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Guidance: ICF Visitation

As Ohio continues to cope with COVID-19 and take steps to reopen in phases, the Ohio Department of Developmental Disabilities (DODD) recommends continued vigilance as Ohioans with developmental disabilities, families, guardians, and providers consider visits. People who are vulnerable may live in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) settings and be particularly susceptible to the virus. As you consider lifting visitation restrictions, an abundance of caution and planning is advised.

Lack of in-person engagement with family and friends who live outside of the congregate setting may significantly diminish a person’s quality of life, making visits necessary to address the person’s emotional wellness despite potential physical health risks. For these people, the provider will need to make every effort to mitigate risks to the highest degree possible. For some, their family and friends may be aged or terminally ill, and delaying visitation may have untenable consequences.

Visits for people in congregate care settings present a significant challenge due to the number of vulnerable people living together, and the number of staff needed to ensure visits are conducted safely. The ability for facilities to understand and know where the residents have been or who has had contact with them is critical to contain the spread of infection if someone tests positive for COVID-19. To minimize the risk of spreading the virus, staff must be educated and informed of droplet precautions and must adhere to enhanced infection control precautions including

  • reliable and persistent wearing of masks (face coverings),

  • diligent handwashing,

  • and use of other PPE such as gloves as the situations warrant.

It is essential to keep in mind that visitors may not have been as diligent in their prevention strategies. Contact tracing is much more difficult for the provider to monitor or ascertain where visitors may have been and the people they have been in close contact with before visits.

The Ohio Department of Health’s (ODH) suspension of visitation inside all long-term care facilities remains in effect except for end of life care. However, at the discretion of each provider, planning for outdoor only visits may be an option. This approach assumes people’s visitation plans include the usual COVID-19 precautions, face coverings, social distancing, vigilant handwashing, surface cleansing, etc. Each facility can determine how best to implement outdoor visitations for its residents in a way that works best for them.

  • All implications for a resident’s physical and mental well-being need to be carefully considered when determining when to allow facility and personal visitation.

  • The person’s team must evaluate to ensure the visitation is going to be emotionally beneficial, knowing about social distancing guidance and that the visitor will be expected to wear a mask (facial covering). Take into consideration if the individual has indicated a desire to have visitors, and if the individual being visited will be able to wear a mask (facial covering).  

  • Each ICF provider must develop a visitation policy that includes, at a minimum, limiting visits, creating a screening process for visitors, and using sign-in sheets to track visitors. The sign-in sheets should be maintained for at least six months and must contain confirmation that each visitor provided identification, a phone number, and address.  

  • Providers need to educate residents on the risks of the spread of COVID-19 when interacting with visitors and the appropriate/applicable safety precautions.

  • Providers must educate families/friends of the risks of the spread of COVID-19 and the potential health impact for not just their loved one, but all residents of the home.

  • Providers need to have enough personnel available to check visitors in, take temperatures (both resident & visitor), do health screening (visitor), and monitor visits.

  • If more than one person has a visitor, the visits should take place in distinctly separate outdoor areas so that groups are distant and not able to comingle.

  • Visitors may not take people off the grounds unless approved by the provider in advance.

  • Visitors should be advised, in advance, that access to the residential living area will not be granted for any reason (e.g., restrooms), so the visitor needs to plan accordingly. Additionally, no visitation may occur indoors, even in non-residential buildings or areas.

  •  Facilities that can offer restrooms in non-residential buildings that are not in use by residents at the time of visitation, may consider accompanying visitors to and from those locations as needed. Those areas must be thoroughly cleaned after visitation before use by residents.

  • Contingency plans need to be in place to address potential adverse weather conditions. Consider the temperatures and making areas of shade available, especially taking into consideration medication-related sun sensitivity.

  • It is preferable for visits to be contact-free. If contact does occur, it is recommended that the individual wash hands thoroughly and change clothes when returning indoors. Items such as wheelchairs or other touched items need to be cleaned and disinfected.

  • Hand sanitizer should be available to visitors and individuals to use before and during the visit.

  • Facilities are encouraged to maintain, and in some cases enhance, virtual visitation options to augment visitations. Examples include Face Time, Skype, and Zoom.
     

Visits need to be:

  • Prescheduled with the provider and notify the visitor of the length of time available for the visit.

  • Include screening of visitors for temperature and symptom reporting, and hand sanitizing.

  • Limited in group size based on the space available to maintain social distancing, including the individual and any staff needed to assist.

  • In structured settings that are designed to encourage social distancing and supervised to address any misuse of wearing facial coverings or lack of cooperation with social distancing.

  • Conducted in an outdoor location where surfaces and furniture will be cleaned and sanitized before and after the visit.

  • Limited to the individual and their visitors in an outdoor location of their own that will not be entered or used until cleaned after the visit.

  • Planned to avoid anything that would require removing the visitor’s masks (such as eating).

  • Planned in accordance with visitation guidelines required by the provider to maintain the health and safety of all residents.

  • Planned to avoid sharing items such as balls, games, or craft supplies.
     

Visitors need to:

  • Agree to sign-in, have temperature taken, complete a health screening & wash hands/use hand sanitizer upon arrival.

  • Agree to wear face coverings during the visit.

  • Agree to minimize physical contact when possible and determined necessary by the team.

  • Agree to follow any visitation guidelines required by the provider to maintain the health and safety of all residents.

  • Understands the health risks of COVID-19 and the importance of taking steps to minimize exposure for all the residents of the home.

  • Agree to potential cancelation or reschedule of visits on short notice depending on the availability of staff, or the health status of any resident in the home or weather conditions.
     

Provider Considerations for Initiating Outdoor Visitation:

  • Is the facility clear of quarantine, isolation, COVID-19 positive cases (for 14 days since last COVID-19  positive or known exposure)?

  • Is the facility clear of staff COVID-19 positive cases (for 14 days since last with staff COVID-19 positive diagnosis was in the facility)?

  • Have other factors recently increased the risk of exposure to COVID-19 occurred in the last 14 days with/without COVID-19 consequences (such as staff assignments, or in facility resident movement among buildings, attending Adult Day Services, or other outings from the facility)?

Risks

Risk Mitigation

COVID-19 spreads easily and is believed to be spread primarily through airborne droplets from an infected person’s speech, coughs, and sneezes. When enough droplets from the air enter the mouth or nose of another person, that person can become infected.

 

People without known symptoms can spread the virus to others.

Having visits occur outdoors allows droplets to be dispersed and decreases the droplets that accumulate in the air for other people to inhale.

Wearing face coverings decreases the number of droplets expelled by speech and potentially inhaled by another person.

Limiting close personal physical contact decreases the risk of droplet or contact transmission.

Droplets that land on surfaces and are transmitted to a person’s mouth nose or eyes may spread the infection.

 

Teaching/assisting people to wash their hands before visits and to keep their hands away from their faces until hands are washed again after the visit.

Cleaning and sanitizing touchable surfaces before and after visits.

Using hand sanitizer before touching any surfaces after the visit.

People with some underlying health conditions have a higher risk of an adverse outcome from a COVID-19 infection? These include:

  • diabetes
  • severely obesity
  • older than 65 years old
  • known respiratory issues
  • known cardiac disease, including hypertension
  • immunocompromising conditions (ex: HIV, cancer, post-transplant, Prednisone treatment, etc.)
  • renal disease
  • other underlying health problems

Health screening of visitors before the visit.

Maintaining a social distance of at least 6 feet during the visit.

Keeping face coverings on the entire visit.

Avoiding personal contact during a visit.

Thoroughly washing hands after a visit.

Wiping off any gifts before they go to a person’s living area.

Roommates or housemates with high-risk health conditions.

Consider cohorting people who are getting visits to live separately from people not getting visits.

Visitors who may not want to wear face coverings or maintain social distancing.

Educate visitors on the risks to the individual and housemates. Be clear that visitation is contingent on compliance with all safety precautions.

Consider the possibility of delaying visitation or visiting through a closed window only.