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New guidance released on visitation restrictions to prevent COVID-19 spread

Patti Cullen
By Patti Cullen  |  March 12, 2020  |  All members

This week, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) released new active guidance to prevent the COVID-19 virus from spreading into long-term care buildings. This guidance is similar to updated guidance released by the Centers for Medicare & Medicaid Services (CMS) on March 9, 2020, in the QSO 20-14 memo.

The AHCA skilled nursing facility/nursing facility (SNF/NF) guidance includes a recommendation to restrict all non-essential visits. This includes restricting family visits, school groups, bands, and other outside group activities. As we learn more about how serious this virus is for the elderly—particularly the experience in facilities caring for the elderly and how it can spread once it's in a facility—we believe this new guidance is prudent to help achieve our collective goal to prevent the entry of the virus and to put our residents first.

AHCA/NCAL strongly recommends five actions to help prevent the entry of COVID-19 into your facilities, whether or not it has been found in your surrounding community:
  1. Allow entry to only individuals who need entry
  2. Restrict activities and visitors with potential for exposure
  3. Actively screen individuals entering the building and restrict entry to those with respiratory symptoms or possible exposure to COVID-19
  4. Require all individuals entering the building to wash their hands at entry
  5. Set up processes to allow remote communication for residents and others

The NCAL assisted living (AL) guidance recognizes that assisted living communities vary in size, scope of care, and residents’/families' ability to enter and exit the building freely. Therefore, the AL guidance includes some possible suggestions for the limitation of visitors, including asking residents to encourage their loved ones not to visit, establishing specific visiting hours, limiting the number of entrances, and enacting a sign-in policy for all visitors at a central entry point.

Shortly after releasing the guidance, Care Providers of Minnesota staff shared the recommendations with leaders within the Minnesota Department of Health (MDH), noting the importance of going further than the passive notices suggested earlier by CMS and CDC of reminding visitors that are sick or who traveled to not come into the buildings.

There are slight differences between the AHCA/NCAL recommendations and the revised CMS guidance. View the differences here.

Here is a bit of rationale that went into this new recommended guidance for members:

After careful review of the epidemiology and case fatality rate in elderly and the experience in King County, WA with COVID-19, we believe SNFs and ALs must take dramatic action to limit individuals from entering our buildings and to ensure that employees who are sick stay home. This recommendation is based on the fact that the mortality rate for our residents is shocking. The often-cited mortality rate for individuals over 80 in the general population is 15% in China. The recent World Health Organization report estimates the mortality rate at 21.9% for those over 80. However, because our residents have so many other issues than the average 80-plus individual, their mortality rate may be higher than that. At the Life Care building in Kirkland, Washington, there have been 20 residents who tested positive for the virus and 19 have died (the exact numbers will continue to change). This is a shockingly high mortality rate which may change as more residents who are not hospitalized are tested.  Unfortunately, the Seattle area now has two additional long term care centers with diagnosed cases of the virus in staff and residents (one skilled nursing facility and one assisted living).

Young people often show no symptoms of sickness. Under the current CDC standards, there is a risk that people who seem healthy (visitors, families, etc.) will enter the buildings and infect residents with the virus.  With the current shortage of supplies and staffing issues, once this begins, facilities will struggle to contain the spread. Historically, recommendations to limit viral spread in epidemics is often at least two weeks behind what should have been made earlier, in hindsight. Studies of past pandemics has shown delays in recommending mitigation efforts to prevent spread until the virus is known to be in the community are associated with higher mortality than communities who implement them early.

To reflect this new guidance, AHCA/NCAL has also created a screening checklist for SNF visitors and updated communication materials, including template letters to employees and residents & family members, as well as talking points for facilities without any confirmed cases currently. All these resources can be found on the “COVID-19 (coronavirus) Resources” page of the Care Providers of Minnesota website. Please email AHCA with any questions.

Patti Cullen  |  President/CEO  |  |  952-851-2487

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Care Providers of Minnesota is a non-profit membership association with the mission to Empower Members to Performance Excellence. Our 900+ members across Minnesota represent non-profit and for-profit organizations providing services along the full spectrum of post-acute care and long-term services and support. We are the state affiliate for the American Health Care Association/National Center for Assisted Living, and with our national partners we provide solutions for quality care.

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