Answers to Your Questions about the Nursing Home Visitation Update

August 10

The New Jersey Department of Health issued a new directive that changes the visitation policy for residents of Long-Term Care Facilities (LTCFs).  Specifically, EXECUTIVE DIRECTIVE NO. 20-026 , tells LTCFs what steps to take to reopen LTCFs to visitors. The policy only allows LTCFs to reopen slowly, in phases, described below.  The phases range from 0 (most restrictive) to 3 (least restrictive).

All long-term care facilities (LTCF) began at “Phase 0.” Phase 0 allows for outdoor visitation.  Indoor visitation is limited to compassionate care (defined below). For now, all the information about rules for visitation listed in DRNJ’s FAQ, Nursing Home Visitation, remains the same.

There is no set date for LTCFs to move from one phase to another. LTCFs can move to higher phases and allow more liberal visitation depending on factors like the length of time the facility has been without a COVID-19 outbreak and whether the particular LTCF has met certain other requirements, such as having enough people on staff, and having a stock of Personal Protective Equipment (PPE) available. To move to the next phase, each LTCF must provide a written attestation (sworn statement) to the Department of Health stating that the LTCF meets the requirements to advance to the next phase.  

If there is an outbreak of Covid-19 at the facility, the facility will return to Phase “0.” An outbreak in a LTCF is defined as more than one case in a resident or more than two health care personnel. Virtual communication must be provided to the residents, families, and resident representatives. 

Visitors should contact the LTCF to find out what phase the facility is currently on. Then, review the chart below to determine who can visit a resident during that phase and where the visit can take place.

General Rules For All Visitors:

     SAFETY:

The information on Disability Rights NJ’s FAQ, Nursing Home Visitation, contains information about the rules all visitors must follow for things like:

• Prohibiting sick people from visiting;

• Screening visitors;

• Personal Protective Equipment; and

Those rules remain the same at all phases. 

   NEW RULE FOR PHYSICAL CONTACT:

A new rule is that indoor visitors can have physical contact with the resident they’re visiting but must practice social distancing and avoid physical contact with anyone else. 

            OTHER:

LTCFs may also make rules for visitors to follow. 

NEW DEFINITION OF COMPASSIONATE CARE:

This new directive expands the definition of Compassionate Care. Until now, New Jersey defined compassionate care to mean end-of-life situations only. Now, New Jersey’s definition of compassionate care also includes the following situations:

• A resident who recently moved from her family home into a LTCF

• Visiting a resident whose family member or friend recently died

• A resident whose health status is declining

Compassionate care visits are allowed in all phases but must be kept at a minimum in Phase 0. Facilities must work with residents, healthcare providers, families, or guardians to determine when visits for compassionate care are appropriate and can be safely conducted. 

NEW RULES FOR ESSENTIAL CAREGIVERS:

An “essential caregiver” is someone who helped the resident with activities of daily living regularly before the COVID-19 outbreak. Activities of daily living include things like bathing, dressing, and eating, for example. 

Residents can designate people as Essential Caregivers.  In fact, LTCFs must check with each resident to find out if there is an Essential Caregiver. 

An essential caregiver could be a family member, outside caregiver, or friend as long as they used to assist the resident with activities of daily living before COVID. Each facility must create a policy to determine whether a designated person meets the definition of an Essential Caregiver.  

A resident may have more than one essential caregiver. If a resident identifies more than one person as an essential caregiver, the facility should work with the resident and caregivers to create a visitation schedule.

Essential caregivers can visit a resident indoors at every stage as long as:

• The resident is not in a 14-day quarantine period,

• The resident is not symptomatic or in isolation after testing positive for Covid-19, and

• The Essential Caregiver follows the general screening and visitation policies applicable to all visitors

• The essential caregiver should be able to provide care in the same manner as the caregiver was prior to the pandemic.

The number of times an Essential Caregiver may visit, and length of visit is limited by phase:

• Phase 0 – ONE visit per week - up to two (2) hours per visit

• Phase 1 – TWO visits per week – up to four (4) hours total per week

• Phase 2 - TWO visits per week – up to four (4) hours total per week

• Phase 3 – Caregiver visitation schedule will follow the regular, pre-COVID facility procedure

TAKING RESIDENTS OFF PREMISES:

Until Phase 3, LTCFs can restrict trips away from the facility unless the trip is medically necessary. The executive directive does not limit outings in Phase 3, except that the resident must be COVID-19 negative and asymptomatic or COVID-19 recovered. LTCFs can also make their own restrictions at Phase 3 based on the LTCF’s risk assessment.