AFL 20-22.9 From the California Department of Public Health August 12, 2021 TO: Skilled Nursing Facilities SUBJECT: Guidance for Limiting the Transmission of COVID-19 in Skilled Nursing Facilities (SNFs)(This AFL supersedes AFL 20-22.8) All Facilities Letter (AFL) Summary This AFL notifies SNFs of updated CDPH, Centers for Medicare and Medicaid Services (CMS), and Centers for Disease Control and Prevention (CDC) guidance for improving their infection control and prevention practices to prevent the transmission of COVID-19, including guidance for visitation.This AFL authorizes SNFs to temporarily modify their facility’s visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.This AFL provides CDPH guidance for group activities and communal dining based upon vaccination status of residents.This revision requires SNFs to develop and implement processes for verifying the vaccination status of all visitors, and for obtaining and tracking documentation of SARS-CoV-2 diagnostic test of all visitors who are unvaccinated and incompletely vaccinated to have an indoor visit.
AFL 20-38.7 From the California Department of Public Health June 16, 2021 TO: All FacilitiesSUBJECT: Visitor Limitations Guidance(This AFL supersedes AFL 20-38.6) All Facilities Letter (AFL) Summary This AFL revision updates and consolidates California Department of Public Health’s (CDPH’s) visitation guidance into single set of recommendations for all facilities in all counties, considering California is moving Beyond the Blueprint for a Safer Economy framework effective June 15, 2021.This AFL also provides updated visitation guidance based upon CDC’s updated healthcare infection prevention and control recommendations in response to COVID-19 vaccination for non-long-term care facilities (e.g., General Acute Care Hospitals, Acute Psychiatric Hospitals).Long-term care (LTC) facilities should continue to refer to AFL 20-22.8 for updated LTC visitation guidance.
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.
Nursing homes 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 these facilities. Since the beginning of the pandemic, the Centers for Medicare & Medicaid Services (CMS) has recognized that physical separation from family and other loved ones has taken a physical and emotional toll on residents and their families.
On September 17th, the Centers for Medicare and Medicaid Services (CMS) released a memo to the states, restoring visitation in nursing homes. CMS is requiring facilities to permit visitation whenever a facility has had no new COVID outbreaks for 14 days and the community positivity rate is less than 10%. Facilities required to permit visitation are encouraged to have outdoor visitation, weather permitting, but are also required to accommodate indoor visitation, including in resident rooms, when outdoor visits are unavailable.
On August 25, the California Department of Public Health (DPH) issued All Facilities Letter 20-22.4 outlining some significant changes to the State’s ever-evolving guidance relating to visiting nursing homes and other health facilities during the COVID pandemic. The AFL makes clear that visitation restrictions cannot be absolute. Facilities may not bar any of the following: Visits by Ombudsmen: Facilities must permit ombudsmen in the facility.
On June 26, the California Department of Public Health released a new policy regarding visitation that, for the first time since March, REQUIRES nursing homes to permit visitors for outdoor and indoor visits. Facilities MUST permit outdoor visitation unless there is a local public health order that prohibits it. Indoor visits must be permitted if a facility meets six criteria: no current COVID-19 outbreak, a decline in cases in the community, no new COVID-19 cases in the facility for the past 14 days, no staffing shortages and not using a COVID-19 staffing waiver, an adequate testing plan per AFL 20-53, and an approved COVID-19 Mitigation Plan.
On June 26, the California Department of Social Services released updated guidance regarding visitation in PIN 20-23-ASC that, for the first time since March, REQUIRES assisted living facilities to permit visitors under specified narrow circumstances, and permits indoor and outdoor visitation when certain criteria are met. Providers are required to follow the guidance unless there are contradictory or stricter requirements imposed by the Centers for Disease Control and Prevention (CDC), California Department of Public Health (CDPH), or local health departments.