State updates guidelines for visiting long-term care facilities

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New rules for nursing home visits expands compassionate care visit criteria.

New rules for nursing home visits expands compassionate care visit criteria. Photo by Matthias Zomer from Pexels



Delaware has issued new guidelines for reopening visitation at long-term care facilities that say indoor visits should be allowed and supported regardless of COVID-18 vaccine status, with a few exceptions.

The Department of Health and Social Services said in press release Friday that the new rules had been created March 17 and sent to the state’s 86 long-term care facilities. They are based on recent recommendations from the Centers for Medicare & Medicaid Services, which cited fewer new cases and increased vaccination in nursing homes.

Among other things, the rules say a facility may not restrict visitation without a reasonable clinical or safety cause that is consistent with regulations regarding rates of COVID-19 positivity in the county and the facility, and the rate of immunization among residents.

The rules also say visitors should not be required to be tested or vaccinated as a condition of visitation, but that facilities in medium- or high-positivity counties are encouraged to offer testing to visitors, if feasible. Facilities also may encourage visitors to be tested on their own two to three days before a visit.

The rules redefine what an outbreak is: A ssingle new COVID-19 infection in a facility staff member, or an infection in a resident that began in the facility. A resident admitted to the facility with COVID-19 does not constitute a facility outbreak, the press release said.

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Exceptions for indoor visits

  • If fewer than 70 percent of residents in the facility are fully vaccinated and the facility’s home county positivity rate is greater than 10 percent.
  • If a resident has a confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions.
  • If the resident is in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine. Even then, they may receive visits that are virtual, through windows, or in-person for compassionate care situations, with adherence to transmission-based precautions.
  • LTC facilities should consider how the number of visitors per resident at one time and the total number of visitors in the facility at one time will affect social distancing and other core guidelines.

During a visit

  • Visitors should go directly to the resident’s room or designated visitation area.
  • Visitor movement in the facility should be limited, and visitors should physically distance from other residents and staff.
  • Visits for residents who share a room should not be conducted in the resident’s room, if possible. For situations where there is a roommate and the health status of the resident prevents leaving the room, facilities should attempt to enable in-room visitation while following infection prevention guidelines.
  • If a resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.

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 Outdoor visitation

  • Outdoor visits are preferred even when the resident and visitor are fully vaccinated against COVID-19. Visits should be held outdoors whenever practicable.
  • Aside from weather considerations or an individual’s health status, outdoor visitation should be routinely facilitated.
  • LTC facilities should have a process to limit the number and size of visits simultaneously to support safe infection prevention practices.


Compassionate Care Visits

Compassionate care visits should be allowed at all times regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak.

The term “compassionate care visit” applies to end-of-life situations but also for residents who are struggling with the change from living at home to living in the facility, a resident who is grieving after a friend or family member has died, a resident  who accustomed to family/caregiver encouragement with eating or drinking and is now losing weight or dehydrated; a previously content resident who is experiencing emotional distress, seldom speaking or crying more frequently.

Compassionate Care visits can also include clergy or lay persons offering religious and spiritual support.

All the visits must follow social distances and other infection guidelines.

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