Long-Term Care Providers: Restrictions on Visitors in Light of COVID-19

Quarles & Brady’s Long-Term Care Practice Group continues to stay abreast of the updates impacting long-term care providers as a result of COVID-19. On March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) released revised Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes, available here. This guidance document was updated late last Friday to completely restrict visitation at skilled nursing facilities for all visitors and non-essential health care personnel. The guidance document provides only one exception to this ban (i.e., certain compassionate care situations, such as an end-of-life situation).

With respect to the compassionate care exception, CMS advises that facilities should adhere to the following recommendations:

1. Screen all visitors for respiratory symptoms;
2. Provide instruction to visitors before entering the facility on hand hygiene, limiting surfaces touched, and use of Personal Protective Equipment (PPE);
3. Suggest that visitors refrain from physical contact, such as hand-shaking and hugging, and maintain 6 feet of distance between individuals;
4. Advise visitors to monitor themselves for signs and symptoms of a respiratory infection for at least 14 days after exiting the facility and to notify the facility in the event that signs and symptoms of a respiratory infection appear;
5. Restrict visitors' access to one specific room within the facility, a dedicated visitation room, or a “clean room” near the entrance which should be disinfected after each visit;
6. Require visitors to perform hand hygiene and frequently remind visitors of this requirement; and
7. Require visitors to use PPE such as facemasks.

This restriction does not apply to health care workers and surveyors, provided that they meet CDC guidelines. Facilities should closely monitor individuals who work at multiple and, where possible, restrict their access to minimize the risk to individuals in the facility. 

Facilities need to also consider how they interact with other third parties, including vendors, transportation providers taking residents to appointments, non-health care providers such as food delivery personnel, or other health care providers on site and take any required steps to prevent possible transmission of COVID-19. Examples provided in the CMS guidance include having supplies dropped off in a loading dock, and ensuring such visitors are following appropriate CDC guidelines for transmission-based precautions.

Facilities are expected to notify potential visitors via multiple means, to defer visitation until further notice unless they meet the exceptions noted above. CMS also notes that if a state implements actions that exceed CMS requirements, a facility would not be out of compliance with federal requirements, and surveyors would not cite for noncompliance with federal visitation requirements.

Despite these visitor restrictions, residents still have the right to access the Ombudsman program, subject to the same in-person compassionate care limitation. Facilities should facilitate resident communication with the Ombudsman by phone or another digital format. CMS also recommends setting up a listserv, or providing a recorded line or a dedicated staff for inbound calls and regular outbound calls for family member updates on general operations and facility visitation policies.

Going forward during this pandemic, telephone, FaceTime, and Skype are going to be the recommended methods of keeping in touch for residents generally. Communication using these alternative methods will be important for residents to stay connected to their greater community.

Indiana is one example of a state that has embraced CMS’ lead, and has extended the same visitor restrictions to residential care facilities and housing with services providers (assisted living), among other additional facility types. We expect other states will also formally extend these restrictions to other facilities.

Quarles & Brady's Health Law Team is continuously monitoring the ever-changing landscape of the COVID-19 pandemic. For more information please contact your Quarles & Brady attorney or:

• Randall R. Fearnow: (312) 715-5194 / randall.fearnow@quarles.com
• Jaya F. White: (312) 715-5242 / jaya.white@quarles.com