With nursing home visitation back in place, providers are working hard to figure out how to safely facilitate visitation while still in the COVID-19 Public Health Emergency (PHE). Last week, we looked at F562 Immediate Access to the Resident to remind providers of their responsibility to allow certain parties access to their residents at all times. For this next “Ftag of the Week,” we will look at the regulatory requirements for another visitation-related Ftag, F564.
Visitation Rights – and Restrictions
Facilities are required to inform all residents, or their representatives, of their visitation rights as well as associated facility policy & procedures. The P&P should include information regarding the clinical basis for any visitation restrictions in place and who the restrictions are applicable to. Pre-COVID-19, this may have been to simply explain when the resident/representative was provided with information at admission, or in the information about his/her rights. Now, with a year’s worth of varying Federal and State restrictions on visitation, it is important to ensure everyone has a clear understanding of under what circumstances visitation may be limited.
After CMS released its March QSO Memo stating that visitation should generally be allowed at all times, the media widely reported that visitors were welcome – implying that nursing homes were ready and able to receive them, which as we know, is not always the case. Some facilities need to conduct outbreak testing and temporarily pause their visitation, and others are still dealing with many positive cases, which can throw a wrench in the ability to provide visitation for their residents.
After CMS released its March QSO Memo stating that visitation should generally be allowed at all times, the media widely reported that visitors were welcome – implying that nursing homes were ready and able to receive them, which as we know, is not always the case.
Ensure that residents and their representatives are aware of why visitation may need to be limited for certain residents, in alignment with the facility’s P&P. Proactively ensuring all parties are on the same page can help to reduce frustration for families who are excited to see their loved ones after extended periods of time of not being able to visit, and help to set resident expectations appropriately. If there are limitations placed on a resident’s visitation, the clinical or safety reason must be communicated to the resident/ resident representative in a manner they can understand. This means that if visitation is open at facility, but a resident is COVID-19+, for instance, the facility must ensure that the resident/ representative is informed of the clinical basis for the temporary restriction on in-person visitation. This does not mean that alternate options, such as Facetime or a Zoom meeting, do not need to be offered so some type of visitation occurs.
Equal Visitation Access
Providers may not restrict/limit/deny visitation privileges for residents based on race, color, national origin, religion, sex, gender identity, sexual orientation or disability. Additionally, limitations for visitation cannot be put into place due to law enforcement requirements (i.e., probation or parole) or be based on a resident’s status as a justice-involved individual.
What Else is Required
Within the visitation information provided to residents, facilities must:
- Inform residents of their right to receive visitors that they have designated/consented to, including spouses/partners, other family members and friends. Same-sex spouses/ partners should not be restricted.
- Inform residents that they may withdraw their consent to have a visitor whenever they like.
A Note on Overly-Restrictive Visitation Policies
Now that CMS has provided visitation guidance and the Agency’s expectations are that facilities will make visitation happen, it is even more important to ensure that your facility’s visitation policies are not overly restrictive. Even though the intent is to protect residents and staff, visitation policies must align with State and Federal requirements, so make sure your policies are current and reflective of that guidance. This means that facilities cannot restrict surveyors or LTC Ombudsman if they do not provide proof of vaccination upon entry to the building or prohibit a family member who does not bring a negative test result with them from visiting.
So, while there may need to be some restrictions in place, make sure they are sound and based on best practices and regulatory guidance. For instance, if a facility decides to restrict young children from visiting since they may not tolerate a face mask or otherwise understand what is expected of visitors, that is different from a teenager who can perform appropriate hand hygiene, wear a mask, and understand social distancing. That facility could potentially restrict younger visitors and allow individuals over a certain age to visit, but the reasoning should be explained to the resident/ representative and not be overly restrictive. It is essential to strike a balance between ensuring residents and staff are safe with the psychosocial benefits that visitation will provide to residents.
