In March of this year, the Centers for Medicare and Medicaid Services (CMS), the federal agency that regulates nursing homes, issued strict rules regarding visitors to nursing homes in order to prevent the spread of COVID-19. At that time, CMS mandated that all nursing homes restrict visitation to only essential healthcare personnel, except in “compassionate care” situations, which was then defined as “end of life” situations. Assisted living facilities, though not directly regulated by CMS, essentially followed the same protocols with guidance provided at the state level. For months, residents of nursing homes and assisted living facilities were almost entirely cut off from contact with the outside world.
Recently, however, restrictions have begun to be lifted. Effective October 17, 2020, and consistent with CMS guidance, the Minnesota Department of Health issued new regulations for nursing homes and skilled nursing facilities that greatly expanded visitation rights for residents and their loved ones. The regulations recognized the profound adverse effect of social isolation on residents and the important impact that family and caregiver visits can have on the overall health and wellbeing of residents.
The new guidance says that long term care facilities should facilitate both indoor and outdoor visits with residents so long as visitors adhere to the “core principles” of COVID-19 infection prevention (wearing masks, using hand-sanitizer, and keeping six-feet apart, etc.), and so long as the facility meets two additional criteria: (1) there have been no new COVID-19 cases at the facility in the last 14 days, and (2) the rate of community spread in the surrounding county is sufficiently low. This last factor is determined by the county’s test positivity rate for the last 14 days. This information is available on the MN Department of Health’s website. MDH releases COVID-19 statistics weekly, so to determine the applicable county positivity rate you take the average of rates for the last two weeks for your county. If the 14-day average test positivity rate is less than 5%, which is considered “low”, visits should be allowed. If the rate is between 5% and 10% (“medium risk”), visits should still be allowed but additional restrictions may be imposed by the facility. If the rate is above 10% (“high risk”), then visits are restricted to only “essential caregivers” and for “compassionate care situations.” MDH has expanded the definition of “compassionate care situations” beyond just end of life situations to now include situations where a resident may be experiencing other forms of acute emotional distress. MDH also encourages but does not require facilities to establish an “essential caregivers” program to allow each resident to designate at least one person as “essential” who would be permitted to visit them even when visitation is restricted due to high test positivity rates or other reasons.
With COVID-19 cases surging yet again, many long term care facilities will likely begin restricting visitation due to high test positivity rates in their counties. For example, several counties now exceed the 10% test positivity rate, including Beltrami, Big Stone, Chisago, Hubbard, Kandiyohi, Mahnomen, Marshall, Morrison, Nobles, Roseau, Stearns, Todd, and others. And if this trend continues as predicted, many more counties will join this list. Therefore, unless you are deemed an “essential caregiver” for your loved one, or if your loved one meets the criteria for “compassionate care,” you may lose the right to visit your loved one in their long term care facility quite soon. This reality underscores the importance of continuing to remain vigilant against the community spread of this disease so that our most vulnerable community members can stay safe and maintain a level of contact with family and friends to stay mentally, emotionally, and physically healthy.
