The Gardens At DePugh
SUBJECT: In-Person Visitation – Florida
DATE: May 5, 2022
It is the policy of the facility that in-person visitation procedures are consistent with regulatory compliance.
This facility will not restrict visitation without a reasonable clinical or safety cause consistent the 42 CFR §483.10(f) (4) (Resident Rights). Policies will continue to be updated as regulatory guidance is updated.
The facility requires residents to wear masks. There may be residents that are unable to tolerate masks due to medical conditions and those with memory issues that cannot remember to leave a mask in place and may therefore not be able to consistently follow the source control portion of these policies. The staff will continue to encourage resident compliance with all infection control practices. The Administrator or designee is responsible for ensuring that staff and other persons adhere to the policies and procedures of the facility.
Visitation at the facility will be conducted following the core principles of COVID-19 infection prevention and best practices consistent with the Centers for Disease Control and Prevention (CDC) guidance in order to reduce the risk of COVID-19 transmission.
1. All staff, visitors to the facility and other persons entering the facility will be screened for signs and symptoms of COVID-19 and the results will be documented on the screening tool. The facility administration and nursing staff have the responsibility to deny entry to the facility of any persons failing to meet the screening guidelines including those with a positive viral test, with signs or symptoms of COVID-19, or who meet the criteria for quarantine.
2. All visitors will follow the proper method for completing hand hygiene during their visit with the proper use of alcohol-based hand rub being the preferred method.
3. All visitors must wear a face covering or mask covering their mouth and nose at all times when entering The Facility, while inside the facility’s common areas and when around any staff and other residents.
4. All visitors will adhere to the CDC Guidance for physical distancing of at least 6 feet from staff and other residents during their visit.
5. Instructional signage with source control information for visitors and staff is located throughout the facility.
6. Visitor education will be provided on COVID-19 signs and symptoms, the facility infection control precautions, required use of face coverings, hand hygiene, proper entrance and exits to use when arriving and departing the facility and the routes to designated areas.
7. The facility will clean and disinfect high-frequency touched surfaces often and will clean and disinfect the designated visitation areas after visits.
8. Staff will appropriately use and wear PPE.
9. Effective cohorting of residents will be followed at the facility, (e.g., having separate areas dedicated for COVID-19 care and a separate transition area for new admissions).
10. Resident and staff testing will be conducted as required at 42CFR 483.80(h). (See QSO-20-38-NH)
Indoor In-Person Visitation
The facility will facilitate in-person indoor visitation for all residents as permitted under the applicable CMS regulations and the April 6, 2022, State of Florida, SB 988, “No Patient Left Alone Act.” The facility residents may receive visitors of their choosing at the time of their choosing in a manner that does not place other residents at risk or impose on the rights of another resident.
1. Visitors to the residents are not required to schedule a visit appointment in order to spend time with a resident for a routine visit.
2. The facility has placed no limit on the length of visits, the frequency of visits or the number of visitors an individual resident may have at one time. In an effort to ensure that physical distancing is maintained in adherence to the COVID-19 principles of infection prevention, large gatherings with a large number of visitors in the same place at the same time will be avoided unless a venue suitable to maintain the required physical distancing is available.
3. Outdoor visits are a preferred venue for residents and visitors who are unvaccinated for the protection of the other facility residents but are not mandatory.
4. Visits may take place for residents in their room unless they share the room with a roommate who is unvaccinated or is immunocompromised. In that case, the visit will take place in a designated visiting area other than in the resident’s room.
5. Visitors will not be allowed to wander through the facility. They must go directly to their designated visitation area or resident’s room after completing the COVID-19 screening and must leave the facility promptly at the end of the visit via the appropriate exit route.
6. The staff values and honors the rights of the resident to deny consent for a visit at any time and will assist the resident as needed in such circumstances.
7. As per the CDC Core Principles of COVID-19 Infection Prevention, source control (masking) and physical distancing will be observed by visitors based on the County’s level of community transmission rate as indicated in the CDC’s COVID online Data Tracker – County View.
a. The CDC Core Principles recommend:
i. When the facility’s County’s level of community transmission rate is substantial or high, residents and visitors should wear face masks and practice physical distancing at all times regardless of vaccination status.
ii. When the facility’s County’s level of community transmission rate is low to moderate residents and visitors are recommended to wear face masks and practice physical distancing especially if either the resident or the visitor is not up- to-date with all recommended COVID-19 vaccine doses. If both the resident and visitor are up-to-date with all recommended COVID-19 vaccine doses and neither one is at risk for severe disease, both may choose to remove face masks and forego physical distancing during the visit.
b. Residents, regardless of vaccination status, can choose not to wear face coverings or masks when other residents are not present and have close contact (including touch) with their visitor. Residents (or their representative) and their visitors, who are not up-to-date with all recommended COVID-19 vaccine doses, will be advised of the risks of physical contact prior to the visit.
c. The April 6, 2022, Florida State “No Patient Left Alone Act” SB 988 mandates that consensual physical contact between a resident and the visitor must be allowed.
8. All visitors regardless of vaccination status must wear face masks and maintain physical distancing of at least six feet from all staff and other residents while in the facility.
9. For the protection of residents and staff, visitors who violate the Core Principles of COVID- 19 Infection Prevention and the facility’s policies and procedures after being educated, will be asked to leave the facility and in-person visitation will be suspended for the specific visitor.
Designation of and In-person Visitation by an Essential Caregiver
In accordance with the April 6, 2022, State of Florida, SB 988, “No Resident Left Alone Act,” each resident will be asked to designate a family member, friend, guardian or other person as an “essential caregiver”. Under the Act, this essential caregiver is allowed to visit the resident for at least two (2) hours daily in addition to any other visitation authorized by the facility. The essential caregiver is not required to provide any form of care to the resident during their visits. Residents have the right to decline designation of an essential caregiver. The designated essential caregiver will be documented in the resident clinical record.
Special Circumstances Requiring In-person Visitation
In accordance with the April 6, 2022, State of Florida, SB 988, “No Resident Left Alone Act,” the facility allows in-person visitation in all of the following circumstances unless the resident objects:
- End-of-Life situations;
- With a resident who is struggling with a change in environment and the lack of in- person family support when having previously lived with family before admission to the facility;
- With a resident is experiencing emotional distress or is grieving the loss of a friend or family member who has recently died;
- With a resident who is in the process of making one or more major medical decisions;
- With a resident who needs cueing or encouragement to eat or drink when that assistance was previously provided by a family member or caregiver; and/or
- With a resident who used to talk and interact with others who is now seldom speaking.
In-person Visitation during COVID-19 Outbreak in the Facility
Under the November 12, 2021 CMS guidance, indoor visitation for the facility residents may occur for all residents at all times including during the times when the facility is investigating or experiencing an outbreak of COVID-19. An outbreak is defined by CDC as a new COVID- 19 infection in any healthcare personnel or the nursing-home onset COVID-19 infection in a resident.
1. The facility will make a resident or their representative and the visitor(s) aware of the facility’s status when under investigation or outbreak for COVID-19, the risks associated with visiting during this time, and the infection control practices to be followed during their visit.
2. During such times visitation should take place in the resident’s room unless disallowed due to contraindications concerning a resident’s roommate.
3. Both resident and visitor must wear face masks regardless of vaccination status.
4. Residents on transmission-based precautions are not recommended to have visitors; however, CMS states that visitation may be allowed in the resident’s room with the resident wearing a face mask and the visitor wearing required Personal Protective Equipment (PPE) during the visit. The facility may offer to provide PPE to the visitors to wear during the visit but under this guidance is not required to do so.
5. When other Personal Protective Equipment (PPE) in addition to face coverings is necessary for the visit, visitors must follow the instructions from the staff and wear the PPE properly during the entire visit.
Important Considerations for Visitation
Visitation for a resident will be person-centered, considering the resident’s physical, mental and psychosocial well-being and will support their quality of life. To further reduce transmission risk, physical barriers such as Plexiglas dividers or curtains may be used when necessary due to SARS-CoV-2 level of infection in the community. The facility will enable visits to be conducted with an adequate degree of privacy.
The CMS guidelines do not indicate any age restriction for visitors; however, all visitors to the facility must be able to adhere to the core principles of COVID-19 infection prevention. If a specific visitor violates the core principals of COVID-19 infection prevention and/or the facility’s visitation policies and procedures in-person visits will be suspended and the visitor will be asked to leave. The facility staff will monitor for any visitors having difficulty adhering to the core principles of COVID-19 infection prevention and take appropriate action to educate and/or to ensure that the visitor leaves The Facility.
Covid-19 Testing and Vaccination of Visitors
The facility will encourage testing of visitors during times when the facility’s County community transmission rate is at the substantial or high level. The Facility will encourage all visitors to be tested on their own prior to coming to the facility (e.g. within 2-3 days) of their visit. However, under CMS guidance, visitors are not required to test or to show proof of having tested as a condition of visitation.
The facility will educate and encourage visitors to become vaccinated against COVID-19 to help prevent the spread of COVID-19 illness. Visitors are not required to be vaccinated or to show proof of vaccination as a condition of visitation. Visitors who decline to disclose their vaccination status will be assumed to be unvaccinated and will be required to wear a face mask at all times while in the facility. This assumption applies to representatives of the Office of the State Long-Term Care Ombudsman and protection and advocacy systems.
The Administrator of the facility will make every effort to facilitate safe indoor in-person visitation consistent with the regulations set forth by the Centers for Medicare and Medicaid Services, the Centers for Disease Control, the Florida Department of Emergency Management, the Agency for Health Care Administration and the State of Florida SB 988, April 6, 2022, “No Patient Left Alone Act.” This policy will be updated as regulatory guidance from CMS is announced.