MINNESOTA DEPARTMENT OF HEALTH Frequently Asked Questions: Long-term Care Visitation and Activities Recommendations What is the purpose of this guidance? The Minnesota Department of Health developed this guidance to support long-term care facilities as they seek to find the proper balance between protecting residents from COVID-19 and ensuring they have healthy social and emotional connections with their family and friends. Since before the first case of COVID-19 was reported in Minnesota, we have been working to help facilities prepare and protect their residents. We have implemented a five-point plan to help stabilize facilities and support them as they deal with the ongoing threat of COVID-19. Recognizing that we will be dealing with COVID-19 concerns for months to come, this guidance is designed to help facilities keep their COVID-19 guard up while taking a cautious step toward ensuring residents have more social connections and interaction. Why is this guidance needed? Ensuring the health and well-being of our loved ones in long-term care facilities requires that we address not just physical and mental health, but quality of life issues as well. That is not a sustainable situation for the emotional and social well-being of residents. This also takes a significant toll on the loved ones who are not able to visit their family and friends in facilities. Furthermore, allowing visits from family and friends can help identify any potential maltreatment or abuse of our elders. According to our state regulators, the number of maltreatment reports coming into the Minnesota Department of Health has dropped by 20% compared to a similar period, March to the end of July, from 2019. It is unlikely that such a significant drop would have happened by coincidence. This drop suggests that having family and friends visiting residents of facilities plays an important role in identifying potential maltreatment. What does the guidance say? This guidance sets forth a safe and measured process long-term care facilities can use to determine on an ongoing basis. It provides a series of factors facility management should use to evaluate risk levels for 1 of 5 FAQ: VISITATION GUIDANCE FOR LONG-TERM CARE FACILITIES the facility and its surrounding community. It sets forth a clear process and procedure for allowing greater visitation in a safe manner when facility and community factors indicate it is appropriate to do so. The guidance states facilities must develop testing plans and requires or recommends baseline facilitywide testing within a window of time before or after opening, depending on facility type. Nursing homes must test and testing is recommended in assisted living facilities. Facilities should refer to existing MDH guidance on the appropriate use of testing in long-term care facilities. What specific factors will be used to determine whether a facility should or should not allow visitors? There is one main, and quite stringent, risk factor for a long-term care facility to either open up to more visitation and activities. This is whether there has been an exposure in the facility from a COVID-19 case in a resident, staff, or visiting service provider within the past 28 days. Those facilities with a case within the past 28 days stay in or return to Visitation and Activities Level 1, the most restricted level. Those without a case can consider moving to Visitation and Activities Level 2, which allows for more visits and activities. MDH and partners agreed on a strict threshold due to the extremely vulnerable population in these facilities. For example, schools would not have to automatically go to distance learning if they confronted a single case, but nursing homes will have to do so. Aside from the 28-day history of exposure at a facility, the guidance indicates several other risk factors for facility management to assess when making the decision to move to a higher level of visitation and activities. These include case incidence in the surrounding community, facility size, and the extent to which staff at the facility are working at other LTC facilities as well. Type of facility is also an important risk factor. To move to the more open Visitation and Activities Level 2, at least initially, nursing homes must do facility-wide testing, at least initially, due to the demonstrated higher risk of their residents contracting and dying from COVID-19. Assisted living type-facility residents are still at high risk, and so facility-wide testing is recommended. Community case counts are also a factor for facilities to consider. Facilities should monitor the 14-day case rate in their county. 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. 2 of 5 FAQ: VISITATION GUIDANCE FOR LONG-TERM CARE FACILITIES Why should facilities be allowing visitation when COVID-19 is still circulating widely? The recommendations on visitation and activities in long-term care facilities have been developed with the health and welfare of residents as our highest priority. Relaxing visiting requirements, and allowing more people to enter facilities, comes with some increased risk of infection. However, we also know that ongoing isolation will take a physical and emotional toll on residents. With no end in sight to this pandemic, we must carefully consider the implications of our strategies and actions on Minnesota’s seniors. While we encourage facilities to proceed with caution, we also encourage them to ensure that residents are not separated from their family and friends any longer than necessary. Facilities should regularly monitor the factors that increase their risk of COVID-19 and adjust restrictions as conditions indicate. Throughout the process, the Minnesota Department of Health will provide technical assistance and other support to help ensure the stability of facilities. How does this guidance compare to the state’s guidance for schools? There are similarities between this guidance and the guidance recently developed for schools, especially in their flexible and localized approach. However, the long-term care visitation guidance is more conservative. This is because most residents of long-term care facilities are older and dealing with underlying health conditions – factors that make them more vulnerable to severe illness if they contract COVID-19. What protections are built into this guidance to prevent COVID-19 from being introduced and spread within a facility? While we expect long-term care facilities, their staff, visitors, and other individuals to follow and practice proper infection control practices and social distancing inside and outside of work, we also understand there is always a risk of COVID-19 in a facility. The guidance indicates that if a facility has been exposed from a COVID-19 case in within the past 28 days they must move back to the more closed Visitation and Activities Level 1. Moving quickly back into level 1 will decrease further risk for the facility. The Minnesota Department of Health has issued a Long-term Care Toolkit and the State of Minnesota has implemented extensive efforts to provide facilities with the staffing, testing capacity, and personal protective equipment and COVID-19 management support they need to prevent COVID-19. 3 of 5 FAQ: VISITATION GUIDANCE FOR LONG-TERM CARE FACILITIES Who is responsible for which parts of this process? The State of Minnesota responsibilities include providing guidance and sharing best practices, regulation and oversight, conducting investigations of facility complaints, investigating disease outbreaks, and consulting on mitigation measures. Part of regulatory oversight includes ensuring that resident rights are protected. During the pandemic, the state also supports stability of long-term care providers by acting as a safety net in crisis situations and can assist in building statewide infrastructure and increasing access to testing and personal protective equipment. It is the responsibility of long-term care facilities to act in the best interest of their residents and staff, to ensure their safety, implement appropriate infection control measures, and plan for adequate staffing levels. Long-term care facilities are also responsible for carefully reviewing current conditions at their facility and in their community to determine if any adjustments to their visitation and activity level are needed, creating and implementing a testing plan, seeking assistance from the state as needed, and appropriately communicating with the family members of residents. When will this guidance be implemented? The guidance will go into effect on August 29, 2020. Providers with questions or concerns about the guidance or the timeline can email health.fpc-web@state.mn.us to reach the MDH health regulation division. How might this guidance change if the outbreak becomes more intense or changes in other ways? This guidance may be modified to better reflect changing conditions and to ensure the continued health and welfare of residents in long-term care facilities. Facilities should closely monitor conditions in their communities, the health and welfare of their residents, and other conditions as outlined in the guidance, and be prepared to move back into the more restrictive Visitation and Activities Level 1 when indicated. The guidance takes into account the fluctuating COVID-19 case counts and identifies that one of the factors that can inform decisions on relaxing restrictions is the case activity level in communities. It is recommended that facilities closely track the incidence of the virus in their county, with a COVID-19 case incidence of 10 per 10,000 over a 14-day-time-period as elevated risk of disease transmission. MDH does have county data available to facilities on a weekly basis to support their decision-making. Who provided input into this guidance? The guidance was developed by the Minnesota Department of Health in collaboration with partners and stakeholders, including Minnesota’s long-term care industry and resident advocates. 4 of 5 FAQ: VISITATION GUIDANCE FOR LONG-TERM CARE FACILITIES What will happen if a facility refuses to allow visitations? Most long-term care facilities in Minnesota clearly understand they have an obligation to act in the best interest of their residents and staff, to ensure their safety, implement appropriate infection control measures, and plan for adequate staffing levels. If a facility has a visitation policy in place that either presents an undue risk of disease transmission, or needlessly inhibits the ability of residents to have contact with friends and family, the Minnesota Department of Health’s Health Regulation Division will work with the facility to correct the situation. You can email health.ohfc-complaints@state.mn.us to contact the MDH health regulation division. Facilities should ensure residents, and their loved ones, have access to advocacy services through the Office of Ombudsman for Long-Term Care at 651-4312555 or 1-800-657-3591. Minnesota Department of Health health.mn.gov 651-201-5000 625 Robert Street North PO Box 64975, St. Paul, MN 55164-0975 To request an alternate format, please call 651-201-4989 8/10/2020 5 of 5