The Arling­ton of Naples Pol­i­cy: Covid-19 Visitation‑R

Revised 4.6.2022 to Reflect the State of Flori­da ​“No Patient Left Alone Act” April 6, 2022

Indoor In-Per­son Visitation

With Res­i­dents of the Arling­ton of Naples

The admin­is­tra­tion and staff of The Arling­ton of Naples under­stand the impor­tance of the res­i­dents being able to spend time with their loved ones, fam­i­ly, and friends. Dur­ing COVID-19 Pub­lic Health Emer­gency (PHE) per Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS), indoor gen­er­al vis­i­ta­tion for all res­i­dents has been very restric­tive to pro­tect the health and safe­ty of those most vul­ner­a­ble, our res­i­dents, as well as the pro­tec­tion of the facil­i­ty staff need­ed to care for our res­i­dents. The Arling­ton of Naples has updat­ed the rel­e­vant poli­cies to the Sep­tem­ber 17, 2020, QSO-20 – 39-NH revised March 10, 2022, by CMS in con­junc­tion with the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) regard­ing res­i­dent vis­i­ta­tion and the April 6, 2022, State of Flori­da SB 988, ​“No Patient Left Alone Act.” Con­se­quent­ly, this facil­i­ty will not restrict vis­i­ta­tion with­out a rea­son­able clin­i­cal or safe­ty cause con­sis­tent the 42 CFR §483.10(f) (4) (Res­i­dent Rights). Poli­cies will con­tin­ue to be updat­ed as reg­u­la­to­ry guid­ance is updated.

The Arling­ton of Naples acknowl­edges the con­cerns for infec­tions trans­mis­sion to resident/​patients, vis­i­tors and staff asso­ci­at­ed with open vis­i­ta­tion and will con­tin­ue to require staff and vis­i­tors to adhere to the core prin­ci­ples of COVID-19 infec­tion pre­ven­tion to mit­i­gate these con­cerns. The require­ment for resident/​patients wear­ing of masks is men­tioned through­out our vis­i­ta­tion poli­cies. It is under­stood that many of facil­i­ties residents/​patients are unable to tol­er­ate masks due to med­ical con­di­tions and that those with mem­o­ry issues can­not remem­ber to leave a mask in place and may there­fore not be able to con­sis­tent­ly fol­low the source con­trol por­tion of these poli­cies. The Arling­ton of Naples staff will con­tin­ue to encour­age resident/​patient com­pli­ance with all infec­tion con­trol prac­tices. The admin­is­tra­tor or designee is respon­si­ble for ensur­ing that staff and oth­er per­sons in the facil­i­ty adhere to the poli­cies and pro­ce­dures of the facility.

Core Prin­ci­ples of COVID-19 Infec­tion Prevention

Vis­i­ta­tion at The Arling­ton of Naples will be con­duct­ed fol­low­ing the core prin­ci­ples of COVID-19 infec­tion pre­ven­tion and the best prac­tices con­sis­tent with the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) guid­ance for nurs­ing homes, assist­ed liv­ings, and oth­er health­care set­tings in order to reduce the risk of COVID-19 transmission.

  1. Staff, vis­i­tors to The Arling­ton of Naples and oth­er per­sons enter­ing the facil­i­ty will be screened for signs and symp­toms of COVID-19 in con­junc­tion with a man­u­al tem­per­a­ture check. The Arling­ton of Naples admin­is­tra­tion and nurs­ing staff have the respon­si­bil­i­ty to deny entry to the facil­i­ty of any per­sons fail­ing to meet the screen­ing guide­lines includ­ing those with a pos­i­tive viral test, with signs and symp­toms of COVID-19 or who meet the cri­te­ria for quarantine.
  2. Vis­i­tors will fol­low the prop­er method for com­plet­ing hand hygiene dur­ing their vis­it with prop­er use of alco­hol-based hand rub being the pre­ferred method. 
  3. Instruc­tion­al sig­nage with source con­trol infor­ma­tion for vis­i­tors and staff will be placed through­out the facility. 
  4. Vis­i­tor edu­ca­tion will be pro­vid­ed on COVID-19 signs and symp­toms, Arling­ton of Naples infec­tion con­trol pre­cau­tions, required use of face cov­er­ings, hand hygiene, prop­er entrance and exits to use when arriv­ing and depart­ing the facil­i­ty and the routes des­ig­nat­ed areas.
  5. The facil­i­ty will clean and dis­in­fect high fre­quen­cy touched sur­faces fre­quent­ly and as needed. 
  6. Staff will appro­pri­ate­ly use and wear PPE.
  7. Effec­tive cohorts of res­i­dents will be fol­lowed at the Arling­ton of Naples, (e.g., hav­ing sep­a­rate areas for COVID-19 care and a sep­a­rate tran­si­tion area for new admis­sion). The Arling­ton of Naples has 44-pri­vate rooms in the skilled area. 
  8. Res­i­dents and staff test­ing will be con­duct­ed as required at 42CFR 483.80(h). (See QSO-20 – 38-NH)

Indoor In-Per­son Visitation

The Arling­ton of Naples will facil­i­tate in-per­son indoor vis­i­ta­tion for all residents/​patients as per­mit­ted under the applic­a­ble CMS reg­u­la­tions and the April 6, 2022, State of Flori­da, SB 988, ​“No Patient Left Alone Act.” Residents/​patients may receive vis­i­tors of their choos­ing at the time of their choos­ing that does not place oth­er res­i­dents at risk or impose on the rights of anoth­er resident.

  1. Vis­i­tors to the Arling­ton of Naples’ residents/​patients are not required to sched­ule a vis­it appoint­ment in order to spend time with a resident/​patient for a rou­tine visit. 
  2. The Arling­ton of Naples has placed no lim­it on the length of vis­its or the fre­quen­cy of vis­its. The num­ber of vis­i­tors an indi­vid­ual resident/​patient may have at one time will be lim­it­ed to the size of the space to allow for phys­i­cal dis­tanc­ing in adher­ence to the COVID-19 prin­ci­ples of infec­tion prevention.
  3. Out­door vis­its are a pre­ferred venue for residents/​patients and vis­i­tors who are not up to date with vac­cines for the pro­tec­tion of the oth­er facil­i­ty residents/​patients but are not mandatory. 
  4. Vis­its may take place for residents/​patients in their room. 
  5. Vis­i­tors must go direct­ly to their designed vis­i­ta­tion area or resident’s room after com­plet­ing the COVID-19 screen­ing and must leave the facil­i­ty prompt­ly at the end of the vis­it via the appro­pri­ate exit route. 
  6. The staff of the Arling­ton of Naples val­ues and hon­ors the rights of the resident/​patient to deny con­sent for a vis­it at any time and will assist the resident/​patient as need­ed in such circumstances. 
  7. As per the CDC Core Prin­ci­ples of COVID-19 Infec­tion Pre­ven­tion, source con­trol (mask­ing) and phys­i­cal dis­tanc­ing will be observed by vis­i­tors, regard­less of vac­ci­na­tion sta­tus, based on the Col­lier Coun­ty facil­i­ties com­mu­ni­ty trans­mis­sion rate as indi­cat­ed in the CDC’s COVID online Data Track­er-Coun­ty View.
    1. The CDC Core Prin­ci­ples recommend:
      1. When the Arling­ton of Naples County’s lev­el of com­mu­ni­ty trans­mis­sion rate is sub­stan­tial or high, residents/​patients and vis­i­tors should wear face masks and prac­tice phys­i­cal dis­tanc­ing regard­less of vac­ci­na­tion status. 
      2. When the Arling­ton of Naples County’s lev­el of com­mu­ni­ty trans­mis­sion is low to mod­er­ate residents/​patients and vis­i­tor are rec­om­mend­ed to wear face masks and prac­tice phys­i­cal dis­tanc­ing espe­cial­ly if either the res­i­dent or the vis­i­tor is not up to date with all rec­om­mend­ed COVID-19 vac­cines dos­es. If both resident/​patient and vis­i­tor are up to date with all rec­om­mend­ed COVID-19 vac­cine dos­es and nei­ther one is at risk for severe dis­ease, both may choose to remove face masks and forego phys­i­cal dis­tanc­ing dur­ing the visit.
    2. Res­i­dents, regard­less of vac­ci­na­tion sta­tus, can choose not to wear face cov­er­ings or masks when oth­er res­i­dents are not present and have close con­tact (includ­ing touch) with their vis­i­tor. Res­i­dents (or their rep­re­sen­ta­tive) and their vis­i­tors, who are not up to date with all rec­om­mend­ed COVID-19 vac­cine dos­es, will be advised of the risks of not phys­i­cal dis­tanc­ing dur­ing the visit. 
    3. The April 6, 2022, Flori­da State, ​“No Patient Left Alone Act” SB 988 man­dates that con­sen­su­al phys­i­cal con­tact between a resident/​patient and their vis­i­tor must be allowed. 
  8. For the pro­tec­tion of resident/​patients and staff, vis­i­tors who vio­late the Core Prin­ci­ples of COVID-19 Infec­tion Pre­ven­tion and the Arling­ton of Naples poli­cies and pro­ce­dures after being edu­cat­ed, will be asked to leave the facil­i­ty and in-per­son vis­i­ta­tion will be sus­pend­ed for the spe­cif­ic visitor. 

Des­ig­na­tion of and In-per­son Vis­i­ta­tion by an Essen­tial Caregiver

In accor­dance with the April 6, 2022, State of Flori­da, SB 988, ​“No Res­i­dent Left Alone Act,” each resident/​patient will be asked to des­ig­nate a fam­i­ly mem­ber, friend, guardian, or oth­er per­son as an ​“essen­tial care­giv­er.” Under the Act, the essen­tial care­giv­er is allowed to vis­it the resident/​patient for at least 2 hours dai­ly in addi­tion to any oth­er vis­i­ta­tion autho­rized by the Arling­ton of Naples. The essen­tial care­giv­er is not required by the Arling­ton of Naples to pro­vide any form of care to the resident/​patient dur­ing their vis­its. Residents/​patients have the right to decline des­ig­na­tion of an essen­tial care­giv­er. This des­ig­nat­ed essen­tial care­giv­er will be doc­u­ment­ed in the resident/​patient clin­i­cal record.

In-per­son Vis­i­ta­tion dur­ing COVID-19 Out­break in the Facility

Under the Novem­ber 12, 2021, CMS guid­ance, indoor vis­i­ta­tion for the Arling­ton of Naples residents/​patients may occur for all res­i­dents at all times includ­ing dur­ing the times when the facil­i­ty is inves­ti­gat­ing or expe­ri­enc­ing an out­break of COVID-19. An out­break is defined by the CDC as a new COVID-19 infec­tion in any health­care per­son­nel or the facil­i­ty onset of COVID-19 infec­tion in a resident.

  1. The Arling­ton of Naples will make a resident/​patient or their rep­re­sen­ta­tive and the visitor(s) aware of the facil­i­ties sta­tus when under inves­ti­ga­tion or out­break for COVID-19, the risks asso­ci­at­ed with vis­it­ing dur­ing this time and the infec­tion con­trol prac­tices to be fol­lowed dur­ing their visit. 
  2. Dur­ing such times vis­i­ta­tion should take place in the resident’s/patient’s room.
  3. Both resident/​patient and vis­i­tor must wear face masks regard­less of vac­ci­na­tion status. 
  4. Residents/​patients on trans­mis­sion-based pre­cau­tions are not rec­om­mend­ed to have vis­i­tors; how­ev­er, CMS states that vis­i­ta­tion may be allowed in the resident’s room with the res­i­dent wear­ing a face mask and the vis­i­tor wear­ing required Per­son­al Pro­tec­tion Equip­ment (PPE) dur­ing the vis­it. The Arling­ton of Naples may offer to pro­vide PPE to the vis­i­tors to wear dur­ing the vis­it but under this guid­ance is not required to do so. 
  5. When oth­er Per­son­al Pro­tec­tive Equip­ment (PPE) in addi­tion to face cov­er­ings is nec­es­sary for the vis­it, vis­i­tors must fol­low the instruc­tions from staff and wear the PPE prop­er­ly dur­ing the entire visit. 

Impor­tant Con­sid­er­a­tions for Visitation

Vis­i­ta­tion for the Arling­ton of Naples resident/​patient will be per­son-cen­tered, con­sid­er­ing the resident’s/patient’s phys­i­cal, men­tal, and psy­cho­log­i­cal well-being and will sup­port their qual­i­ty of life.

The CMS guide­lines do not indi­cate any age restric­tion for vis­i­tors; how­ev­er, all vis­i­tors to the facil­i­ty must be able to adhere to the core prin­ci­ples of COVID-19 infec­tion pre­ven­tion. If a spe­cif­ic vis­i­tor vio­lates the core prin­ci­ples of COVID-19 infec­tion pre­ven­tion and the facil­i­ty poli­cies and pro­ce­dures, in-per­son vis­its will be sus­pend­ed, and the vis­i­tor will be asked to leave. Facil­i­ty staff will mon­i­tor for any vis­i­tors hav­ing dif­fi­cul­ty adher­ing to the core prin­ci­ples of COVID-19 infec­tion pre­ven­tion and take appro­pri­ate action to edu­cate and/​or to ensure that the vis­i­tor leaves the facility.

Covid-19 Test­ing and Vac­ci­na­tion of Visitors

Under CMS guid­ance, vis­i­tors are not required to test or to show proof of hav­ing test­ed as a con­di­tion of visitation.

Vis­i­tors are not required to be vac­ci­nat­ed or to show proof of vac­ci­na­tion as a con­di­tion of vis­i­ta­tion. Vis­i­tors who decline to dis­close with vac­ci­na­tion sta­tus will be assumed to be unvac­ci­nat­ed and will be required to wear a face mask at times while in the facil­i­ty. This assump­tion applies to rep­re­sen­ta­tive of the Office of the State Long-Term Care Ombuds­man and pro­tec­tion and advo­ca­cy systems.

The Admin­is­tra­tor of the Arling­ton of Naples will make every effort to facil­i­tate safe indoor, in-per­son vis­i­ta­tion con­sis­tent with reg­u­la­tions set forth by the Cen­ters for Medicare and Med­ic­aid Ser­vices, the Cen­ters for Dis­ease Con­trol, the Flori­da Depart­ment of Emer­gency Man­age­ment, the Agency for Health Care Admin­is­tra­tion and the State of Flori­da SB 988, April 6, 2022, ​“No Patient Left Alone Act.” This pol­i­cy will be updat­ed as reg­u­la­to­ry guid­ance from CMS is announced.