Nursing home and adult care Facility visitation guidelines - NYS Department of Health
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Throughout the pandemic it may have been hard to keep up with the visitation guidelines for both nursing homes and adult care facilities as they were constantly changing. We have detailed the most current guidelines for visitation in both nursing homes and ACFs below.
Nursing Homes
There are no longer scenarios related to COVID-19 where visitation should be limited except for certain situations when the visit is limited to the resident’s room or the rare event that visitation is limited to compassionate care (i.e., a resident is severely immunocompromised and the number of visitors the resident is exposed to needs to be kept to a minimum). Compassionate caregiving is defined as personal caregiving provided in anticipation of the end of the resident’s life or in the instance of significant mental, physical or social decline or crisis.
Nursing homes must allow indoor visitation at all times and for all residents. Advance scheduling of visits is no longer required. All visitors 2 years and above who can medically tolerate a mask shall continue to be required to wear a mask. Failure of a facility to facilitate visitation would constitute a potential violation and the facility would be subject to citation and enforcement actions.
Nursing Homes Cannot Limit:
The frequency and length of visits for residents; or
The number of visitors at one time.
Nursing Homes Can:
Encourage physical distancing during peak times of visitation and large gatherings (i.e. parties, events);
Take measures to limit crowding in communal spaces.
Visitation Over the Holidays
During peak times of visitation and large gatherings, facilities should encourage physical distancing. Facilities may restructure the visitation policy such as asking visitors to schedule their visit at staggered time-slots throughout the day, and/or limiting the number of visitors in the facility or a resident’s room at any time, to reduce the risk of COVID-19 transmission. Again, there is no limit on length of visits, in general, as long as the visit poses no risk to other residents and does not infringe upon their rights.
Visitor COVID Testing
Visitors are required to provide a negative COVID test prior to visitation. Facilities must make every effort to verify visitors have a negative COVID test result within 1 day for a rapid test or within 2 days for a PCR. Facilities can offer to conduct onsite testing of visitors.
Visitor testing does not apply to compassionate caregiving visitors who are visiting in anticipation of the end of a resident’s life, in the instance of a significant mental, physical, or social decline or crisis of a resident, or to emergency medical services personnel.
Residents on Transmission-Based Precautions (TBP)
While not recommend, residents who are on TBPs or quarantine can still receive visitors. Before visiting residents who are on TBP or quarantine, visitors should be made aware of the potential risk of visiting and precautions necessary in order to visit the resident.
Visitation During Outbreak Investigation
An outbreak investigation is initiated when a new nursing home onset of COVID-19 occurs (i.e., a new COVID-19 case among residents or staff). While it is safer for visitors not to enter the facility during an outbreak investigation, visitors must still be allowed in the facility. Visitors should be made aware of the potential risk of visiting during an outbreak investigation and adhere to the core principles of infection prevention. These visits should ideally occur in the resident’s room.
Communal Dining and Activities
While adhering to the core principles of COVID-19 infection prevention, communal activities and dining may occur. The safest approach is for everyone, particularly those at high risk for severe illness, to wear a face covering or mask while in communal areas of the facility.
If a resident is unable to wear a mask they may attend communal activities but should physically distance from others during large gatherings. If a resident is unable to wear a mask and staff cannot prevent having close contact (ie cognitively impaired), staff should limit the size of group activities and assist with maintaining physical distancing as much as possible. If resident refuses to wear a mask and physically distance from others during large gatherings, the nursing home should educate the resident, and the resident should not participate in large gatherings.
Communal activities and dining do not have to be paused during an outbreak unless directed by the state or local health department. Residents who are on TBP should not participate in communal activities and dining until the criteria to discontinue TBP has been met.
Resident Outings
Facilities must permit residents to leave the facility as they choose. Should a resident choose to leave, the facility should remind the resident and any individual accompanying the resident to follow all recommended infection prevention practices including wearing a face covering or mask, physical distancing, and hand hygiene and to encourage those around them to do the same.
Upon the residents’ return, if the outing is less than 24 hours, transmission-based precautions are generally not necessary. If the outing is more than 24 hours, transmission-based precautions need to be followed. The resident should be tested upon returning to the facility. Additionally, the resident should be advised to wear a mask for up to 10 days.
Links to Guidance: (Centers for Medicare & Medicaid Services Guidance , New York State Department of Health Guidance)
Adult Care Facilities (ACFs)
All ACFs must provide immediate access to any resident of visitors of their choice, including but not limited to immediate family or other relatives of the resident and any others who are visiting with the consent of the resident. This is subject to the resident’s right to deny or withdraw consent at any time. Visitation should always be person-centered with consideration of the individual residents’ physical, mental, and psychosocial well-being, and support their individual quality of life.
Visitors must adhere to the requirements for use of face coverings or masks in accordance with the NYS DOH Commissioner’s Determination on Masking in Certain Indoor Settings. Current guidance, since September 7, 2022, requires all visitors two years of age and older to wear a face covering/mask. While there is no limit on the number of visitors a resident can have at one time, visits should be conducted according to the ACF’s COVID-19 infection prevention and control procedures. Residents and their visitors, when alone in the resident’s room, or in a designated visitation area, may choose to have close contact.
Visitation During an Outbreak
While it is safer for visitors not to enter the facility at that time, visitors are still allowed in the facility and should be made fully aware of potential risks associated with visitation during and outbreak investigation. Residents and their visitors should wear face masks during the visit regardless of their vaccination status, and the visit should occur in the resident room.
Testing and Vaccination
Visitors cannot be required to be vaccinated (or show proof of such) as a condition of visitation. However, the facility is allowed to screen for signs and symptoms of COVID-19 prior to visitation. Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they meet CDC criteria to end isolation. In this situation, the facility is required to facilitate virtual or telephonic visitation.
Outings
According to DOH each facility is required to have appropriate policies and procedures in place to address infection control and prevention after outings. The ACF staff must remind the resident and anyone accompanying the resident to follow all recommended infection prevention practices including wearing a face mask, maintaining physical distance, and practicing hand hygiene.
Quarantine Isolation Requirements
The NYS DOH ACF guidance released on December 23rd, 2022, refers to/is in alignment with the recommendations of the Centers for Disease and Prevention (CDC). The CDC guidance includes a useful isolation and exposure calculator.
If the resident tests positive for COVID-19, the resident should isolate for 5 days and wear a mask if they are around others. Whether isolation may end after day 5 depends on whether the resident is fever-free for 24 hours and whether symptoms are improving. See the CDC guidance for additional information.
Communal Activities and Dining
Unless directed by the local health department, communal activities and dining do not have to be paused during an outbreak. However, residents who are in isolation should not participate in communal activities and dining until the criteria to discontinue isolation have been met.
Link to the ACF Guidance (New York State Department of Health Adult Care Facility Visitation Guidance)
The Center for Elder Law & Justice is available to help. If you are a resident or family member of a resident in a long-term care facility in Western New York, and have questions or concerns about visitation, please contact us at (716) 853-3087. In addition, our free legal advice helpline can provide answers to brief legal questions to residents of New York State who are 55 or older. Call at 1-844-481-0973 between 9am and 11am to reach an attorney directly or call and leave a message. The helpline can also be contacted via e-mail at helpline@elderjusiceny.org.
