This week the Minnesota Department of Health (MDH) released long-awaited recommendations on modifying visitation policies in aging services settings. The recommendations are effective August 29, 2020 and apply both to nursing homes and housing with services/assisted living settings.
 

You will find the recommendations posted to the state’s Long-Term Care COVID-19 webpage:

• Recommendations for Long-term Care Visitation and Activities: How and When to Safely Transition to the Next Level Throughout the COVID-19 Pandemic (PDF)
• Long-term Care Visitation and Activities Recommendations Summary (PDF)
• Frequently Asked Questions: Long-term Care Visitation and Activities Recommendations (PDF)

Overview

The recommendations identify key considerations and risk factors that nursing homes and housing with services/assisted living communities must assess when making decisions about how and when to ease limitations on visits and activities within your settings. Facilities have discretion to determine how you proceed.

The guidance is effective Saturday, August 29, but that does not mean providers are required to modify visitation by that date. It is the earliest date a provider could consider modifying visitation, if it wished to and if it met the criteria set out in the MDH guidance.

MDH identifies two levels of visitation and activities, based on risk. Level 1 is the most restrictive regarding visitation and activities, which represents our current state of work. Level 2 allows more visitation and activities to occur, contingent on the factors identified by MDH. Settings can and likely will move back and forth between Level 1 and Level 2 over time.

On the issue of when a setting may consider moving to Level 2, MDH identifies COVID-19 case-status at the facility level and testing as key factors.

• Case status presents a bright line rule: Facilities with COVID-19 exposure of staff or resident(s) within the past 28 days cannot transition to Level 2. Facilities with no exposure due to a COVID-19 positive resident, staff, or visiting health care provider within the past 28 days may consider transitioning to Level 2. If a resident tests positive for COVID-19, or if a staff member tests positive for COVID-19 and worked in the facility while infectious, the facility must move back to MDH LTC visitation and activities Level 1 immediately.
• Testing for COVID-19 when transitioning to Level 2: All nursing homes are required to complete, or have a plan to complete, at least one round of facility-wide testing (i.e., testing of all staff and residents at a point in time) on or after May 1, 2020, but no later than two months after moving to MDH LTC visitation and activities Level 2. All housing with services/assisted living settings are encouraged to complete one round of facility-wide testing within that same time frame, but MDH does not require it.

NOTE: All provider types must have a written testing plan in place based on contingencies informed by the CDC as well as protocols for ongoing testing. Facilities should consider ongoing changes in risk and refer to the MDH Long-term Care Testing Guidance when developing a testing plan, and should include options for managing specimen collection, test processing, and financing.

Beyond case status and testing protocol, MDH recommends that providers carefully consider the following risk factors when making decisions about how and when to ease limitations on visits and activities.

MDH recommends that providers be informed of the level of community transmission in your county, as one key risk factor. Facilities should monitor the 14-day case rate in their county. Facilities can determine the 14-day case rate on the MDH webpage Weekly Case Rate by County of Residence. Select the Weekly Case Rate by the County of Residence link and download the Weekly Case Rate by County of Residence (CSV) file. Add the numbers of the two most recent weeks in your county to determine the 14-day case rate. If that number is greater than 10, you may consider the county at elevated risk of disease transmission. If a facility is close to a county border, also assess the adjacent county’s case incidence.

Other key risk factors identified by MDH include:

• Case status in your setting of care
• Availability of adequate staffing
• Access to adequate testing, with a written testing plan in place following CDC and MDH guidelines
• Access to adequate supplies of PPE
• Ability of the local hospital to accept transfers from LTC facilities on general and intensive care units.

Resources for Members

LeadingAge MN has developed a new resource (Toolkit on Modifying Visitation) to help you plan, implement and communicate changes in visitation based on this new guidance, It includes a sample policy and protocols, checklists and template letters for supporting both visitation and a delay in modifying visitation.

Our team will also develop Frequently-Asked-Questions resource for members, and we invite you to send your questions to Jon Lips or Kari Everson.

We will continue to report on this complex and important issue through our daily Member Updates, and please know we are here to support you