A state public health order went into effect today that essentially shut down visitation in long term care facilities in California. The order requires all visitors to have a negative COVID test in the past 2 days (PCR tests) or 1 day (antigen tests) in order to visit. Given the substantial challenges to test access, this is tantamount to a visitation lockout.
The Centers for Medicare & Medicaid Services (CMS) announced in a September 21, 2021 press release that it has added a new feature to its Care Compare website to make it easier to check COVID-19 vaccination rates for nursing home staff and residents. The information is intended to help people make informed decisions when choosing a nursing home. To access the vaccination rate data, search a nursing home’s zip code or city on Care Compare, click on the name of the nursing home, then scroll down to click “View COVID-19 Vaccination Rates” to see the data.
Despite the ongoing pandemic, in-person visitation is mandatory in California long term care facilities. However, a number of facilities are shutting down all in-person visitation indefinitely when a staff member or resident tests positive for COVID-19. Generally, these visitation lockouts are illegal. The only time a facility may temporarily shut down in-person visitation is when a local public health authority has directed that visitation be stopped or in nursing homes under very specific circumstances outlined by the Centers for Medicare and Medicaid Services.
The State of California has taken an important step to safeguard the wellbeing of residents of long term care by mandating that virtually all facilities providing care in congregate settings take steps to ensure that their workers are vaccinated. In an order issued July 26, the State mandates that hospitals, skilled nursing facilities, and adult and senior care facilities verify the vaccination status of all employees, and that they require that all unvaccinated employees submit to testing twice weekly in skilled nursing and intermediate care facilities and once weekly in assisted living facilities.
It may be fewer than you would expect. According to federal data as of July 11, 2021, less than 80 percent of current nursing home staff in California were vaccinated. However, variation from facility to facility was extreme, ranging from 0 to 100 percent. While 827 California nursing homes reported that 75 percent or more of staff are vaccinated, over 350 facilities fall below that rate.
Despite plummeting rates of COVID infections and deaths in nursing homes and the lifting of public health-oriented restrictions, long term care facilities throughout the state are still limiting visits from families and friends to a measly 30 minutes per week. Other facilities, in stark contrast, are permitting extensive daily visitation. The wide range of visitation policies among facilities has been enabled by the State’s continued waiver of laws that normally require broad visitation access for residents. Potential residents and their loved ones are strongly encouraged to speak with the managers of facilities they are considering and ask for written copies of their visitation policies.
After a year of stringent restrictions imposed because of COVID-19, the California Department of Social Services (DSS) released new guidance on March 19, 2021 significantly relaxing restrictions on visitors to Residential Care Facilities for the Elderly (RCFE). The guidance also relaxes restrictions on communal dining and group activities, and on residents returning from outings. Set forth in PIN 21-17-ASC, the guidance is effective immediately.
CANHR has reviewed the various federal and California guidance regarding visitation in long term care facilities and synthesized the rules into a new fact sheet to guide residents and their families. The fact sheet highlights the types of visitation nursing homes and residential care facilities for the elderly must provide and under what conditions as well as the infection control protocols facilities may impose during visits. Download the Fact Sheet HERE (PDF)
State and federal authorities have issued a raft of new guidance on visitation. While many of these new rules significantly relax restrictions on visitors, some questions remain regarding areas of inconsistency between the two sets of rules. On March 10 the Centers for Medicare and Medicaid Services (CMS) issued new guidance for nursing homes intended to relieve some of the harm experienced by long term care residents as a result of COVID-19-related restrictions on visitation.
A study from the American Health Care Association has found that the COVID-19 vaccines are contributing to lower infection rates and COVID spread in nursing homes. This study, based on preliminary data gathered shortly after the introduction of the vaccine in nursing homes in late 2020, provides evidence in favor of reopening nursing homes after its residents and staff have been vaccinated.