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No Patient Left Alone, Visitation & Facial Coverings Policy

Overview of In-Person Visitation Guidelines in the Health Pavilion

The administration and staff at Oak Hammock at the University of Florida understand the importance of our residents being able to spend time with loved ones, family, and friends.  During the COVID-19 Public Health Emergency (PHE), per the Centers for Medicare and Medicaid Services (CMS), indoor general visitation for all residents was very restrictive in an effort to protect the health and safety of the residents and the facility staff needed to care for our most vulnerable population.  Aligning with revisions to the September 17, 2022, QSO-20-39-NH by CMS, in conjunction with the Centers for Disease Control and Prevention (CDC), on March 10, 2022, and on September 23, 2022, and corresponding to the April 6, 2022, State of Florida SB 988, “No Patient Left Alone Act,” Oak Hammock at the University of Florida updated relevant policies regarding resident visitation.  CMS indicates that indoor visitation between residents and their desired guests should be resumed “at all times and for all residents, regardless of vaccination status.” Oak Hammock at the University of Florida will not restrict visitation without a reasonable clinical or safety cause consistent with 42 CFR §483.10(f) (4) (Resident Rights). The facility will accommodate and support indoor and outdoor visitation, including visits for reasons beyond compassionate care, based on the guidelines issued by CMS and the CDC.  Policies related to visitation will continue to be revised as regulatory guidance is updated.

Oak Hammock at the University of Florida acknowledges that there may still be concerns for infection transmission to residents, 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.  Oak Hammock at the University of Florida will offer education to staff and residents on the risks and benefits of COVID-19 vaccines and will offer to administer the vaccine.  Oak Hammock at the University of Florida will continue to report staff and resident vaccination data to the CDC’s National Healthcare Safety Network (NHSN).

Core Principles of COVID-19 Infection Prevention

Visitation at Oak Hammock at the University of Florida will be conducted following the Core Principles of COVID-19 Infection Prevention and best practices consistent with the Centers for Disease Control and Prevention (CDC) guidance for nursing homes in order to reduce the risk of COVID-19 transmission.  Core Principles of COVID-19 Infection Prevention should be adhered to at all times.  While visiting our facility, a visitor should be aware that they are at risk for potential exposure to COVID-19.

  1. Visitors may enter and exit the building using any unlocked exterior door, preferably using the front entrance. Additionally, visitors from the Independent Living community at Oak Hammock at the University of Florida may enter through the hallway connecting Independent Living to Assisted Living or through the hallway connecting Independent Living to Skilled Nursing.
  2. Oak Hammock at the University of Florida will post guidance for recommended actions for visitors who have a tested positive for or who have been in close contact with someone who has COVID-19. Visitors with symptoms of or who have confirmed COVID-19 infection, or visitors who have had close contact with someone with COVID-19 infection will be encouraged to defer non-urgent, in-person visitation until they meet CDC criteria for ending isolation in the healthcare setting.  Oak Hammock at the University of Florida administration and/or nursing staff have the responsibility to deny entry to the facility of any persons who have a positive viral test or who have signs or symptoms of COVID-19 Infection.
  3. All visitors will follow the proper method for completing hand hygiene during their visit with alcohol-based hand rub being the preferred method. Alcohol-based hand rub dispensers have been placed at the entry to the facility, throughout common areas of the facility, and at the entry/exit to resident rooms.
  4. As described in the CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, source control, which refers to the use of respirators or well-fitting masks to cover a person’s mouth and nose to prevent the spread of respiratory secretions, remains an important intervention during periods of higher respiratory virus transmission. Source control may be recommended for employees, but pursuant to Emergency Rule 59AER23-2, an employee may opt out of facial covering requirements based on certain criteria.  Residents and visitors will not be required to wear masks, unless specific criteria is met, but may elect to wear face coverings or masks, if they choose.  Oak Hammock at the University of Florida will make available masks, free of charge, to residents and visitors, as requested.
  5. Visitor education will be available, including the following, upon request: COVID-19 signs and symptoms; Infection control precautions and best practices; Proper use of face coverings; Proper hand hygiene; and proper entrance and exits to use when arriving and departing the facility and the routes to designated areas.
  6. Oak Hammock at the University of Florida will clean and disinfect high-frequency touched surfaces often and will clean and disinfect any visitation areas after visits.
  7. Oak Hammock at the University of Florida will make efforts to effectively cohort residents who are diagnosed with COVID-19 Infection.
  8. If an outbreak investigation is initiated, which occurs when a single new case of COVID-19 is identified among residents or staff, the facility will adhere to Centers for Medicare and Medicaid Services (CMS) regulations and guidance for COVID-19 outbreak testing. If an outbreak investigation is occurring, Oak Hammock at the University of Florida will encourage visitors to physically distance themselves from other residents and staff, when possible.  Limited visitor movement (e.g., walking about different hallways of the facility) will be encouraged.
  9. Residents and staff will be tested as required per 42 CFR 483.80(h).
  10. All visitors are encouraged to inform administrative staff if they develop a fever or symptoms consistent with COVID-19, or test positive for COVID-19 within 10 days after visiting.
  11. For the protection of residents and staff, visitors who violate the Core Principles of COVID-19 Infection Prevention and the Oak Hammock at the University of Florida policies and procedures, after being educated, will be asked to leave the facility and in-person visitation will be suspended for the specific visitor.

Indoor and Outdoor In-Person Visitation

Oak Hammock at the University of Florida will facilitate in-person indoor or outdoor visitation, of their choosing, for all residents, regardless of vaccination status, as permitted under the applicable Centers for Medicare and Medicaid Services (CMS) regulations and the April 6, 2022, State of Florida, SB 988, “No Patient Left Alone Act.” Residents may receive visitors of their choosing at the time of their choosing in a manner that does not place other residents at risk or impose on the rights of another resident.  Oak Hammock at the University of Florida will allow visits to be conducted with an adequate degree of privacy.

  1. Visitors to Oak Hammock at the University of Florida residents are not required to schedule a visit appointment in order to spend time with a resident for a routine visit.
  2. Oak Hammock at the University of Florida has placed no limit on the length of visits, the frequency of visits or the number of visitors an individual resident may have at one time as long as visitors are adhering to the Core Principles of COVID-19 Infection Prevention. During peak times of visitation and large gatherings (e.g., parties, events), Oak Hammock at the University of Florida will encourage physical distancing. In an effort to ensure that physical distancing is maintained in adherence to the Core Principles of COVID-19 Infection Prevention, large gatherings with a large number of visitors in the same place at the same time should be avoided unless a venue suitable to maintain the required physical distancing is available.
  3. Outdoor visits pose a lower risk of transmission due to increased space and airflow. Oak Hammock at the University of Florida will allow visitation in available accessible and safe outdoor spaces throughout the community.  When conducting outdoor visitation, all appropriate infection control and prevention practices should be followed.
  4. Communal activities and dining may occur, with alterations as necessary, to adhere to the guidelines for preventing transmission of COVID-19 Infection.
  5. Consensual physical contact between a resident and a visitor will be allowed.
  6. The staff at Oak Hammock at the University of Florida values and honors the rights of the resident to make choices about aspects of his or her life in the facility that are significant to the resident, including their right to deny or withdraw consent for a visit at any time. Oak Hammock at the University of Florida will assist the resident as needed in such circumstances.
  7. While not recommended, residents who are on transmission-based precautions (TBP) or quarantine can still receive visitors. In these cases, visits should occur in the resident’s room and the resident and visitor should wear Personal Protective Equipment (PPE) during the visit. Visitors will be made aware of the potential risk of visiting and precautions necessary in order to visit the resident.

Important Considerations for Visitation

Visitation for an Oak Hammock at the University of Florida resident will be person-centered, considering the resident’s physical, mental and psychosocial well-being, and will support their quality of life.

The Centers for Medicare and Medicaid Services (CMS) guidelines do not indicate any age restriction for visitors; however, all visitors to Oak Hammock at the University of Florida must be able to adhere to the Core Principles of COVID-19 Infection Prevention, or must have a responsible party who is able to facilitate these principles.

In accordance with the April 6, 2022, State of Florida, SB 988, “No Resident Left Alone Act,” unless a resident objects, Oak Hammock at the University of Florida must allow in-person visitation for end-of-life situations or for a resident who:

  1. was living with family before being admitted and is struggling with the change in environment and lack of in-person family support;
  2. who is in the process of making one or more major medical decisions;
  3. is experiencing emotional distress or grieving the loss of a friend or family member who has recently died;
  4. needs cueing or encouragement to eat or drink which was previously proved by a family member or caregiver;
  5. used to talk and interact with others is seldom speaking.

Oak Hammock at the University of Florida, in accordance with the April 6, 2022, State of Florida, SB 988, “No Resident Left Alone Act,” will allow consensual physical contact between a resident and their visitor, regardless of vaccination status.

During an outbreak status, visitation will still be allowed per Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidelines.  An outbreak exists when a new nursing home onset of COVID-19 occurs among a resident or a staff member.  Visitors will be required to adhere to the Core Principles of COVID-19 Infection Prevention during their visit.

COVID-19 Testing and Vaccination of Visitors

Under Centers for Medicare and Medicaid Services (CMS) guidance, visitors are not required to test or to show proof of having tested as a condition of visitation.  This assumption applies to representatives of the Office of the State Long-Term Care Ombudsman and protection and advocacy systems.

Use of Facial Coverings for Infection Control

The Agency for Health Care Administration (AHCA) and the Florida Department of Health (DOH) have published emergency rules, effective June 30, 2023, to establish standards for the appropriate use of facial coverings for infection control in the health care setting, including nursing centers and assisted living facilities.  These emergency rules prohibit businesses, government, and educational entities from requiring a person to wear a facial covering to gain entry to, or use, their services.  However, the legislation recognizes instances where masking is clinically appropriate in health care settings. In accordance with the June 30, 2023, State of Florida Statute section 120.54(4)(a), health care practitioners and health care providers may choose to require a resident to wear a facial covering only when the resident is in a common area of the health care setting and is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission. In addition, the guidance in this statute also allows health care practitioners and health care providers to require a visitor to wear a facial covering when the visitor is:

  1. Exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission;
  2. In sterile areas of the health care setting or an area where sterile procedures are being performed;
  3. In an in-patient or clinical room with a resident who is exhibiting signs or symptoms of or who has a diagnosed infectious disease that can be spread through droplet or airborne transmission; or,
  4. Visiting a resident whose treating health care practitioner has diagnosed the resident with or confirmed a condition affecting the immune system in a manner which is known to increase risk of transmission of an infection from employees without signs or symptoms of infection to a resident and whose treating practitioner has determined that the use of facial coverings is necessary for the resident’s safety.

In accordance with the Florida Patient Bill of Rights and Responsibilities, section 381.026, F.S., and Emergency Rule 59AER23-2(1), health care practitioners and health care providers who choose to require a facial covering for any visitor must include in the policy a provision for opting-out of wearing a facial covering if an alternative method of infection control or infectious disease prevention is available.

If an outbreak investigation is initiated, which occurs when a single new case of COVID-19 is identified among residents or staff, the facility may recommend for staff to use source control, including the use of respirators or well-fitting masks to cover the mouth and nose to prevent the spread of respiratory secretions when they are breathing, talking, coughing and sneezing.  Pursuant to Emergency Rule 59AER23-2(2), health care practitioners must allow an employee to opt out of facial covering requirements unless the employee is:

  1. Conducting sterile procedures;
  2. Working in a sterile area;
  3. Working with a patient whose treating health care practitioner has diagnosed the resident with or confirmed a condition affecting the immune system in a manner which is known to increase the risk of transmission of an infection from employees without signs or symptoms of infection to a resident and who treating practitioner has determined that the use of facial coverings is necessary for the resident’s safety;
  4. With a resident on droplet or airborne isolation; or,
  5. Engaging in non-clinical potentially hazardous activities that require facial coverings to prevent injury or harm in accordance with industry standards.

Responsibilities of Administrative Staff

The Administrator of Oak Hammock at the University of Florida, and other designated staff, including the Director of Nursing, Assistant Director Nursing, and Infection Control Nurse, will make every effort to facilitate safe indoor or outdoor, in-person visitation consistent with the 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.”

Designation of Responsible Party

The Administrator of Oak Hammock at the University of Florida is responsible for ensuring that all staff adhere to the policies and procedures set forth by this organization.

References:

CMS QSO-20-39-NH/revised 3/22/2022, F.S.408.823 In-person visitation “No Patient Left Alone Act”

CMS QSO-20-39-NH/revised 9/23/2022

CMS QSO-20-39-NH/revised 5/8/2023

Emergency Rule 59AER23-2, F.S. 408.824 “Standards for Appropriate Use of Facial Coverings for Infection Control” 6/30/2023

Emergency Rule 64DER23-6, F.S. 408.824 “Standards for Appropriate Use of Facial Coverings for Infection Control” 6/30/2023