New Guidance Should Relax Visitation Restrictions
March 23, 2021 UPDATE:
Governor Phil Murphy released new instructions regarding visitation in long term care communities. These communities “should allow direct, in-person visits for residents regardless of vaccination status.” This will only apply to counties where the COVID-19 Activity Level Index is rated low to moderate. However, even in counties where the rating is high, vaccinated residents will be entitled to indoor visitation. The best news is that if seventy (70%) percent of the facility, including residents and staff are vaccinated, then all residents regardless of vaccination status may have visitors regardless of the COVID level. As of the update, about 367 facilities in New Jersey meet the criteria.
The New Jersey Long-Term Care Ombudsman, Laurie Brewer, has made it clear that visits with family members must resume right away, as long as all safety protocols are followed. The spirit of the revised guidelines is to address and combat the adverse effects of social isolation and loneliness. Furthermore, if you encounter any unwarranted roadblocks to your visitation with a loved one, you can contact the Office of the Long-Term Care Ombudsman at 877-582-6995 or through their website:
This is a blog post about good news and COVID, for once!
The federal government released recently (March 10, 2021) new guidance that should relax the visitation restrictions implemented last March. The past year has been grueling for everyone, and loved ones and families alike have suffered with feelings of social isolation. Visitation can now be conducted through different means based on a community's structure and residents' needs. Core principles of COVID-19 infection prevention are still in place (health screening, hand hygiene, face coverings, and social distancing, among other things) but the guidance should lead to these communities making their own visitation policies considering their residents' physical, mental, and psychosocial well being.
The preferred method of visitation is outdoors, but the guidance encourages visitation indoors at all times, except for circumstances where visitation should be limited due to high risk of COVID-19 transmission. These circumstances include the restriction on unvaccinated residents if the community meets the current guidelines for high infection rates in the county where the building is located. For most of the people in New Jersey, almost every county fell into that category until January 2021 or so, and counties have been escaping that category especially as infections have dropped due in part to vaccines. The federal guidance does place limits, though: communities should monitor the number of visitors per resident at one time, and the total number of visitors in the community at one time. It is likely for example that rooms with multiple unrelated people might not have visitors at the same time, and those visits might be scheduled. However, a resident who is fully vaccinated can choose to have close contact (including touch!) with their visitors while wearing a well-fitting face mask and performing hand hygiene before and after.
Some indoor visitation might still be allowed during an outbreak, which is a departure from current procedures, but there will be strict guidelines in place. When a new case of COVID-19 is identified, the community should continue to begin outbreak testing and suspend all non-required visitation until a first round of testing reveals no additional COVID-19 cases in other areas, and for the affected until the unit's outbreak is definitely under control. In all cases, the community is still bound to notify visitors about potential exposure, infection prevention, and general transparency to residents and families.
A note about “required visitation:” compassionate care visits and visits required under federal disability rights laws should be allowed at all times, for any resident. A compassionate care visit is not just one that refers to end of life situations. A compassionate care situation can include, but are not limited to the following scenarios: A resident who was living with their family before recently being admitted to a nursing home and is struggling with the change of environment, a resident who is grieving after a friend or family member recently passed, a resident who needs cueing and encouragement with eating and drinking who is experiencing weight loss or dehydration, and a resident who used to talk and interact with others who is now experiencing emotional distress. Again, this is not an exhaustive list, and the community has the ability to determine what it considers to be a “compassionate care situation.” These compassionate care visits are not limited to only family members, and extend to anyone that meets the resident's needs, such as clergy or lay persons offering religious and spiritual support.
From a community standpoint, communal activities and dining may occur so long as there is adherence to principles of COVID-19 infection prevention. Residents can now eat in the same room with social distancing. Group activities for residents who have fully recovered from COVID-19, and for those not in isolation for observation, or with suspected or confirmed infection, can be facilitated with the usual social distancing, masks, and hand hygiene in place. The community can offer a wide variety of activities, from bingo to movies, so long as they can facilitate them with alterations that adhere to transmission prevention guidelines.
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