MDH Issues Visitor Restrictions for Residential Settings with At-Risk Residents
On March 18, 2020 by Jonathan Lips
The Minnesota Department of Health (MDH) has issued updated guidance advising residential settings with at-risk residents, including housing with services establishments and their arranged home care providers, residential hospices, and licensed-only nursing homes, to impose strict limitations on visitation and to take other operational steps to mitigate the risk of COVID-19.
Note: This article uses the term “facilities” to apply to the settings identified by MDH.
With this announcement, MDH has adopted guidelines developed by CMS for nursing homes (QSO-20-14-NH-Revised) and extended them to these additional residential settings serving vulnerable populations. MDH states it is adopting the CMS guidance and any future revisions, which means that if CMS updates nursing home guidelines, those updates will apply. LeadingAge MN will track those updates for members.
This article describes key aspects of the MDH guidelines, but it does not attempt to cover the material fully. Housing with services establishments, assisted living settings and your arranged home care providers are advised to read the MDH document in its entirety and implement the guidelines immediately.
We recognize there are some questions regarding how this guidance applies to arranged home care providers as essential health care personnel and having access to your settings and their clients. There are ongoing conversations with MDH, the Minnesota Home Care Association and others to get additional clarification on this issue. We are participating in these conversations and will share more information with you, so please watch your email for updates.
Restrictions for Visitors and Non-Essential Health Care Personnel
Beginning immediately, facilities should restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, such as an end-of-life situation.
For visitors entering the facility in compassionate situations, visitors will be limited to a specific room only, and facilities should require visitors to perform hand hygiene and use Personal Protective Equipment (PPE), such as facemasks. If possible, facilities should create dedicated visiting areas (e.g., “clean rooms”) near the entrance to the facility where residents can meet with visitors in a sanitized environment. Facilities should disinfect rooms after each resident-visitor meeting.
Those with symptoms of a respiratory infection (e.g., fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations).
Exceptions to Restrictions
Facilities should follow CDC guidelines for restricting access to health care workers. This CDC guidance for health care workers in facilities also applies to other health care workers, such as hospice workers, EMS personnel, or dialysis technicians, who provide care to residents. They should be permitted to come into the facility as long as they meet the CDC guidelines for health care workers.
Other Operational Guidelines
As a measure to prevent spread of the virus, MDH instructs facilities to cancel communal dining and all group activities, such as internal and external group activities. Facilities should:
- Implement active screening of residents and staff for fever and respiratory symptoms.
- Screen all staff at the beginning of their shift for fever and respiratory symptoms. Actively take their temperature and document absence of shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and self-isolate at home.
- Facilities should identify staff that work at multiple facilities (e.g., agency staff, regional or corporate staff) and actively screen and restrict them appropriately to ensure they do not place individuals in the facility at risk for COVID-19.
- In lieu of visits, facilities should consider: a) Offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.). b) Creating/increasing listserv communication to update families, such as advising to not visit. c) Assigning staff as primary contact to families for inbound calls, and conduct regular outbound calls to keep families up to date. d) Offering a phone line with a voice recording updated at set times (e.g., daily) with the facility’s general operating status, such as when it is safe to resume visits.
Managing People Arriving at Your Community: Decision tree to help you screen everyone entering your building.
1-Page Fact Sheet - COMING SOON: We are developing a 1-page fact sheet on visitor guidance to help you interpret the CMS and MDH guidance and better understand whom it applies to and how you should implement.
Visitor Guidance Toolkit: We are updating this toolkit based on the new recommendations from MDH and the clarification we are seeking from MDH on home care personnel. We will share this resource with you as soon as we can.