As part of the state government’s continuing efforts to stem the spread of the COVID-19 virus to vulnerable people, the Community Care Licensing Division of the State Department of Social Services (CCLD) has issued new, even stricter guidelines regarding visitor access to assisted living facilities housing California elders. It is important to note that while the CCLD now supports some extraordinary new measures to limit visitor access to facilities, it has also made clear that facility administrators must work to assist families and friends of residents to provide alternative forms of access and information.
As we explained in our update of March 13 , California protects the rights of residents to have visitors and to leave facilities (http://canhr.org/publications/PDFs/coronavirus_rcfe_guidelines_20200313.pdf).
However, during the State of Emergency declared by Governor Newsom in response to the rapid spread of the virus, many rules and practices affecting assisted living residents are being changed, as reflected in the newest guidelines issued by CCLD, which can be found at https://cdss.ca.gov/Portals/9/CCLD/PINs/2020/ASC/PIN%2020-07-ASC%20COVID19%20Implementation%20with%20Statewide%20Waiver%20.pdf?ver=2020-03-13-175747-783.
CCLD does not recommend complete restrictions on all visitors, but recommends that facilities limit access to only individuals who need entry, such as:
- Facility staff, contractors, volunteers, consultants who need to keep the operations running and ensure the needs of persons in care are met.
- Government officials who in their capacity require entry (e.g. the CDC or public health staff).
- Immediate families or friends.
CCLD recommends restricting visitors altogether when:
- There are COVID-19 confirmed cases in the surrounding community, or for
- Other visitors for routine social visits, tours with prospective persons in care or their families, and outside group activities
Significantly, in its current guidance to providers, CCLD also urges that facilities restrict altogether any individuals, including facility staff, government workers, and health professionals, who have had:
- Respiratory symptoms, including fever, cough, sore throat, and shortness of breath;
- Contact with someone with a confirmed diagnosis of COVID-19, or under investigation for COVID-19, or ill with respiratory illness within the last 14 days;
- Domestic or international travel within the last 14 days to areas where COVID-19 cases have been confirmed; Anyone who has worked in another care setting with confirmed COVID-19 cases.
- Anyone who has worked in another care setting with confirmed COVID-19 cases, or
- Residence in a community where community spread of COVID-19 is occurring.
Because community spread is increasingly common, residents and their loved ones should expect that outright restrictions on visitors will be becoming more frequent.
Consistent with this new guidance, CCLD has issued a statewide waiver permitting facilities to limit entry to only individuals who need entry as necessary for prevention, containment, and mitigation measures. This waiver applies to a person in care’s right to visitation. Implementation of the visitation waiver must comply with certain conditions set out in the new guidelines, including notice to residents and their responsible parties.
CCLD also recommends cancelling resident activities that take place in public places but warns that residents must still be permitted to leave facilities for essential medical care such as dialysis or doctor visits. CCLD also advises that movements inside facilities should be limited as well by reducing walking the halls and congregating in dining rooms.
Because of these new restrictions and limitations, CCLD demands that facilities adopt measures to ensure that families and friends of residents continue to be able to communicate and share information.
Specifically, they must
- Set up a process to allow remote communication for persons in care and others.
- Ensure emergency contact information for family members and the person’s responsible party is up to date.
- Develop alternative means of communication for persons in care to visit and talk with loves ones, such as video chat, telephone, texting, or social media.
- Inform persons in care, or their responsible parties, of these changes using clear, concise, jargon-free messages.
- Ensure proactive communication with persons in care, loved ones, contractors, volunteers, etc. to make them aware of these restrictions and to keep them up to date.
- Assign staff as a primary contact to families for inbound calls and conduct regular outbound calls to keep families up to date.
- Offer a phone line with a voice recording updated at set times (e.g. daily) with the facility’s general operating status, such as when it is safe to resume visits.
- Develop a process for family members to communicate with the facility with questions.
Residents and their families can also reach out to CCLD by means of a special email address intended specifically for coronavirus concerns regarding RCFEs: CCLCOVID-19INFO@dss.ca.gov. More information about this resource can be found at: https://www.cdss.ca.gov/Portals/9/CCLD/PINs/PIN_20-05-CCLD_CoronavirusRelatedQuestions.pdf.
CANHR encourages residents and their families to take advantage of resident councils to express their views and concerns where that is possible: http://www.canhr.org/factsheets/rcfe_fs/PDFs/FS_RCFE_Resident_Councils.pdf.
However, because some council meetings may be limited during the crisis as an infection control measure, residents and their families should consider exchanging information and support by reaching out to one another using email, text, and “telephone trees”. Until this health crisis slows, this kind of community building will be more important than ever.
Finally, the coronavirus crisis in no way restricts the access of residents and their families to the ombudsman program. The name and contact information of the facility ombudsman should be displayed in public areas in the facility, but the ombudsman can also be located at the state website: https://www.aging.ca.gov/Find_Services_in_My_County/.