Royal Health Group facilities promotes person-centered visits while balancing the safety of all residents and staff. Royal Health Group honors residents’ right to receive visitors of his or her choosing at the time of his or her choosing, and in a manner that does not impose on the rights of other residents.
- Visitation may be conducted through different means based on the facility’s structure and residents’ needs, such as in resident rooms, dedicated visitation spaces, and outdoors.
- All visitors will be screened prior to visiting residents indoors or outdoors. Visitors will not be permitting in the facility if they have a fever, COVID or other respiratory symptoms, tested positive for COVID-19 within the past 10 days or had close contact with someone with COVID -19 with 14 days. (See section on Screening Visitors)
- Regardless of how visits are conducted, certain core principles and best practices reduce the risk of COVID-19 transmission:
- Hand hygiene (use of alcohol-based hand rub is preferred)
- Face covering or mask (covering mouth and nose) and physical distancing at least six feet between people, in accordance with CDC guidance
- Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exits and routes to designated areas, hand hygiene)
- Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit
- Use of physical barriers if available, such as plexi-glass dividers or curtains.
- Appropriate staff use of Personal Protective Equipment (PPE)
- Effective cohorting of residents (e.g., separate areas dedicated to COVID-19 care)
- Resident and staff testing per State and Federal guidance
- Testing and Vaccination can help prevent the spread of COVID-19
- Visitors are encouraged to get tested 2-3 days before visiting the facility. If unable, the facility may offer on-site testing.
- Facility cannot require visitors to be tested, or proof of, as a condition of visitation.
- Facility may ask visitors about vaccination status but cannot require it as a condition of entry to the facility.
- Visitors will be provided education regarding COVID-19 and infection control measures, including the need for frequent hand hygiene with alcohol-based hand rub.
- Foods brought in should follow company policy. Visitor to be screened per policy.
- Visitors should not be present during AGPs or other specimen collection procedures.
- The facility will clean the designated visitation space, including high-touch areas, when used using an appropriate EPA-registered disinfectant.
- Transport of a resident to and from the designated visitation space must be safe and orderly. At a minimum, safe transport means that the resident or visitor cannot be transported through any space designated as COVID-19 care space or space where residents suspected or confirmed to be infected with COVID-19 are present.
- If HCP expect to provide direct care to residents while transporting the resident or monitoring the visitation, they must wear appropriate PPE in addition to mask and eye protection.
- Whether or not a resident has visitors should not impact their access to fresh air and time outdoors.
- Residents have the right to access the Ombudsman Program or Alliance and to consult legal counsel.
- Any individual who enters the long-term care facility and develops signs and symptoms of COVID-19 such as fever, cough, shortness of breath, sore throat, myalgia, chills, or new onset loss of smell or taste within 2 days after exiting the long-term care facility or designated outdoor space must immediately notify the long-term care facility of the date they were in the facility, the individuals they were in contact with, and the locations within the facility they visited. Long-term care facilities should immediately screen the individuals who had contact with the visitor for the level of exposure and follow up with the facility’s medical director or resident’s care provider.
- Visitors who unable to follow facility protocols and the core principles of infection prevention will not be permitted to visit.
Indoor Visits
- Indoor visitations are allowed at all times and for all residents as permitted under the regulations.
- Facility will not limit the frequency and length of visits for residents, the number of visitors, or require advance scheduling of visits. Although there is no limit on the number of visitors that a resident can have at one time, visits should be conducted in a manner that adheres to the core principles of COVID-19 infection prevention and does not increase risk to other residents.
- Visitors must wear face coverings or masks and physically distance themselves from other residents or healthcare personnel, regardless of vaccination status.
- Facilities should ensure that physical distancing can still be maintained during peak times of visitation (e.g., lunchtime, after business hours, etc.).
- Facilities should avoid large gatherings (e.g., parties, events) where large numbers of visitors are in the same space at the same time and physical distancing cannot be maintained.
- During indoor visitation, facilities should limit visitor movement in the facility. For example, visitors should not walk around different halls of the facility. Rather, they should go directly to the resident’s room or designated visitation area.
- If a resident’s roommate is unvaccinated or immunocompromised (regardless of vaccination status), visits 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 adhering to the core principles of infection prevention.
- If the nursing home’s county COVID-19 community level of transmission is substantial to high, all residents and visitors, regardless of vaccination status, should wear face coverings or masks and physically distance, at all times.
- In areas of low to moderate transmission, the safest practice is for residents and visitors to wear face coverings or masks and physically distance, particularly if either of them is at increased risk for severe disease or are unvaccinated. If the resident and all their visitor(s) are fully vaccinated and the resident is not moderately or severely immunocompromised, they may choose not to wear face coverings or masks and to have physical contact.
- If the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor.
- Unvaccinated residents may also choose to have physical touch based on their preferences and needs, such as with support persons for individuals with disabilities and visitors participating in certain religious practices, including in end-of-life situations. In these situations, unvaccinated residents (or their representative) and their visitors should be advised of the risks of physical contact prior to the visit.
- Facilities may contact their local health authorities for guidance or direction on how to structure their visitation to reduce the risk of COVID-19 transmission.
- Massachusetts-Specific Guidance
- Facility will identify a designated space for visitation that is as close to the entrance as possible where visits can be socially distanced from other residents and minimize visitor impact in the facility.
- Facility will ensure that ventilation systems operate properly, have been serviced in accordance with manufacturer recommendations and increase circulation of outdoor air as much as possible.
- Residents who are fully vaccinated may visit with loved ones who are fully vaccinated in their rooms if they reside in a private room or if their roommate is also fully vaccinated and not immune compromised.
- Residents who are fully vaccinated may visit with loved ones who are fully vaccinated without maintaining social distancing.
Visiting Residents on Precautions
- While not recommended, residents who are on transmission-based precautions (TBP) or quarantine can still receive visitors.
- Visits should occur in the resident’s room and the resident should wear a well-fitting facemask (if tolerated).
- Before visiting residents, who are on TBP or quarantine, visitors should be made aware of the potential risk of visiting and precautions necessary to visit the resident.
- Visitors should adhere to the core principles of infection prevention, such as wearing a mask, physically distancing and hand hygiene.
- Facilities may offer well-fitting facemasks or other appropriate PPE, if available; however, facilities are not required to provide PPE for visitors.
- Massachusetts-Specific Guidance
- It is strongly advised that visitors to COVID-19 positive or quarantined residents should be fully vaccinated and maintain physical distance.
- Facilities must offer and visitors must wear well-fitting filtering facemasks and monitor visitor compliance with hand hygiene.
Indoor Visitation during an Outbreak Investigation
- An outbreak investigation is initiated when a new nursing home onset of COVID-19 occurs (i.e., a new COVID-19 case among residents or staff).
- While it is safer for visitors not to enter the facility during an outbreak investigation, visitors must still be allowed in the facility.
- Visitors should be made aware of the potential risk of visiting during an outbreak investigation and adhere to the core principles of infection prevention, including wearing a facemask, physically distancing, and hand hygiene.
- If residents or their representative would like to have a visit during an outbreak investigation, residents should wear face coverings or masks during visits, regardless of vaccination status, and visits should ideally occur in the resident’s room.
- Facilities may contact their local health authorities for guidance or direction on how to structure their visitation to reduce the risk of COVID-19 transmission during an outbreak investigation.
Compassionate Care Visits
- Compassionate care visits are allowed at all times.
- Compassionate care visits include but are not limited to:
- End of life visits
- Newly admitted resident struggling with change in environment
- Resident grieving after a friend or family member recently passed away
- Resident who needs cueing and encouragement with eating and drinking, previously provided by family and/or caregivers, and who is experiencing weight loss or dehydration.
- Resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).
- The number of visitors allowed may be limited if the resident is severely compromised.
- Visitors will be screened in the same manner as all visitors.
- Visitors must follow the core principles of infection prevention which include masks, physical distancing and hand hygiene.
- Massachusetts Specific Guidance
- Decisions about compassionate care visits should be made on a case-by-case basis, based on resident care needs. The facility will work with residents, families, caregivers, resident representatives, and health care personnel to identify the need for compassionate care visits.
- For compassionate care situations visitors will be limited to a specific room: either the resident’s room, if the resident has a private room or the resident’s roommate has been fully vaccinated, or another location designated by the facility.
- Decisions about visitation during a compassionate care situation should be made on a case-by-case basis, which should include careful screening of the visitor per facility screening process.
- Facility will continue to offer electronic methods for virtual communication between residents and visitors, such as Skype, FaceTime, WhatsApp, or Google Duo to augment in-person visitation.
Outdoor Visits
- Outdoor visits are preferred when the resident and/or visitor are not fully vaccinated.
- Visits with a resident in a designated outdoor space with a covering for adverse weather are dependent on permissible weather conditions, availability of outdoor space, and sufficient staffing at the facility to meet resident care needs, and the health and well-being of the resident.
- If utilized, the tent must flame retardant and no smoking or flames allowed in or near the tent. The tent should be a minimum of 10 feet from the building. There should be a sign showing where to exit and stating no smoking is allowed.
- Core principles of infection prevention, such as masks, physical distancing, and hand hygiene, should be followed.
- Massachusetts Specific guidance
- Residents who are fully vaccinated may visit with loved ones who are fully vaccinated without maintaining social distancing or wearing a mask outside.
- A facility staff member should be immediately available to assist residents or visitors to maintain resident safety as they would for routine outdoor visits. This could be through close distance or mechanism to notify staff of need.
Federal Disability Rights Laws and Protection & Advocacy (P&A) Programs
- Facilities are required to allow immediate access to a resident by any representative of the protection and advocacy systems.
- Representatives of P&A programs are permitted access to all facility residents, which includes “the opportunity to meet and communicate privately with such individuals regularly, both formally and informally, by telephone, mail and in person.”
- If the P&A is planning to visit a resident who is in TBP or quarantine, or an unvaccinated resident in a county where the level of community transmission is substantial or high in the past 7 days, the resident and P&A representative should be made aware of the potential risk of visiting and the visit should take place in the resident’s room.
- If communicating with individuals who are deaf or hard of hearing, it is recommended to use a clear mask or mask with a clear panel. Face coverings should not be placed on anyone who has trouble breathing or is unable to wear a mask due to a disability, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
- If a resident requires assistance to ensure effective communication (e.g., a qualified interpreter or someone to facilitate communication) and the assistance is not available by onsite staff or effective communication cannot be provided without such entry (e.g., video remote interpreting), the facility must allow the individual entry into the nursing home to interpret or facilitate, with some exceptions.
- All visitors must adhere to the core principles of COVID-19 infection prevention.