By Kay Kaylor
I advocate for residents in skilled nursing and assisted living residences as the Region 9 long-term care ombudsman employed at the San Juan Basin Area Agency on Aging (SJBAAA). Some of the many aging and care concerns will be addressed here.
On Nov. 12, the federal Centers for Medicare and Medicaid Services (CMS) announced the further opening of visitation of residents in long-term care facilities due to their high vaccination rates for COVID-19. The memo applies to all homes that take Medicare and Medicaid payments.
A few days later, Colorado updated its visitation rules through the Colorado Department of Public Health and Environment (CDPHE). Its guidance mostly mirrors CMS and covers all residential care facilities, including assisted living, group homes and intermediate care facilities.
Instead of scheduling visits and limiting them in other ways, “Facilities should allow for visitation at all times and for all residents,” CDPHE states in a document. In addition, “Visitors are not included in surveillance and outbreak testing nor are they offered vaccination.” In other words, they are not required to be vaccinated nor show proof of it unless they want to participate in group activities, such as outings and meals. Testing visitors for the virus is also not a condition of entry, but may be offered.
As the pandemic continues, visitation rules have changed frequently, starting from visitors not allowed in at all, other than compassionate care visits. Evidence has shown how these restrictions have harmed residents.
CMS notes the following in its memo, rights that are also covered by state and federal laws: “Additionally, visitation should be person-centered, consider the residents’ physical, mental and psychosocial well-being, and support their quality of life.” Residents have the right to refuse or end a visit.
The care homes must still screen visitors for illness and follow local public health orders. Visitors must agree to infection control practices based on community transmission, such as wearing face masks and social distancing. The CDPHE recommends that a resident have only two visitors at a time in a room, but CMS does not mention a number. However, CMS does say that a roommate should not be present unless unable to leave. In Colorado, the roommate should be fully vaccinated and give consent that visits can occur in the room or the visit must take place in another area.
Facilities are to avoid large gatherings, so on holidays they may need to schedule visitors and control which areas they visit. In a group activity or area involving only people who are vaccinated, the resident and visitor may choose not to wear a mask and have “physical contact.” However, when a community has substantial to high transmission, which has been the case for most of Colorado, CMS states that “residents and visitors, regardless of vaccination status, should wear face coverings or masks and physically distance, at all times.”
Outdoor visitation is still preferred and different rules apply to staff and trained volunteers. In addition to family and friends, visitors may include musicians and other group performers. Both agencies give facilities further guidance on infection control for visits during outbreaks or when a resident tests positive.
SJBAAA offers resources for people age 60 and older or with Medicare; see sjbaaa.org. For further information and assistance, call (970) 264-0501 and listen to the recording to select an extension.