in a single household or different households to visit at the same time.
  • Visitors during a given visit will not be allowed to remain on-site to visit multiple residents at a time. Exceptions will be created for registered facility volunteers who must be fully vaccinated. Movement within the facility will be limited as visitors will not be allowed to walk around different halls in the facility. Rather, they should go directly to the resident room or designated visitation area.
  • There is no limit to the frequency and length of visits for residents, the number of visitors, or required advancing scheduling for visits. However, visits will be conducted in a manner that adheres to the core principles of COVID-19 infection prevention and doesn’t risk residents as well as staff.
  • Duration of visits and capacity may also be determined by how well facility staff can safely accommodate the number of visitors as well as provide adequate number of staff to ensure safety precautions are enforced.
  • Large gatherings with large numbers of visitors are in the same place and social distancing cannot be maintained and will not be allowed during visitation.
  • Facility receptionist will greet visitors at the lobby area at the entrance of the facility and item 1-3 listed below must be completed:
  • Screen all visitors and service providers.
  • Perform temperature check and symptom screening.
  • Ensure visitors are fever-free, symptom-free, and have no known exposure to someone with COVID-19.
  • Individuals visiting the facility must not be under quarantine after non-essential travel to a high-risk state/Country.
  • The facility’s receptionist will ensure all visitors have a surgical mask, face covering or an N-95 that does not have an exhalation valve, and ensure the mask covers the visitor’s nose and mouth. See section on “Consideration for visits to  residents who are up to date with their recommended vaccine doses” for exceptions to this guidance.
  • The receptionist/ designee will ensure all visitors clean their hands with alcohol-based hand sanitizer upon entering and exiting the facility.
  • At the reception, the facility screening receptionist will collect and document screening questions for the purpose of contact tracing.
  • The facility will deny entry to visitors or service providers who do not pass screening or who refuse to comply with any of the requirements.
  • Visitors who are unable to adhere to the core principles of COVID-19 infection control protocol will not be permitted and asked to leave.

During Indoor Visitation

  • All visitors to the facility will enter through the main entrance and will follow the core principles of infection prevention as outlined in this policy. Individuals will be denied entry for displaying signs and symptoms of COVID-19, answering affirmative to screening questions or for been unable to adhere to the core principles of facility’s infection control protocol.
  • Visitors must wear a face covering, surgical mask or N-95 mask with no valve during the entire visit and maintain 6 feet from the resident. See section on “Consideration for visits to residents who are up to date with their recommended vaccine doses” for exceptions to this guidance
  • Residents are encouraged to wear a cloth face covering or surgical face mask during the visit, including the transition to and from the indoor visitation location. See section on “Consideration for residents who are up to date with recommended vaccine series” for exceptions to this guidance
  • Indoor visitation to residents’ room is allowed, however visitation at the facility’s designated visitation location is preferred over in room visitation. Visitors must only visit the resident they intend to visit at the designated visitation location or in the resident room. If a resident’s roommate is not up to date with all recommended COVID-19 vaccine doses, or not immunocompromised (regardless of vaccination status), visits should not be conducted in the resident’s room, if possible. For situations where there is a roommate and health status of the resident prevents leaving the room, the facility will attempt to enable in room visitation while adhering to the core principles of infection control.
  • Indoor visitation is limited to areas that allow for appropriate social distancing and must not exceed the maximum capacity limitation of the space.
  • The visitation area will be reserved for the residents and their designated visitors.
  • The visitation area is ventilated and has specified entries, exits, and pathways that minimize exposure to other residents.
  • Resident rooms can be used for visitation as accommodation for residents who cannot access the area being used for indoor visitation due to a variety of health concerns. If visitation occurs in a resident’s room; visitors must not sit or lay on the resident’s bed. Visitors must treat each roommate as having a separate zone and privacy curtains must be drawn to limit direct contact.  However, residents that have a private room may have visitation in their rooms but must still adhere to all infection control guidelines as specified in this document.
  • Visitors will not be allowed to use resident facilities, including restrooms. Visitors will instead be directed to use restrooms that are not used by residents. Visitors should ask the facility receptionist for the location of the guest restrooms and the key to gain entry.
  • Cleaning and disinfection of the resident room will occur after the visit is completed.

After indoor visitation:

  • Facility will require visitors to clean their hands with alcohol-based hand sanitizer upon exiting the facility.
  • The space designated for visitation will be cleaned and disinfected by the activity staff coordinating the visit between visitors.
  • Facility will clean and disinfect high touch surfaces (e.g., light switches, elevator buttons, door handles) in the facility frequently.

Considerations for visits to fully vaccinated residents (who are not immunocompromised):

  • Physical contact between residents and visitors can occur if resident and visitors are up to date with vaccination series.
  • Newly admitted or readmitted residents who are up to date with recommended vaccination doses will not require any quarantine and will be allowed indoor/outdoor visitation.
  • Residents who are up to date with vaccination series can choose to have close contact including touching with their visitors.
  • Visitors who want to remove their masks or have close contact during the start of visitation must have the ability to verify their vaccination status to the facility by either presenting their vaccination card or providing a doctor note/medical record of their vaccination.
  • The resident should properly perform hand hygiene immediately before and immediately after touching the visitor. The visitor must also perform hand hygiene immediately before and after touching the resident.
  • Visitors should always try to maintain 6 feet of physical distance from other residents and staff in the facility while visiting.
  • Participation in small gatherings, dining and meals with other residents and families can occur; if there are less than 10 individuals all of whom are verified to be fully vaccinated. If all participants are verified to be up to date with recommended vaccination series, then face mask and physical distancing is not required.
  • If any participant in a gathering is unvaccinated or vaccination status cannot be verified, then all participants must wear a face mask and maintain physical distance.

Considerations/Suggestions/Recommendation for visits to unvaccinated, partially vaccinated, and immunocompromised residents:

  • While alone in the resident’s room or the facility’s designated visitation room, the resident can have close contact with their unvaccinated visitor while both continue to wear a well fitting face mask. The safest approach continues to be physical distance and wearing a face mask.
  • Unvaccinated residents may also choose to have physical touch based on their preference and needs.
  • While outside, residents and their visitor can choose to have close contact while both continue to wear a well fitted face mask.
  • Participation in small gathering events with less than 10 individuals can occur if all individuals wear a face mask and all maintain a physical distance of 6 feet.
  • Meals and dining can occur if a face mask is worn when not eating and physical distancing occurs.
  • While not recommended, residents who are on transmission-based precaution or quarantine can still receive visitors. In such cases, visits will only occur in the resident’s room and the resident should wear a well fitted face mask if tolerated. Visitors should also be aware of the potential risk when visiting a resident who is on transmission-based precaution and must wear all required Personal Protective Equipment’s (PPE).

Visitation during outbreaks:

  • While it is safer for visitors not to enter the facility during an outbreak investigation, visitors will be permitted if the local health department permits visitation. Visitors must understand they are at risk for getting infected or infecting others. Visitors must abide by all infection control protocols should they decide to visit. Restriction of visitation during an outbreak will apply based on the recommendation of the local health department.
  • Visitors are not required to be vaccinated but encouraged to be vaccinated. Visitors who cannot or don’t comply with use of face covering, surgical mask or non valve N-95 mask, social distancing, hand hygiene and other facility requirements will not be allowed to participate in outdoor or indoor visitation.

Notification of a COVID-19 exposure:

  • The facility’s designee will notify visitors/family members of outbreaks should such an event occur within 48 hours of a visit and recommend the visitor(s) seek testing.

Safe Outdoor Visitation:

  • While taking a person centered approach and adhering to the core principles of COVID-19 infection prevention, outdoor visitation is preferred when the resident and/or visitor are not up to date with all recommended COVID-19 vaccine doses.
  • Outdoor visitation is preferred to indoor or in room visitation if weather permits.
  • All infection control protocols, and screening requirement established for indoor visitation will also apply to outdoor visitation. Hand sanitizer will be located in the facility front courtyard.
References:
Center for Medicare & Medicaid Services. Nursing Home Visitation-COVID-19 (Revised): Ref:
QSO-20-39-NH. Revised 03/10/2022.
Screening tools Guidance: coronavirus.dc.gov/healthguidance
Quarantine after non-essential travel to high risk area:coronavirus.dc.gov/phasetwo