NAVIGATE YOUR PRACTICE THROUGH COVID-19
New MDHHS Order for Visitation in Residential Care Facilities
By Jeanne E. Murphy, ICLE | 03/02/21

On March 2, 2021, the Michigan Department of Health and Human Services (MDHHS) issued an order, effective immediately under the Public Health Code setting out protocols for visitation to address the threat to public health caused by COVID-19. This order rescinds and replaces an order issued on December 8, 2020.

Testing. Testing is required before indoor visitation at all facilities, except it is not required for

  • window visits
  • end of life visits
  • visitors younger than 14 years old (however, all individuals 13 years old or older who are visiting indoors in nursing homes, homes for the aged, and adult foster care facilities licensed to care for 13 individuals or more must be tested).

Point of entry testing should be done of visitors wherever possible. If point of entry testing is not available, visitors must be tested on their own within 72 hours of visiting and must provide proof of negative test results on entry. Testing for medical service providers, nonmedical service providers, and volunteers must the same as for similar staff working at the facility.

Indoor visitation. Indoor visitation may take place only if

  • the facility has no new COVID-19 cases (employee or resident) within the prior 14 days (admission of a COVID-19-positive resident is not included in this assessment) and is not doing outbreak testing;
  • the local health department has not prohibited visitation at the facility;
  • it is not with a resident who is in isolation or otherwise under observation for symptoms of COVID-19.

If visitation is not allowed due to the conditions listed above, visitation can still be achieved under these circumstances:

  • window visitors
  • a parent, foster parent, or guardian of a resident who is 21 years of age or under
  • those necessary for the support of activities of daily living (ADLs) under certain circumstances
  • those necessary to ensure effective communication with individuals with hearing, vision, or speech impairments
  • those, including clergy, visiting an individual under the facility’s care who is in serious or critical condition or in hospice care except where visitor is COVID-19 positive
  • those necessary for the provision of medical care (must be provided outdoors or in a well-ventilated area whenever possible)

Nonmedical providers and volunteers. Even when visitation would not be allowed because the local health department or MDHHS prohibited such, nonmedical providers and volunteers are allowed. Hairdressers, nail salon technicians, cosmetologists, providers of religious or spiritual services, etc., are allowed when it is determined by a qualified medical professional that there will be a negative effect (actual or potential) on the resident when the service is not provided and the resident will not benefit from remote service. These services may be provided to residents who have never been diagnosed with COVID-19 or who are no longer infectious. Services must be provided outdoors or in a well-ventilated area. Volunteers who have been trained in infection control measures and who are supporting visitation may also visit.

Some additional requirements for all types of visits include the following (see the order for the entire list under section (3)(c)):

  • Visitation must take place by appointment only and the facility may set reasonable time limits on the visit.
  • Visitors must log arrival and departure times, provide contact information, and state in writing that they will inform the facility if they develop COVID-19 symptoms within 14 days of the visit.
  • There is a maximum of two visitors per visit.
  • Visitors must use a face covering, follow hand hygiene requirements, and comply with the facility’s PPE requirements.
  • Visitors must use designated entrances that allow for COVID-19 screening.
  • There must be a health evaluation of visitors, which includes tests for fever and other symptoms of COVID-19 as well as inquiry regarding exposure to someone with COVID-19. No one with a fever or known exposure may be admitted.
  • Visitors must follow social distancing and refrain from physical contact, except for visits that support ADLS, visits to those in serious or critical condition or in hospice care, or visits by medical service providers.
  • Limit the number of overall visitors at the facility at any time based on limited space, infection control capacity, and other factors
  • There must be accommodation for visits to residents who share a room. These visits shall not be conducted in the resident’s room.

There must be adequate staff to assist with transition of residents, monitoring of the visitation, and for disinfecting of surfaces in the visitation area after each visit.

Outdoor visitation. Outdoor visitation area must allow for 6 feet of distance between people and provide protection from weather.

Residential care facilities include homes for the aged, nursing homes, adult foster care facilities, hospice facilities, substance use disorder residential facilities, and assisted living facilities. It does not include independent living facilities.

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