DATE:
TO:
FROM:

July 10, 2020
Nursing Home Operators and Administrators
New York State Department of Health
Health Advisory: Skilled Nursing Facility Visitation
Please distribute immediately to:
Operators, Administrators, Directors of Nursing, Medical Director, Activities
Professionals

On March 13, 2020, the Department of Health (“Department”) issued guidance to nursing
homes (NHs) limiting visitation to medically necessary or end-of-life services. Such guidance
was updated July 10, 2020. The guidance further provided that facilities where one or more
residents tested positive for COVID-19 should cancel congregate meals and activities. The
Department will now permit outside visitation, and limited indoor visitation and activities, if the
NHs meet specific benchmarks and develop a reopening plan via the NY Forward Safety Plan.
This directive details specific criteria NHs must follow for reducing such restrictions, while
mitigating the risk of resurgence of COVID-19. Nothing in this directive absolves a NH’s
responsibility to ensure that resident and family communication is ongoing and supported by
virtual visits, whenever possible, nor does it change the guidance previously issued relative to
visitation for medically necessary or end-of life services.
Nursing Homes in Phase 3 regions may resume limited visitation and activities beginning five
(5) days after the release of this health advisory and only under the following conditions:
1. The region in which the NH is located is in Phase 3.
2. The NH is in full compliance with all state and federal requirements, state Executive
Orders and guidance, state reporting requirements including COVID-19 focus surveys,
HERDS and staff testing surveys, and federally required submission of COVID-19 data
to the National Healthcare Safety Network (NHSN).
3. The NH has protocols to separate residents into cohorts of positive, negative, and
unknown as well as separate staffing teams to deal with COVID-positive residents and
nonpositive residents. In order to effectuate this policy, nursing home facilities should
transfer residents within a facility, to another long-term care facility, or to another
noncertified location if they are unable to successfully separate out patients in individual
facilities.
4. The NH has completed the NY Forward Safety Plan and submitted a copy of the
completed plan to covidnursinghomeinfo@health.ny.gov. The facility must retain a copy
of the plan at the facility where it is easily accessible and immediately available upon
request of the Department or local health department. Any changes to the plan must be
immediately communicated to the Department. The plan must clearly articulate the
space(s) to be used for visitation (outdoors and indoors) including the number of visitors
and residents which could be safely socially distanced within the space(s). Such plan

 shall include attestation of compliance with all State and federal guidelines as described
in number 2.
5. The NH has no staffing shortages as evidenced by the NH’s individual staffing plan and
as reported by the NH through submissions to the National Health Safety Network
(NHSN).
6. The absence of any new onset of COVID-19 among staff or residents as reported to the
Department on the HERDS and staff testing surveys and as reported to the NHSN for a
period of no less than twenty-eight (28) days, consistent with CMS established
thresholds.
7. Access to adequate testing. The NH should have a testing plan in place that, at a
minimum, ensures all consenting nursing home residents have received a single
baseline COVID-19 test. In addition, the NH must have the capability to test or can
arrange for testing of all residents upon identification of any individual with symptoms
consistent with COVID-19. If a staff member tests positive for the SARS-CoV-2 virus, the
NH must have the capacity to continue re-testing all nursing home staff and residents, as
applicable.
8. An executed and operationalized arrangement with laboratories to process SARS-CoV-2
virus tests. As recommended by CMS, the test used should be able to detect SARSCoV-2 virus (e.g., polymerase chain reaction (PCR)) with greater than 95 percent
sensitivity, greater than 90 percent specificity, with results obtained and rapidly reported
to the NH.
9. Adherence to written screening protocols for all staff during each shift, each resident
daily, and all persons entering the facility or grounds of such nursing home, including
visitors. Resident monitoring must include daily symptom checks, vital signs, and pulse
oximetry.
10. A copy of the NH’s formal visitation plan is posted to their public website and
broadcasted via email or social media to provide visitors with clear guidelines for visiting
and to announce if and when visitation is paused due to an increase in the number of
residents and/or staff with a confirmed positive COVID-19 diagnosis.
When a NH meets all of the above criteria, the nursing home may resume visitation
following the guidelines outlined below which must also be included in the NH’s NY
Forward Safety Plan.
1. Visitation should be limited to outdoor areas, weather permitting. Under certain limited
circumstances, as defined by the facility, visitation can be inside, in a well-ventilated
space with no more than 10 individuals who are appropriately socially distanced and
wearing a facemask or face covering while in the presence of others. This may include
residents visiting each other.
2. At this time, visitation is strictly prohibited in resident rooms or care areas with the
exception of parents and immediate family members visiting a pediatric resident (up to
age 21) on a dedicated pediatric unit/wing when such room is only occupied by the
child receiving a visit. In those instances, all other requirements listed in this directive
apply.
3. Specialty practitioner, podiatric, and dental services may continue. Strict adherence to
infection control guidelines is required.
4. Limited visitation, including, but not limited to, family members, loved ones,
representatives from the long-term care ombudsman program (LTCOP), and resident
advocacy organizations, will be permitted under the following conditions:
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 a. Adequate staff are present to allow for personnel to help with the transition of
residents, monitoring of visitation, and cleaning and disinfecting areas used for
visitation after each visit using an EPA-approved disinfectant.
b. The nursing home maintains signage regarding facemask utilization and hand
hygiene and uses applicable floor markings to cue social distancing
delineations.
c. Visitors are screened for signs and symptoms of COVID-19 prior to resident
access and visitation will be refused if the individual(s) exhibits any COVID-19
symptoms or do not pass the screening questions. Screening shall consist of
both temperature checks and asking screening questions to assess potential
exposure to COVID-19 which shall include questions regarding international
travel or travel to other states designated under the Commissioner’s travel
advisory. The facility must maintain screening questions asked onsite and
make it available upon the Department’s request.
d. Documentation of screening must be maintained onsite in an electronic format
and available upon the Department’s request for purposes of inspection and
potential contact tracing. Documentation must include the following for each
visitor to the nursing home:
i.. First and last name of the visitor;
ii. Physical (street) address of the visitor;
iii. Daytime and evening telephone number;
iv. Date and time of visit;
v. Email address, if available; and
vi. A notation indicating the individual cleared the screening (both
temperature and questions) that does not include any individual
temperatures or other individual specific information.
e. There is adequate PPE made available by the nursing home to ensure
residents wear a facemask or face covering which covers both the nose and
mouth during visitation, if medically tolerated.
f. Visitors must wear a face mask or face covering which covers both the nose
and mouth at all times when on the premises of the NH. Visitors must maintain
social distancing, except when assisting with wheelchair mobility. The nursing
home must have adequate supply of masks on hand for visitors and must
make them available to visitors who lack an acceptable face covering.
g. Facilities provide alcohol-based hand rub, consisting of at least 60 percent
(60%) alcohol, to residents, visitors, and representatives of the long-term care
ombudsman visiting residents and those individuals are able demonstrate to
appropriate use.
h. No more than 10 percent (10%) of the residents shall have visitors at any one
time and only two visitors will be allowed per resident at any one time. The
nursing home should design and communicate visitation policies in order to
comply with this requirement and schedule such visits.
i. Visitors under the age of 18 must be accompanied by an adult 18 years of age
or older.
j. Current COVID-19 positive residents, residents with COVID-19 signs or
symptoms, and residents in a 14-day quarantine or observation period are not
eligible for visits.
k. The nursing home should develop a short, easy-to-read fact sheet outlining
visitor expectations including appropriate hand hygiene and face coverings.
The fact sheet must be provided upon initial screening to all visitors
5. Residents may also be assisted to go outdoors with staff supervision. The appropriate
infection control and safety and social distancing requirements must be maintained.
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 6. An interdisciplinary team must be created by the facility to review visitation program
compliance with this Health Advisory.
7. If any visitor fails to adhere to the protocol, he/she/they will be prohibited from visiting
for the duration of the COVID-19 state declared public health emergency.
Facilities should establish additional guidelines as needed to ensure resident and staff safety
and continuity of facility operations. Hours of visitation must be clearly delineated in policy and
within the visitation fact sheet. Nursing homes must continue to refrain from sending residents
to non-medically necessary trips outside the nursing home until further notice. Please be
reminded that communal dining and hairdresser services remain suspended at this time.
Violations of this directive will result in the imposition of fines and additional enforcement
remedies.
If the facility falls out of compliance with requirements listed in this advisory, the NH should
immediately halt visitation and inform the Department. In addition, the Department can halt
visitation at the nursing home at any time due to community or facility spread of infection, or
when the Department identifies that the NH has failed to comply with requirements of this
advisory.
In summary, while these guidelines are intended to restart limited visitation, the Department
reserves the right to restrict visitation at any point. Failure to follow these guidelines may
result in restriction or revocation of visitation.
Information for healthcare providers on topics related to COVID-19 is readily available on the
Department of Health public website at https://coronavirus.health.ny.gov/informationhealthcare-providers.
Thank you for your ongoing support and cooperation in responding to COVID-19 concerns.
Questions may be routed to covidnursinghomeinfo@health.ny.gov.

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