PURPOSE:  Residents derive value from physical, emotional and spiritual support they receive through visitation from family and friends. The community will accommodate and support the resident’s right to receive visitors of his or her choosing at a time of his or her choosing, in a manner that does not impose on the rights of another resident, such as a clinical or safety restriction and following guidelines from CMS and the CDC. Residents may deny or withdraw consent for visit at any time.

DEFINITIONS:

“Close Contact” Being within 6 feet for a cumulative total of 15 minutes or more over a 24-hour period with someone with COVID-19 infection.

“Facial Covering” means a cloth or surgical facemask, a face shield, or any other covering that covers the mouth and nose.

 “Immunocompromised” Moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the Interim Consideration for Use of COVID-19 Vaccines.

“Health care setting” refers to any place where health care practitioners and/or health care providers practice their profession or provide services.

 “Sterile areas” refers to locations where surgery is conducted or where procedures that require aseptic techniques are performed.

“Sterile procedure” refers to aseptic procedures with the goal of minimizing the risk of microbial contamination to reduce the rate of invasive or surgical site infection.

“Visitor” refers to any person in a health care setting who is not an employee or resident of the health care setting.

CORE PRINICIPLES OF COVID-19 INFECTION PREVENTION

Regardless of how visits are conducted, certain core principles and best practices reduce the risk of COVID-19 transmission.

  • If a visitor, resident, and their representative is aware of the risks associated with visitation, and the visits occur in a manner that does not place other residents at risk, the resident will be allowed to receive visitors as he/she chooses.
  • A visitor exhibiting signs or symptoms of, or who have been diagnosed with, an infectious disease that can be spread through droplet or airborne transmission, should refrain from visiting unless absolutely necessary
  • Adherence to the most up to date principles of COVID-19 infection prevention guidelines provided by CMS and the CDC
  • Visitors who are unable to adhere to the core principles of infection prevention may not be permitted to visit or should be asked to leave.

Procedure:

  • The community does not require the use of facial coverings by persons in order to gain access to, entry upon, service from, or admission to the facility or otherwise discriminate against persons based on their refusal to wear a facial covering.
  • The community will post information about recommended actions for visitors who have any of the following:
    • A positive viral test for COVID-19
    • Symptoms of COVID-19, or
    • Had close contact with someone with COVID-19 infection.
  • Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they meet CDC criteria for safe visitation to prevent spreading COVID-19 infection to others.
  • Visitors who have had close contact with someone with COVID-19 infection, should follow recommended CDC criteria for safe visitation and defer non-urgent in-person visitation
  • Hand hygiene (use of alcohol -based hand rub is preferred). Alcohol-based hand rub is available throughout the community.
  • The community may choose to require a visitor to wear a facial covering when the visitor is
    1. Exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission;
    2. In sterile areas of the health care setting or an area where sterile procedures are being performed
    3. In resident room with a patient who is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission
    4. Visiting a resident whose treating healthcare practitioner has diagnosed the patient with or confirmed a condition affecting the immune system in a manner known to increase the risk transmission of an infection from employees without signs or symptoms of infection to a patient and whose treating practitioner has determined the use of facial coverings is necessary to the resident’s safety.
  • The community will follow the regulations of 59AER23-2 for persons requesting to opt of wearing a facial covering. A visitor may opt-out of wearing a facial covering, if an alternative method of infection control or infectious disease prevention is available.
  • Visitors are not required to be tested or vaccinated (or show proof of such) as a condition of visitation.

Face Coverings and Masks during Visits

Masks should be well-fitting, and preferably those with better protection, such as surgical masks or KN95. The determination of wearing facemasks will be based on the COVID-19 hospital admission levels recommendations from CDC, state and local health departments and community circumstances.  COVID-19 hospital admission levels will be monitored every two weeks (biweekly) and updates for need to wear masks will be communicated to staff, residents, and representatives.

  • If the county hospital admission levels is high, visitors and residents should wear face coverings or masks within the facility.
  • If the county hospital admission levels is not high, the safest practice is for residents and visitors to wear face coverings or masks, however, the facility will not require visitors or residents to wear face coverings or masks while in the facility, except during outbreak.

Visitation during an Outbreak Investigation

An outbreak investigation is initiated when a single new case of COVID-19 occurs among residents or staff to determine if others have been exposed.

  • The Community will follow the CDC and CMS guidance for visitation, in and out of outbreak status.
  • Visitors will be made aware of the potential risk for visiting by signage posted at entrance of outbreak designated areas.
  • Visitors will be required to adhere to the core principles of infection prevention as stated above.
  • Visits should occur in the resident’s room or designated area. Movement within building should be limited. Visitors should not walk around different areas of the facility, instead going directly to resident room or designated visitation area.
  • Visitors should physically distance themselves for other residents and staff, when possible.

CONSIDERATIONS FOR THE FOLLOWING VISITATIONS:

Long-Term Care Ombudsman

  • The community will Provide representatives of the State Long-Term Care Ombudsman with immediate access to any resident and will not prohibit access based on vaccination status.
  • Long Term Care Ombudsman should not enter a facility if they have:
    • A positive viral test for COVID-19
    • Symptoms of COVID-19, or
    • Currently meet the criteria for quarantine.
  • The representative of the Office of Ombudsman should adhere to the Core Principles of COVID-19 Infection Prevention.
  • If the resident or the ombudsman requests alternative communication in lieu of an in-person visit, facilities must, at a minimum, facilitate alternate resident communication, such as phone or through the use of other technology.

Healthcare Workers and Other Providers of Service – including personnel educating and assisting in resident transition to the community

  • Must be permitted to come into the facility as long as they are not subject to a work exclusion or showing signs or symptoms of COVID-19.
  • Healthcare workers, individuals providing services under arrangement, as well as volunteers, should follow the Core Principles of COVID-19 infection prevention.
  • Screening is not required for Emergency Management Personnel and EMS

State Survey Agency and CMS

  • The community will provide immediate access to any resident for state and federal surveyors and will not prohibit access based on vaccination status.
  • Surveyors should not enter a facility if they have:
    • A positive viral test for COVID-19
    • Symptoms of COVID-19, or
    • Currently meet the criteria for quarantine.
  • Surveyors should adhere to the Core Principles of COVID-19 Infection Prevention and adhere to any COVID-19 infection prevention requirements set by federal and state agencies (including Executive Orders).

RESOURCES:

CMS Nursing Home Visitation – COVID-19, QSO-20-39-NH, Revised 05/08/2023

Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, CDC, May 8, 2023

CDC COVID-19 Hospital Admission Level by County

Florida Administrative Code 59AER23-1 and 2 Definitions for Standards for the appropriate use of facial coverings for Infection Control