When can we see grandma? Regulations governing visits to senior living facilities

Seniors face numerous challenges as a result of COVID-19. They are at greater risk of infection and serious illness or death. At the same time, many already suffer from isolation and loneliness. That is exacerbated by the inability to have visitors and direct contact with friends and family. Loneliness and isolation also pose serious risks to the mental and physical health of the senior population.

Whether and to what extent senior living facilities can, in an effort to curb loneliness and isolation, allow visitors has been the source of significant confusion. Many think or have been told that, unless a resident is dying, visitors must be barred.  That, however, is not entirely accurate.

Although the Arizona Department of Health Services (AzDHS) is discouraging visitation, it is allowed in some instances (i.e. “compassionate care situations.”). The term “compassionate care situations” is often interpreted to mean “end of life” situations. But no Arizona rule, statute or executive order has so defined it. In fact, no definition has been provided in Arizona. The Centers for Medicare and Medicaid Services (“CMS”) has provided slightly more guidance on the meaning of “compassionate care situations.” It defines that term broadly and emphasizes that facilities should use discretion in determining when a visit might be warranted:

While end-of-life situations were used as examples of compassionate care situations in previous CMS memoranda, the term ‘compassionate care situations’ does not exclusively refer to end-of-life situations. For example, for a resident who was living with their family before recently being admitted to a nursing home, the change in their environment and sudden lack of family can be a traumatic experience. Allowing a visit from a family member in this situation would be consistent with the intent of the term “compassionate care situations.” Similarly, allowing someone to visit a resident whose friend or family member recently passed away, would also be consistent with the intent of these situations.

Given that many seniors are suffering from significant physical and mental decline due to COVID-19 lockdown protocols initially intended to keep them safe, facilities should work with families to ensure that safe and appropriate limited visitation is available in conformance with AzDHS and CMS guidance.

In Arizona, Governor Ducey’s Executive Order 2020-22 (“E.O. 2020-22”) requires all Residential Care Institutions (this constitutes a healthcare institution other than an Nursing Care Institution or hospital, such as an Assisted Living Facility) and Nursing Care Institutions to provide residents with an electronic form of visual communication, such as FaceTime or Zoom, if visitation has been restricted. Of course, this presents major challenges to facilities that are already overextended whilst fighting COVID-19. In a recent press conference Governor Ducey mentioned that there may be some funding available  for this effort but details are scant. E.O. 2020-22 will remain in effect until the public health emergency declaration related to COVID-19 is lifted.

In situations where in-person visitation is warranted, AzDHS has outlined some directives for handling compassionate care visitors: 

1. They should be screened for symptoms of COVID-19;
2. They should sign logs;
3. They should be instructed on hygiene practices such as hand washing and wearing a mask;
4. Visitation should be limited to certain areas of the facility; and
5. All visitors should be advised to report if they experience COVID-like symptoms within the14 days following the visit.
    

As with other measures to fight COVID-19, facilities should document their visitation policies and make sure to keep records of all visitors and the reason for the visit. For best practices to ensure compliance with AzDHS and CMS guidance, as well as how to ensure senior living visitation is appropriately tailored to avoid risk to residents and staff, consider contacting a Fennemore Craig attorney.