State releases guidance for visits at long-term care facilities

Missouri has released revised guidance for long-term care facilities that wish to establish an "essential caregiver" program or resume general visits for patients.

Facilities are asked to have a policy in place to illustrate how contact with loved ones can occur while protecting the health of all their residents.

The Department of Health and Senior Services offered guidance here.

The proposed guides suggest for outdoor visits, the visits should be limited to only residents who are COVID-19 negative or asymptomatic and not suspected to have the coronavirus. Previously, COVID-19-positive patients who have been released from isolation may also have outdoor visits.

Under the guidance, facilities may offer general (primarily indoors) visits if they have not had any facility-acquired cases in the past two weeks. Facility-acquired cases do not include residents admitted to the facility with a known positive test or residents who test positive within 14 days of admission.

The facilities should limit visits to only residents who are COVID-19 negative, asymptomatic and not suspected of having COVID-19. Residents who have had COVID-19, but since been released from isolation, may also have visitors.

Facilities should create indoor spaces for residents in a room easily reached by visitors without them passing through the general population of the building.

If visits are allowed in a resident's private room because the resident is bed-bound and for health reasons cannot leave their room, any visitors must utilize full personal protective equipment, including a gown, mask and gloves at all times while in the facility. This PPE may be provided at the facility's expense.

Among other suggested guidelines, there should be limits on the number of visitors, both to rooms and overall.

Similar rules should apply to essential caregivers, who are individuals including clergy members, who have been given consent by the resident, or their guardian or legal representative, to provide health care services or assistance with activities of daily living to help maintain or improve the quality of care or quality of life of a facility resident. Care or services provided by the essential caregiver is included in the plan of care or service plan for the resident and may include assistance with bathing, dressing, eating and/or emotional support.

Facilities should require that residents designate who essential caregivers are, if they have one.

They should also limit the number of caregivers a resident has.

Among other guidelines offered, only one essential caregiver should be allowed with the resident at a time.