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Bureau of Veterans Homes

Phased Reopening Plan

The BVH plans to proceed with reopening the Pennsylvania Veterans Homes (PVH) with extreme caution.  It is essential to note that reopening initiatives that are not structured around ongoing screening, surveillance, and universal source control such as 

social distancing, universal masking, or other public health guidance would likely result in a spike of new cases thus moving the PVH into a new closure order.

Throughout this process, we will have guidance in place to support the best public health practices. This guidance will reinforce and build on both the Centers for Disease Control and Prevention (CDC) and The PA Department of Health (DOH) guidance for reopening and safety orders. The plan will also be flexible to adapt to change with the nature of the pandemic, as well as implement lessons-learned from each PVH and surrounding communities.  

The BVH will use a four-phase matrix to determine when individual PVH’s can begin easing some restrictions, for example on admissions, visitation, social interactions, activities, and outings from the facilities. The PVHs will maintain all COVID-19 restrictions through the red and yellow phases of the state’s reopening plan. The BVH will implement the PVH’s phased plan only after the County in which the individual PVH is located transitions into the Green Phase as part of the state reopening plan.  

If at any time a PVH identifies a new onset COVID-19 case in the facility during any phase, that facility returns to the highest level of mitigation, and starts over (even if the community is in a less restrictive phase). 

When a PVH’s county moves into the green phase the PVH will need to fulfill the prerequisites established by DOH and include screening, universal source control and surveillance guidelines first to begin the BVH phased re-opening plan. These guidelines are applicable to all PVHs and will continue until they are no longer warranted. Discontinuance of these guidelines will be determined by the Director and Chief Medical Officer, in consultation with the PVH Commandant.

​Definitions

  • “PVH” Pennsylvania Veterans Home, a skilled nursing facility / personal care home.
  • “Cross-over visitation” refers to visits from an individual residing in a personal care home
  • “Exposed residents” refers to those residents with a known recent exposure to the virus that causes COVID-19 or have had a positive test result for the virus that causes COVID-19 in the past 14 days.
  • “Neutral zone” means a pass-through area (such as a lobby or hallway not in a red, yellow, or green zone per PAHAN 509 and/or an area of the PVH and facility grounds not typically occupied or frequented by residents with COVID-19 or ex[posed to COVID-19 (such as a patio outside or a dining room or activity room). 
  • “New facility onset of COVID-19 cases” refers to COVID-19 cases that originated in the facility, and not cases where the nursing home admitted individuals from a hospital with a known COVID-19 positive status, or unknown COVID-19 status but became COVID-19 positive within 14 days after admission.  
  • “Non-essential personnel” includes contractors and other non-essential personnel. 
  • “Screening” includes checking for fever and symptoms of COVID-19 and asking questions about possible exposure.
  • “Social distancing” is the practice of increasing the physical space between individuals and decreasing the frequency of contact to reduce the risk of spreading COVID-19 (ideally to maintain at least 6 feet between all individuals, even those who are asymptomatic).
  • “Unexposed to COVID-19” refers to an individual who has no known recent exposure to the virus that causes COVID-19 or has not had a positive test result for the virus that causes COVID-19 in the past 14 days.
  • “Universal masking” means the protocols set forth in PAHAN 492 and 497, with homemade cloth masks being acceptable for visitors.
  • “Visitors” includes individuals from outside of the facility as well as cross-over visitors.
  • “Volunteer” is an individual who is a part of the facility’s established volunteer program. 

Reopening 

The prerequisites and requirements define the capability and capacity an individual PVH must have to enter the BVH reopening phases. The criteria for moving forward and backwards among the "Phases" is defined, and the requirements associated with visitation are specified.

The "Phases" were developed to carefully allow PVHs to resume communal dining, activities, volunteers, non-essential personnel, visitors, and outings in a measured approach.  The Phases strike a balance between protecting residents' physical health with their mental health.  

In order to enter reopening, the PVH must meet the following prerequisites and the requirements for entering Phase Alpha.   

Prerequisites

All the following prerequisites must be met before entering Phase Alpha, advancing to each new Phase, or in order to remain in each Phase:

Develop a Reopening Implementation Plan.  The Plan must be posted on the facility's website, and be available to all residents, families, advocates such as the Ombudsman and the DOH upon request.  The plan will be posted on the main page for the Bureau, and subsequent PVH individual plans will be posted on their individual web pages.  The Implementation Plan shall include, at a minimum, the following components:

  1. A testing plan that, at minimum:
  2. Identifies how the facility has fully complied with the Order dated June 8, 2020. Completion of baseline testing must be accomplished prior to reopening. Baseline testing means all residents and all staff who are currently on the schedule to work. 
  3. Includes the capacity to administer COVID-19 diagnostic tests to all residents showing symptoms of COVID-19 and do so within 24 hours.
  4. Includes the capacity to administer COVID-19 diagnostic test to all residents and staff if the PVH experiences an outbreak.
  5. Includes the capacity to administer COVID-19 diagnostic tests to all staff, including asymptomatic staff.
  6. Includes a procedure for addressing needed testing of non-essential staff and volunteers.
  7. Includes a procedure for addressing residents or staff that decline or are unable to be tested.
a. Residents that have refused COVID-19 testing will need to be symptom free based on residents’ clinical baseline for 14 days prior to entering Phase Alpha.
      • A plan to cohort or isolate residents diagnosed with COVID-19 in accordance with PA-HAN 509. 

      • A written screening protocol to screen all staff at the start and end of each shift, each resident on a daily basis, and all persons (visitors, volunteers, non-essential personnel, and essential personnel) entering the facility or facility grounds.

        ~ Daily screenings of residents using a coronavirus resident screening tool is required. 
        ~ Daily screenings of all staff, volunteers, visitors, and vendors using a screening tool. Staff will be screened at start and end of shift.

      • A plan to ensure and a current cache of an adequate supply of personal protective equipment for staff.

      • A plan to ensure and a current status of adequate staffing -- no staffing shortages and the PVH is not under a contingency staffing plan.

      • A plan to allow for communal dining and activities to resume pursuant to the guidance provided by DOH

      • A plan to allow for visitation pursuant to the guidance provided by DOH.

      • A plan to halt all reopening a PVH if the county in which the PVH is located is reverted to a Red Phase of the Governor's Reopening Plan.
8. To begin reopening, a PVH must be in a Green county per the Governor's Reopening Plan.

Requirements for Initial SNF Reopening

    • To enter reopening Phase Alpha, the PVH must meet all the Prerequisites. AND have the absence of any new facility onset of COVID-19 cases for 28 consecutive days since baseline COVID-19 testing.

Criteria for Advancing to and Regressing from Next Step

    • To enter Phase Alpha, the PVH must meet all Prerequisites. AND have the absence of any new facility onset of COVID-19 cases for 28 consecutive days since baseline COVID-19 testing. AND wait 28 days from the date the County goes green.  

    • If at any point during Phase Alpha (14 consecutive days) there is a new facility onset of COVID-19 cases, the PVH must cease Phase Alpha reopening and return to the most stringent Red Phase restrictions based on DOH guidance.  Moving back following the DOH guidance restarts the 14-day period count.  After the new 14-day period if there is no new PVH onset of COVID-19 cases the PVH may reinitiate Phase Alpha.
From the date the PVH enters Phase Alpha, if there is no new facility onset of COVID-19 cases for 14 consecutive days the facility may move to Phase Bravo.

If at any point during Phase Bravo (14 consecutive days) there is a new facility onset of COVID-19 cases, the PVH must cease Phase Bravo reopening and return to the most stringent Red Phase restrictions based on DOH guidance.  Moving back following the DOH guidance restarts the 14-day period count.  After the new 14-day period if there is no new facility onset of COVID-19 cases the PVH may reinitiate Phase Alpha.

From the date the PVH enters Phase Bravo, if there is no new facility onset of COVID-19 cases for 14 consecutive days the facility may move to Phase Charlie.

If at any point during Phase Charlie there is a new facility onset of COVID-19 cases, the PVH must cease Phase Alpha, Bravo, and Charlie reopening and return to the most stringent Red Phase restrictions based on DOH guidance. Moving back following the DOH guidance restarts the 14-day period count.  After the new 14-day period if there is no new facility onset of COVID-19 cases the PVH may reinitiate Phase Alpha.

If a county in which a PVH is located moves into the Red Phase, the PVH must return to the most stringent Red Phase restrictions based on DOH guidance.  When the county moves back to the Yellow Phase, the PVH may enter reopening again at Phase Alpha only when the prerequisites and requirements are also met. 

Phase Delta.  While this phase will facilitate a return to a “new normal,” it will be equally important to continue to monitor public health indicators and adjust orders and restrictions as necessary to ensure the spread of disease remains at a minimum.

8. To begin reopening, a PVH must be in a Green county per the Governor's Reopening Plan.




Phase Alpha 14 Days

Phase Bravo 14 Days

Phase Charlie 14 Days

Phase Delta New Normal

​Dining


​Modified Communal dining is permitted on the units for residents unexposed to COVID-19.

  • Continue with disposable dishware as appropriate.

  • Maintain social distancing by limiting the number of residents at each table, stagger arrival times, and maintain two service times per meal to allow for fewer residents in common areas at one time. 

Modified Communal dining is permitted on the units for residents unexposed to COVID-19.

  • Return to non-disposable kitchenware as appropriate.

  • Maintain social distancing by limiting the number of residents at each table, stagger arrival times, and maintain two service times per meal to allow for fewer residents in common areas at one time. 

Activities

​On-site activity programs:

    • Onsite small scale (5 residents maximum) activities are allowed on the unit for residents unexposed to COVID-19.

    • Encourage resident use of hand sanitizer upon entry to and exit from the activity location. 

    • Staff will adhere to hand hygiene protocol upon entering, during and exiting the activity. 

    • Staff will ensure that social distancing, hand hygiene, and universal masking guidelines are maintained during activity.

​On-site activity programs:

    • Onsite small scale (10 residents maximum) activities are allowed on the unit for residents unexposed to COVID-19.

    • Encourage resident use of hand sanitizer upon entry to and exit from the activity location. 

    • Staff will adhere to hand hygiene protocol upon entering, during and exiting the activity. 

    • Staff will ensure that social distancing, hand hygiene, and universal masking guidelines are maintained during activity.

  • ​Onsite Activities may be conducted with residents unexposed to COVID-19.  However, events/activities for groups larger than 10 residents must be held in a large room (e.g. multipurpose room) to allow for social distancing, and all participants must adhere to Universal source control guidelines. 

  • Activities vendors are permitted in the facility after screening and with adherence to Universal source control guidelines.


​Outings / Offsite activities

  • ​offsite activity programs are not permitted.

  • ​offsite activity programs are not permitted.


  • ​offsite activity programs are not permitted.

  • ​Outings / off site activities are allowed only for residents unexposed to COVID-19.

  • Outings limited to no more than the number of people where social distancing between residents can be maintained. Appropriate hand hygiene, and universal masking are required.

  • PVH leadership is required to utilize discretion in determining off -site activities. 

Non-essential personnel / ancillary services

​Ancillary services are permitted. In house therapy, hospice and other medical services provided by contracted vendors / credentialed providers are permitted.

  • Vendors will be screened upon entering building per BVH policy. 

  • Vendors may not be co-operating in any county that is in the red or yellow phase

  • Vendors must follow universal source control guidelines.

​Non-essential personnel are allowed as determined necessary by the facility, with screening and additional precautions including social distancing, hand hygiene, and universal masking.

Volunteers​

​Volunteers are allowed only for the purpose of assisting with visitation protocols, that is to assist staff in setting up resident visits with families.

And may only conduct volunteer duties with residents unexposed to COVID-19. 

Screening, social distancing, and additional precautions including hand hygiene and universal masking are required. 

  • Volunteers are allowed but may only conduct volunteer activities with residents unexposed to COVID-19.

  • Volunteers must be screened and follow universal source control guidelines.

  • Test for COVID-19 prior to volunteering, then test for symptoms consistent with COVID-19.

  • Established volunteers (volunteers that regularly / daily perform volunteering at the PVH will be screened following staff guidelines)  

  • Screening, social distancing, and additional precautions including hand hygiene and universal masking are required. 

Visitors

  • Outdoor visitation (weather permitting) is allowed in neutral zones to be designated by the facility. defined in their Implementation Plan. 

  • Visitation is limited to residents unexposed to COVID-19.

  • Visitation will be limited to 2 family members at a time, they can be separate individuals on subsequent visits.  Visits will have time limits established by the PVH. 

  • Must follow universal source control guidelines.

  • All visitors will be screened before visitation.

  • PVH will be responsible for informing the visitor of the screening requirements before visitation.

  • Visitors will follow CDC and DOH social distancing guidelines posted throughout the PVH and distributed to visitors. 

  • Visitors are not permitted in the facility. 

  • Visitations will need to be scheduled through the PVH to maintain universal source control and social distancing guidelines.

  • No Cross-over visitation. 

  • Compassionate care situations are coordinated with PVH leadership, and visitation will take place in a designated area.  [see attached]  

  • Disseminate policies regarding visits to staff, residents, and family members. 
      
  • Have visitors sign an acknowledgement or consent form of understanding.  

  • Establish disinfecting schedule for visitation areas.

  • Place hand sanitizer stations in designated areas.

  • Establish a deep cleaning / terminal clean disinfecting 
    schedule for overnight 
    cleaning of designated visitation / high touch areas.  
  • Visitors are permitted in the facility in designated areas. 

  • Designated areas must be in neutral zones away from other residents. 

  • Visiting times must be scheduled in advance with the PVH staff.

Visitation will be limited to 3 family members 

  • Must follow universal source control measures. Visits will have time limits established by the PVH. 

  • Visitors will follow the CDC and DOH social distancing guidelines.

  • Visitation is limited to residents unexposed to COVID-19.

  • Visiting areas will be cleaned between visits.

  • No Cross-over visitation. 

  • Compassionate care situations will be addressed with the PVH leadership, and visitation will take place in a designated area.

  • Disseminate policies regarding visits to staff, residents, and family members.
      
  • Have visitors sign an acknowledgment or consent form of understanding.  

  • Establish a disinfecting schedule for visitation areas.

  • Place hand sanitizer stations in designated areas.

  • Establish a deep cleaning / terminal clean disinfecting schedule for overnight cleaning of designated visitation / high touch areas.  
  • Indoor visitation is allowed in neutral zones to be designated by the facility.

  • Visitation is limited to residents unexposed to COVID-19.

  • Visiting in a resident's room (within facility's established protocols) is permitted only if the resident is unable to be transported to designated area. Visits will have time limits established by the PVH. 

  • Cross-over visitation is only permitted if there is no new facility onset of COIVD-19 in the facility in which the cross-over visitor resides.

  • Visitation will be limited to 3 family members / 2 family members if the visit is to take place in the resident room.  It can be separate individuals on subsequent visits. 

  • If a resident has a roommate, then only one family member to visit at a time. 

  •  Visitors will be screened and must follow Universal source control guidelines. 

  • Compassionate care situations will be addressed with the PVH leadership, and visitation will take place in a designated area.

  • Disseminate policies regarding visits to staff, residents, and family members.   

  • Have visitors sign an acknowledgement, or consent form of understanding.  

  • Establish a disinfecting schedule for visitation areas.

  • Place hand sanitizer stations in designated areas.

  • Establish a deep cleaning / terminal clean disinfecting schedule for overnight cleaning of designated visitation / high touch areas.  

Resident appointments


  • Medical appointments are permitted.

  • Should be limited as much as possible.

  • Resident must wear a face mask to and from appointment. 

  •  Resident and companion must comply with universal source control guidelines.

  •  Use the infection screening tool upon reentry into the facility for both resident and companion.

  • The use of Telehealth is encouraged and should be used to the maximum extent possible

  • Medical appointments are permitted.
  • Resident must wear a face mask to and from appointment. 

  • Resident and companion must comply with universal source control guidelines.

  •  Use the infection screening tool upon reentry into the facility for both resident and companion.

  • The use of Telehealth is encouraged and should be used to the maximum extent possible


Barber / Beauty Services

  • Must follow universal source control measures.

  • Technicians will follow CDC and DOH social distancing guidelines.

  •  Services are limited to residents unexposed to COVID-19.

  • Vendor may not co-operate in any county that is in the red or yellow phase.

​Canteen

  • Residents are permitted in canteens following CDC and DOH social distancing guidelines.

  • Use of visual cues for reminders.

  • No self-serve.

  • Unpackaged products and dispensing units are permitted. 

  • Enhanced cleaning protocols will be maintained


​Admissions (not referring to readmissions from a hospital)


New Admissions, and admissions from other BVH facilities, hospitals and the community are permitted.

  • Use the infection screening tool before admission (BVH to add COVID screening to the admissions communicable disease screening process).
  • Isolation for 14 days post admission.

  • Maintain adequate space within the facility to cohort residents for infectious diseases.  This space requires purposely leaving open beds in the census. The percentage of open beds is determined by the BVH and PVH leadership.

  • Admissions policy has been updated to allow for modified wait list actions related to applicant COVID-19 status.  If the applicant has not been tested negative for COVID-19 or is positive the admission will not take place until 2 negative tests are completed. OR

  • Applicants with a history of a positive COVID-19 test will have to have completed a 14-day incubation period with no signs and or symptoms immediately prior to the admission date.  

​Marketing / Open House

  • Marketing events such as open houses will be permitted.

  • Adherence to the CDC and DOH social distancing guidelines; masks will be required while attending the event. Masks will be provided by the PVH as needed.

  • Visiting schedules will be arranged for groups not to exceed (10) participants at a time.  

​Resident Leave / Pass

  • Order must be obtained in agreement from the physician.

  • Time on leave should be llimited as much as possible.

  • Resident must wear a face mask or face covering.

  •  The resident and companion must comply with Universal source control guidelines. 

  • Infection screening tool will be utilized upon reentry into the facility 

In-Person Meetings

  • In-person meetings permitted.

  • Resident council, care planning, advisory council.

  • Infection Screening Tool and temperature testing is required for all attendees.

  • Follow universal source control guidelines. 



​Surveillance Testing Guidelines / PAHAN-509 


For PVH without confirmed cases of COVID-19, guidance to keep the virus out and detect cases quickly

  • Actively screen all staff for fever and COVID-19 symptoms at the start and end of their shift; test staff who screen positive.  
  • Staff who have fever or symptoms of COVID-19 should be excluded from work pending results of the test as per BVH screening tool.
  • Staff who test positive for COVID-19 should be excluded from work until they meet return to work criteria.   
  • Conduct baseline testing of all residents and staff.  PVHs will follow their facility testing plan / PAHAN-509 with regard to results from the baseline testing and responding to results for posttest interventions.  
  • Actively screen all residents for fever and COVID-19 symptoms at least daily and test any resident who exhibits fever or symptoms consistent with COVID-19. 

If there is a new confirmed case of COVID-19 in any staff or resident the following testing will be implemented: 

  • Test all residents and staff in the facility even if baseline testing has been completed in the past. If there is a suspect case, and test results for the suspect case are anticipated to take longer than 2-3 days, do not wait to conduct mass screening. Begin planning and execute testing of all residents and staff while awaiting test results. 
  • Do not re-test any residents or staff with a history of confirmed COVID-19. 
  • If testing capacity is limited, test residents and staff on the same unit or floor of a new confirmed case. 
  • If testing all residents on the same unit or floor is not possible due to limited supplies, test symptomatic residents and staff and residents who have known exposure to a case (e.g., roommates of cases or those cared for by a known positive staff). 

For PVH with Confirmed Cases of COVID-19, guidance to stop transmission.

  • After testing all residents and staff in response to active cases follow up testing to ensure transmission has been terminated as follows:

  • Immediately test any resident or staff who subsequently develops fever or symptoms consistent with COVID-19

  • Continue repeat testing of all previously negative residents once a week until the testing identifies no new cases of COVID-19 among residents or staff through at least one 14-day incubation period since the most recent positive result. Day zero for the most recent positive result is the day of symptom onset (or the date of the positive test if asymptomatic).

      • If test capacity is limited, direct repeat rounds of testing to residents who leave and return to the facility (e.g., for outpatient dialysis), have exposure to staff that work in multiple facilities (e.g. wound care consultants) or have known exposure to a case (e.g., roommates of cases or those cared for by a known positive staff).

      • For large facilities with limited test capacity, testing all residents on affected units could be considered, especially if facility-wide serial testing demonstrates no transmission beyond a limited number of units.

  • Continue repeat testing of all previously negative staff at least once a week until the testing identifies no new cases of COVID-19 among residents or staff over at least one 14-day incubation period since the most recent positive result. Day zero for the most recent positive result is the day of symptom onset (or the date of the positive test if asymptomatic).
      • If testing capacity is limited, and as the CDC suggests direct repeat staff testing to staff who work at other facilities where there are known COVID-19 cases.

  • PVH will send line listings to BVH Clinical Staff daily and collaborate on suspect cases.  

Universal Source Control Guidelines

  • Social distancing is maintained to the most practical extent

  • Visitors are required to wear face masks or face covering while in the building PVH will provide a mask to those entering the facilities as needed 

  • Visitors apply hand sanitizer upon entry into the building and perform appropriate hand hygiene as needed to maintain universal source control

  • All staff will wear face masks, unless PPE protocol dictates a higher level of protection 

  • Staff perform appropriate hand hygiene 

  • Screening is allowed inside the facility at the entrance 

  • Residents will be encouraged to wear face masks when out of their rooms



​BVH Coronavirus (COVID-19) Resident Screening Tool


  • This resident screening tool should be used as a guide to screen residents and document in the electronic medical record.
  • The temperature and pulse oximetry reading should be documented in the vitals section.
  • Any detected signs/symptoms OR absence of signs/symptoms should be documented in the progress notes section.
  • Screen residents daily if no signs/symptoms.
  • Screen residents every 8 hours if one or more of the signs/symptoms are present AND initiate droplet precautions.

Temperature: ________  Route:_______                                      Pulse Oximetry reading:__________

​Is the resident exhibiting any signs of the following Signs/Symptoms?
​Yes
​No
​Fever 
Cough​
​Difficulty Breathing or Shortness of Breath
​Sore Throat
​Muscle or Body Aches
​Headache
​Nausea
​Vomiting
​Diarrhea
​Congestion
Runny Nose​
​Fatigue
​Chills
​New Loss of Taste or Smell
References: 

​BVH Coronavirus (COVID-19) Staff/Visitor Screening Tool

It is important for us to protect the health of residents during the COVID-19 pandemic. Elderly and immune compromised individuals are particularly at risk for infection. Please answer these screening questions honestly in order to help us keep our residents safe.

Staff Temperature: Start of Shift___________   End of Shift__________   Route_________
Visitor Temperature:___________   Route__________

​Have you had any of the following Signs/Symptoms in the past 7 years?
​Yes
​No
​Fever (99.5 and >)
Cough​
​Difficulty Breathing or Shortness of Breath
​Sore Throat
​Muscle or Body Aches
​Headache
​Nausea
​Vomiting
​Diarrhea
​Congestion
​Runny Nose
​Fatigue
​Chills
​New Loss of Taste or Smell

NEEDS SCREENED RNS: YES____   NO____                COMPLETED BY RNS (sign/outcome):_________________________

In the past 7 days have you come into close contact (within 6 feet) with a person that has known coronavirus without wearing PPE, OR with a person who is currently being monitored for exposure to coronavirus? YES______    NO_____

In the past 7 days have you worked at another Health care Facility, OR at any other supplemental employment without wearing PPE that has a known coronavirus case? YES_____    NO_____

Where do you hold supplemental employment? WHERE:________________________     LAST DAY WORKED:__________

I certify that the answers above are accurate to the best of my knowledge.

_____________________________________      _______________________________________     ___________________

Print Name                                                          Signature                                                              Date

Staff, volunteers, and contractors - If your status regarding ANY of these questions' changes, it is your responsibility to inform your supervisor/security immediately for further guidance. For Visitors/Contractors- While in the facility frequently perform hand hygiene, limit interactions with others in the facility and surfaces touched, and only visit the resident you are here to see or location you are designated to work in. Revised, 6/5/2020

Bureau of Veterans Homes 
Infection Control Policy and Procedures


​DATE OF ISSUE
27 MAR 2020
​POINT OF CONTACT
CHIEF NURSING OFFICER
​REVISED 
DATE
​REVIEWED

BVH Managing Visitor Access and Movement for End of Life Situations during COVID-19 within the Pennsylvania State Veterans Home (PVH)

T
he Bureau of Veterans Homes (BVH) is responsible for ensuring the health and safety of our Veteran residents by enforcing the standards required to help each resident attain or maintain their highest level of well-being. 

Considering the spread of COVID-19, BVH is restricting visitors to our PVH as per the guidance from the Center for Disease Control and Prevention (CDC), Center for Medicare and Medicaid Services (CMS), and Pennsylvania Department of Health (PADOH) to help control and prevent the spread of the virus. 

Nursing facilities nationwide have been advised to “restrict all visitation except for certain compassionate care situations, such as end of life situations” where it is essential for a resident’s emotional well-being and care. 

When visitation is necessary or allowable for such residents who are receiving compassion care, PVH will make efforts to allow for safe visitation for residents. 

Visitation for end of life emotional well-being and care will be limited to the resident’s room.

All visitors will be screened before entry into the facility for symptoms using the screening questionnaire. 

  • Prior to entering the facility, all visitors of residents at end of life will receive education and training on the following:

    • Performing hand hygiene correctly

    • Frequency of hand hygiene

    • Following respiratory hygiene and cough etiquette precautions while in the facility, especially common areas

    • Limiting the number of surfaces touched

    • Appropriate use of PPE including correct donning and doffing and disposal

    • Limiting physical contact with residents and others while in the facility

    • Practicing of social distances with no handshaking or hugging, and remaining six feet apart

Visitors with suspected or confirmed COVID-19 will be restricted. When possible, alternative mechanisms for resident-visitor interaction will be offered, such as telephone, Facebook, email, video-call applications on cell phones or tablets. 

If visitation must occur, visits should be scheduled and controlled to allow for the following: 

  • Facility will evaluate the risk to the visitor (e.g., visitor might have underlying illness putting them at higher risk for COVID-19) and the ability to comply with precautions.

  • Before the visitor enters the resident’s room, the charge nurse or designee will provide instruction on:

    • Performing hand-hygiene 

    • Limiting surfaces touched 

    • Using PPE while in the resident’s room

    • Visiting that resident room only

    • Not to go to other locations within the facility

  • After the visitor has been trained on the correct use and application of PPE, they will be provided the appropriate PPE and escorted to that resident’s room

  • Visitors are not permitted to be present in the room during specimen collection procedures

  • Visitors that do not demonstrate proper use of infection control techniques will be immediately escorted from the facility

  • When the visitor is ready to leave, a designated staff person will escort them out

  • After the visitor leaves, the facility will disinfect room after each resident-visitor meeting  

  • End of life residents will still have the right to access the Ombudsman program

References:

CDC Guidance: Preparing for COVID-19: Long-term Care Facilities, Nursing Homes - Policies and Procedures for Visitors


(Page Updated July 7, 2020)