This facility has reviewed the State of Illinois document titled Updated Interim Guidance for Nursing Homes and Other Long-Term Care Facilities Incorporating Covid-19 Vaccination revised March19, 2021 and has revised its Visitation Plan accordingly.
CMS and IDPH acknowledge that nursing homes and other long-term care facilities have been severely impacted by Covid-19, with outbreaks causing high rates of infection, morbidity, and mortality. The vulnerable nature of the nursing home population combined with the inherent risks of congregate living in a healthcare setting have required aggressive efforts to limit Covid-19 exposure and to prevent the spread of Covid-19 within the nursing homes and long-term care facilities.
Millions of vaccinations have been administered to nursing home residents and staff, and these vaccines have been shown to help prevent symptomatic Covid-19 infection. Therefore, CMS and IDPH, in conjunction with the CDC is updating its visitation guidance accordingly, but emphasizing the importance of maintaining infection prevention practices, given the continued risk of Covid-19 transmission.
While CMS and IDPH guidance has focused on protecting long-term care residents from Covid-19, they recognize that physical separation from family and other loved ones has taken a physical and emotional toll on residents and their loved ones. They understand that long-term care residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends. In light of this, CMS and IDPH has revised the guidance regarding visitation in long-term care facilities during the Covid-19 epidemic. The information contained in this revised visitation policy supersedes and replaces previously issued guidance and recommendations regarding visitation.
Regardless of how visits are conducted within the facility, there are certain core principles and best practices that reduce the risk of Covid-19 transmission stated below that must be followed during visitation:
Core Principles of Covid-19 Infection Prevention
- Screening of all who enter the facility for signs and symptoms of Covid-19 such as temperature checks, questions and observations of signs or symptoms, and denial of entry of those with signs or symptoms or those who have had close contact with someone with Covid-19 infection in the prior 14 days (regardless of the visitor’s vaccination status)
- Hand hygiene (use of alcohol-based hand rub is preferred)
- Face covering or mask (must cover the mouth and nose at all times)
- Social distancing at least six feet between persons
- Instructional signage and proper visitor education on Covid-19 signs and symptoms, infection control precautions, and other applicable education
- Cleaning and disinfecting high-frequency touched surfaces in the facility often, and designated visitation areas after each visit
- Appropriate staff use of PPE
- Effective cohorting of residents
- Resident and staff testing conducted as required
These core principles are consistent with the CDC guidance and must be adhered to at all times.
Visitors who are unable to adhere to the core principles of Covid-19 infection prevention will not be permitted to visit or will be asked to leave.
Outdoor visits are strongly preferable to indoor visits, weather permitting, even when the resident and visitor are fully vaccinated against Covid-19. Visits shall be held outdoors whenever practicable. When conducting outdoor visitation, all appropriate infection control and prevention practices must be adhered to. The facility will use the following criteria when scheduling visits:
- Outdoor visits will be scheduled if the outdoor temperature is 60⁰ F or higher and there are no other inclement conditions such as rain, high winds, etc.
- Designated visiting areas shall be marked appropriately for six foot separation between visitor and resident.
- All core principles of Covid-19 Infection Prevention shall be followed.
The facility shall allow indoor visitation for all residents (regardless of vaccination status), except for circumstances when visitation should be limited due to a high risk of Covid-19 transmission. The circumstances that limit indoor visitation include:
- Unvaccinated residents, if the facility’s Covid-19 county positivity rate is > 10% and < 70% of residents in the facility are fully vaccinated. (*Fully vaccinated is defined by a person who is greater than or equal to 2 weeks following receipt of the second dose in a 2-dose series, or greater than or equal to 2 weeks following receipt of one dose of a single-dose vaccine.
- Residents with confirmed Covid-19 infection, whether vaccinated or unvaccinated until they have met the criteria to discontinue transmission-based precautions.
- Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for discontinuation of quarantine.
- When a new case of Covid-19 among residents or staff is identified, until at least one round of facility-wide testing is completed. If no additional cases are identified in other areas of the building, then consideration of resuming visitation for residents in areas with no Covid-19 cases will be evaluated by the facility on a case-by-case basis. However, visitation will be suspended in the affected area until the facility meets criteria to discontinue outbreak testing.
The facility will also consider other safety measures for Indoor Visitation and apply the following rules:
- Indoor visits will be scheduled if the outdoor temperature is 59⁰ F or lower. Indoor visits must take place in the facility-designated area.
- The facility-designated area’s layout must allow for a 6-foot separation between the resident and visitor.
- The number of visitors shall be limited to two visitors per resident at one time, and the facility must also consider the number of total visitors in the facility at one time.
- To meet the needs of all residents and families for visitation as well as implement core principles of infection prevention, visits shall be scheduled for 30 minutes.
- During indoor visitation, visitors must go directly to the designated visitation area and remain there for the entirety of the visit.
- In-Room visitation may be permissible for end-of life or compassionate care situations, provided that the room layout allows for a 6-foot separation between the resident and visitor.
- CMS and CDC continue to recommend facilities, residents, and families adhere to the core principles of infection prevention including social distancing. However, it is acknowledged that there is no substitute for physical contact, such as a hug. Therefore, if the resident is fully vaccinated, they can choose to have close contact with their visitor while wearing a face mask and performing hand-hygiene before and after.
- Visitors should always maintain distance from other residents and staff in the facility.
Indoor Visitation During an Outbreak
An outbreak occurs when a single new case of Covid-19 occurs among residents or staff. The facility shall adhere to CMS regulations and guidance for Covid-19 testing, including routine staff testing, testing of individuals with symptoms, and outbreak testing.
When a new case of Covid-19 among residents or staff is identified, the facility will immediately begin outbreak testing and suspend all indoor visitation (except for compassionate care visits and essential caregiver visits), until at least one round of facility-wide testing is completed. Resuming visitation can be considered based on the following criteria:
- If the first round of outbreak testing reveals no additional Covid-19 cases in other areas of the facility, then visitation may be considered for residents in areas with no Covid-19 cases.
- The facility shall suspend visitation on the affected unit/area until the facility meets the criteria to discontinue outbreak testing. Outbreak testing is discontinued when testing identifies no new cases of Covid-19 infection among staff or residents for at least 14 days since the most recent positive result.
- If the first round of outbreak testing reveals one or more additional Covid-19 cases in other areas/units of the facility, then the facility shall suspend visitation (except for compassionate care visits or essential caregiver visits) for all residents (vaccinated and unvaccinated) until the facility meets the criteria to discontinue outbreak testing.
- If subsequent rounds of outbreak testing identify one or more additional Covid-19 cases in other areas/units of the facility, then the facility shall suspend indoor visitation (except for compassionate care visits and essential caregiver visits) for all residents (vaccinated and unvaccinated) until the facility meets the criteria to discontinue outbreak testing.
Compassionate care visits and essential caregiver visits shall be allowed at all times.
CMS does not require visitors to be tested or vaccinated as a condition of visitation or compassionate care visits.
The facility will follow the same criteria for both indoor and outdoor visitation as follows:
- Visitation will be limited to two visitors at a time per resident. No visitors under the age of 18 are permitted.
- The facility must determine the maximum number of residents and visitors allowed in the outdoor space at one time based on the size of the outdoor space, ensuring that a minimum of six feet social distancing is achievable.
- For outdoor visits, the facility will the front courtyard. In order to meet the social distancing and supervision requirements, only up to 2 residents will be allowed to visit with their families at any given time.
b. For indoor visits, the facility will utilize the Town Square. In order to meet the social distancing and supervision requirements, only 2 residents will be allowed to visit with their families at any given time.
- The facility has set the maximum number of visitors allowed in a single day as follows:
- In order to allow for visits for all those wishing to participate, this facility will allow a 30 minute visit.
- Visits will be scheduled every 40 minutes, allowing 10 minutes in between visits to clean and sanitize the visiting area.
- To ensure meal times take place inside the facility, visiting hours will be as follows:
- 9:30am to 11:20am
- 1:00pm to 3:30pm
- All visitors must schedule an appointment with the facility to visit a resident.
- The facility Receptionist will keep an appointment log.
- Appointments can be made by contacting reception desk. The Receptionist is available 7 days/week from 8:00am to 7:00pm.
- In order to comply with the pre-screening requirements, appointments must be made at least 24 hours in advance.
- In order to ensure that everyone is able to visit, we will be limiting each resident to three indoor visits per week until further evaluation. If all resident visit requests have been met during the week, then additional visits may be allowed in the same week for a resident. Virtual visits will also continue to be offered in addition to the indoor/outdoor visits.
- The facility must prescreen visitors via phone with the Centers for Disease Control and Prevention (CDC) symptom checklist not more than twenty-four (24) hours in advance. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
If a visitor is exhibiting any of the symptoms on the checklist, they will not be allowed to visit.
- A facility representative will call the scheduled visitor not more than 24 hours in advance of the scheduled visit to complete the prescreening. If the visitor is not available and does not contact the facility prior to the scheduled visit, the visit will be cancelled.
- The results of the prescreening will be logged onto the VISITOR PRE-SCREENING FORM.
- The facility will screen visitors upon arrival with the same CDC symptom checklist. Additionally, the visitor will have his/her temperature taken and recorded.
- Upon arrival to the facility, the visitor will be screened for symptoms, including a temperature check, by a facility representative.
- The visitor will be asked to sign the checklist acknowledging that they are free of COVID-19 symptoms based on the CDC symptom checklist.
- Any visitor with a temperature of 100.0⁰ F greater or any other symptoms on the above-referenced checklist will not be allowed to visit.
- Additionally, each visitor will be asked to sign a Waiver of Liability.
- Visitors displaying symptoms will not be allowed to visit.
- Visitors will be informed upon arrival that if they develop any symptoms of COVID-19 within 3 days after visiting, they must notify the facility immediately.
- Residents with Active COVID-19 infections, either laboratory confirmed or symptomatic, are not allowed to participate in either indoor or outdoor visits.
- During indoor visitation, Visitors will not be allowed to roam throughout the facility, including use of the restroom. They must remain in the area designated by the facility as the visiting area.
- For the duration of each visit, the resident and visitor must wear a tight-fitting face covering.
- The facility has set the time of duration of each visit as follows:
- The facility has set a duration time of 30 minutes per visit, which is may be adjusted based on the number of requested visits.
- This plan will be updated if this duration is changed. All residents and resident representatives will be notified if a change is made.
- The facility may supervise during each visit to ensure the use of face covering and social distancing. However, based on facility circumstances, including available staff, the facility may choose to have intermittent supervision.
- The facility will assign a staff member who will coordinate and monitor visits. This staff member’s responsibilities will include:
- Screening visitors upon arrival.
- Ensuring visitors have completed the proper screening form.
- Ensuring visitors have signed the Release of Liability
- Ensuring that masks are worn throughout the entire visit
- Ensuring that social distancing of a minimum of 6 feet is maintained throughout the duration of the visit (with the exception of physical touch as earlier mentioned).
- Sanitizing tables/chairs after each visit.
Compassionate Care Visits
Compassionate care situations include but are not limited to:
- A resident who was living with their family before moving to the facility, and is struggling with the change in environment and lack of physical family support.
- A resident who is grieving after a friend or family member recently passed away.
- A resident who needs cueing and encouragement with eating or drinking, previously provided by the family, and is experiencing weight loss or dehydration.
- A resident who used to talk and interact with others, is experiencing emotional distress or behaviors.
- End-of-life situations.
Compassionate care visits may be conducted by the family member, but they may also be conducted by any individual that can meet the resident’s needs such as clergy.
Compassionate care visits may be allowed at all times, regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak.
The need of a compassionate care visits must be assessed on a case by case basis by the facility’s Director of Nursing and Executive Director. Compassionate care visits must be approved ahead of time prior to scheduling a visit.
Requests for consideration of a compassionate care visit shall be made to Tiffany Sirichana, Director of Nursing at 847-526-5551.
Compassionate care visits must only occur in the resident’s room.
Social distancing is recommended between the visitor and the resident during a compassionate care visit. If the resident (fully vaccinated) and visitor choose to have personal contact, it should only be done following the aforementioned infection prevention guidelines, and for a limited duration of time. During close contact, the resident and visitor must be wearing appropriate face coverings and hand-hygiene must be performed before and after.
Compassionate care visits should physically distance from other residents and staff in the facility.
Essential Caregiver Visits
Essential Caregivers are not general visitors.
These individuals meet an essential need for the resident by assisting with activities of daily living or positively influencing behavior of the resident.
The approval for an essential care visit is circumstantial and evaluated on a case by case basis by the facility.
If approved as an essential caregiver, a schedule shall be established by the Director of Nursing in collaboration with the EC and resident.
The following rules have been established by the facility for essential caregiver visits:
- The facility may establish time limits as needed and scheduling of EC visits shall consider the number of ECs in the building at the same time.
- The EC must maintain a distance of at least 6 feet from other residents and staff.
- The EC must wear appropriate PPE when they are in the facility.
- The EC shall be considered an unpaid employee and are required to participate in the same Covid-19 screening and testing protocols that are in place for staff.
- The EC shall provide care and support in the resident’s room or in facility-designated areas within the building.
- The EC must limit movement in the facility and ensure six foot separation from other residents.
- The EC may take the resident outdoors while wearing a facemask or other required PPE. The resident should wear a facemask as tolerated.
- If the EC fails to follow appropriate use of PPE, social distancing from other residents and staff, other Covid-19 related rules, or any other facility policies, the facility may restrict or revoke EC visits. The facility will first discuss the violation and the necessary corrective action with the EC prior to instituting any restriction or revocation of EC visits.
For the safety of our residents, staff and visitors, it is imperative that this plan be followed as written. To maintain a safe environment for all, the facility has put the following rules in place:
1. The facility reserves the right to cancel any scheduled visits at its discretion. Some examples of potential reasons for cancelations include, but are not limited to, maintenance issues, staffing issues, resident request, etc.
- Any visitor who is disruptive and does not adhere to facility/State requirements for visitation will be asked to leave, and may not be allowed to return.
- In order to maintain social distancing, no outside food, gifts, etc. can be given directly to the resident during the scheduled visit. Please hand anything you would like to give to the resident to the staff member who is supervising.
- New admissions to the facility or residents returning from the hospital who are not fully vaccinated must be placed on 14-day quarantine upon arrival to the facility, and therefore, will be unable to participate in visitation until day 15 if they are well and not exhibiting any COVID-19 symptoms. In some circumstances, such as follow-up medical appointments, an unvaccinated resident may need to be placed in quarantine in which case, they would be unable to participate in visitation until day 15 if they are well and not exhibiting any COVID-19 symptoms.
In order to allow the appropriate time for cleaning and disinfecting the visiting areas, the facility reserves the right to cancel visitation if a visitor arrives late.