Health officials provide visitation guidance for long-term care facilities

The Minnesota Department of Health (MDH) today released new visitation guidance to support long-term care facilities’ efforts to balance the need to protect residents from COVID-19 and ensure healthy social and emotional connections with family and friends during the ongoing pandemic.

Since March, visitor restrictions have been in place in long-term care settings to prevent the spread of COVID-19. However, balancing COVID-19 safety and visitation restrictions with the well-being of residents is an urgent priority to limit unintended harms of social isolation. This guidance, which will take effect on August 29, 2020, sets forth a cautious and measured process long-term care facilities can use to determine the most appropriate visitation policy to protect their residents and staff.

The guidance at Long-term Care: COVID-19 states that the primary consideration for facility visitation decisions should be whether there has been an exposure in the facility from a COVID-19 case in a resident, staff or visiting service provider within the past 28 days.

The guidance provides a series of factors facility management can use to evaluate COVID-19 risk for the facility. It sets forth a clear process for opening up to greater level of visitation when factors indicate it is appropriate to do so. According to Minnesota Commissioner of Health Jan Malcolm, MDH and partners developed the guidance with the recognition that COVID-19 will remain a challenge for many more months.

“We will be dealing with COVID-19 for a long time, and it is important to find a way to allow residents to interact with their loved ones safely,” Commissioner Malcolm said. “Residents have been isolated for months, and that presents significant risks for their emotional and social well-being. This guidance helps facilities keep their COVID-19 guard up while taking cautious steps toward ensuring residents have more social connections and interaction.”

Aside from the 28-day history of exposure at a facility, the guidance indicates several other risk factors for facility management to assess when making the decision to move to a higher level of visitation and activities. These include case incidence in the surrounding community, facility size and the extent to which staff at the facility are working at other LTC facilities as well.

The guidance states facilities should develop testing plans with baseline facility-wide testing within a window of time before or after opening, depending on facility type. Facilities should refer to existing MDH guidance on the appropriate use of testing in long-term care facilities. A key factor that determines the testing needed when transitioning to Level 2 is the facility type: nursing home vs. assisted living-type facility. Nursing home residents are considered to be at a higher risk of contracting and dying from COVID-19, which is why they must conduct facility-wide testing. Assisted living type-facility residents are still at high risk, and so facility-wide testing is recommended.

In addition to supporting residents’ vital connections with family and friends, safely allowing visits can help identify any potential maltreatment or abuse of residents. According to MDH regulators, the number of maltreatment reports coming in since March has dropped by 20% compared to a similar period from 2019 – a drop that would not be expected to have happened by coincidence during a major pandemic.

The Office of Ombudsman for Long-Term Care notes it has been dealing with many calls from residents who feel hopeless and helpless stuck inside facilities cut off from family and friends, and from family members who worry about the health and safety of their loved ones.

“The regular presence of family and friends is vital to the health and well-being of residents,” said State Long-Term Care Ombudsman Cheryl Hennen. “In addition to providing emotional support and social connection, family and friends provide essential monitoring and care to residents. Most people understand the importance of restricting visitors from an infection control perspective, but it is very distressing for residents who are lonely and isolated, sick and dying, to not have their families there. This visitor guidance recognizes how long-term care facilities can balance the protection of residents with their needs for family and friend connection.”