March 12, 2020
Last night, Department of Health (ODH) Director Dr. Amy Acton and Director of Veterans Services Deborah Ashenhurst issued an order dealing with visitation in skilled nursing centers and assisted living communities. This order establishes requirements that differ from and in one key way are less stringent than previous guidance from the Centers for Medicare and Medicaid Services (CMS) and AHCA/NCAL, as well as less stringent than President Trump's announcement in his speech last night.
At this time, we recommend that members continue to follow the more stringent visitation guidelines from CMS and AHCA/NCAL. ODH indicated, in informal conversation, that they do not intend to prohibit more stringent and protective measures, but instead to set a floor. OHCA asked that they modify the order to prevent confusion about visitation standards, specifically removing the one-visitor-per-day provision.
Specifically, the order requires:
- Restricting access to the building to personnel who are absolutely necessary for the operation of the facility.
- These personnel are listed as staff, contracted and emergency healthcare providers, contractors conducting critical on-site maintenance, and governmental representatives and regulators and their contractors.
- The order also says, "[i]ncluded are also no more than one (1) visitor per resident per day, except for end of life situations." This provision clearly conflicts with federal guidance about limiting visitation to situations, such as end-of-life, when it is vitally necessary, or in President Trump's words, when medically necessary.
- Personnel entering the building must be screened according to CMS, Centers for Disease Control, and ODH guidelines. The order goes on to say that, "[s]creening should include questions about exposure to COVID-19 and assessing visitors and personnel for cough, shortness of breath, and body temperatures of 100.4 degrees and higher." The last part adds to federal guidance, which does not define fever in such a liberal way. The ODH order does not mandate specifically taking temperatures.
- The order recommends restricting access to one point of entry, but then adds an exception for emergency ingress and egress that is not altogether clear.
- The order specifies that anyone entering the building must show identification and provide their address and phone number and that the facility is to keep a log of this information for at least six months. Presumably this applies to individuals who are not regular employees.
- Along with a reference to licensure rules on infection control, the operative part of the order states that residents may "discharge" from the facility, but if they return, there is a curious statement that they are "subject to the directives above," which could suggest that they could not return if they meet any of the screening criteria applicable to visitors.
Please feel free to contact OHCA if you have any questions about the order on about COVID-19 in general.