Effective 03/08/2022 Revised
The CMS and SD DOH guidance which is the basis for this plan considers all the vaccinations which have occurred in residents and staff. Visitation can be conducted in residents’ rooms, dedicated visitation spaces, and outdoors. Regardless of how visits are conducted, certain core principles and best practices reduce the risk of COVID-19 transmission:
The Core Principles of COVID-19 Infection Prevention
- Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine, will not be allowed at Dow Rummel (regardless of their vaccine status). Screening will be conducted of all who enter the facility for signs and symptoms of COVID-19, status of positive viral test and quarantine status. There will be a limited number of entrances when screenings will be conducted for the licensed care areas. The primary entrance is 1321 W Dow Rummel Street between 8 am and 6:30 pm Sunday through Saturday.
- Hand hygiene (use of alcohol-based hand rub is preferred)
- Face covering or mask (covering mouth and nose)
- Social (physical) distancing at least six feet between persons
- Instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face covering or mask, specified entries, exists and routes to designated areas, hand hygiene)
- Cleaning and disinfection high-frequency touched surfaces in the facility often, and designated visitation areas after each visit
- Appropriate staff use of Personal Protective Equipment (PPE)
- Effective cohorting of residents (e.g., separate areas dedicated to COVID-19 care)
- Resident and staff testing conducted as required by the SDDOH and CMS
These core principles are consistent with the CDC guidance for nursing homes/assisted living centers and should be adhered to at all times. Additionally, visitation should be person-centered, consider the residents’ physical, mental and psychosocial well-being, and support their quality of life. The risk of transmission can be further reduced using physical barriers (e.g., clear plexiglass dividers, curtains). Visits should be conducted with an adequate degree of privacy. Visitors who are unable to adhere to the core principles of COVID-19 infection prevention should not be permitted to visit or should be asked to leave. By following a person-centered approach and adhering to these core principles, visitation can occur safely based on the below guidance.
Outdoor Visitation
While taking a person-centered approach and adhering to the core principles of COVID-19 infection prevention, outdoor visitation is preferred even when the resident and/or visitor are not fully vaccinated against COVID-19. Outdoor visits generally pose a lower risk of transmission due to increased space and airflow. However, weather considerations (e.g., inclement weather, excessively hot or cold temperatures, poor air quality) or an individual resident’s health status (e.g.., medical condition(s), COVID-19 status, quarantine status) may hinder outdoor visits. When outdoor visits can be conducted, one or more accessible and safe outdoor areas for visitation will be set aside to provide adequate space for private conversations. Staff will be available during the scheduled times to do health screenings for all visitors, to ensure all visitors are wearing masks at all times, residents are wearing masks if appropriate and residents and visitors are following the core principles of COVID-19 infection prevention.
Indoor Visitation
Dow Rummel will allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident or visitor. Although there is no limit to the number of visitors that a resident can have at one time, visits should be conducted in a manner that adheres to the core principles of COVID-19 infection prevention and does not increase risk to other residents. Visitors should physically distance from other residents and staff. Physical distancing should be maintained even during peak times of visitation (e.g., lunchtime, after business hours, etc.). Visitors may eat in public areas if they are sitting at a table with ONLY the resident(s) they are visiting, no other residents are sitting at the same table as them and are physically distancing from others. Residents and visitors can reserve the Rose Room, Gathering Hall, Private Dining Room in Covells, Private Dining Room Village East, Private Dining Room in Memory Care, the Oak Room in Village South, the Elmen Room or Warner Room for private parties where they can eat together as long as those who are not up to date with vaccines are wearing a mask when not eating. If residents want to eat with their visitor in their rooms, we can accommodate having meals delivered to the resident’s room. Also, large gatherings (e.g., parties, events) where residents are invited should be avoided when large numbers of visitors are in the same space at the same time if physical distancing cannot be maintained.
If a resident’s roommate is unvaccinated or immunocompromised (regardless of vaccine status), visits should not be conducted in the resident’s room, if possible. For situations where there is a roommate, and the health status of the resident prevents leaving the room, staff and visitors should attempt to enable in-room visitation while adhering to the core principles of infection prevention.
If Minnehaha County’s COVID-19 community level of transmission is substantial or high, all residents and visitors, regardless of vaccination status, should wear face coverings or masks and physically distance, at all times. When the community level of transmission is low or moderate, the safest practice is for residents and visitors to wear face coverings or masks and physically distance, particularly if either of them is at increased risk for severe disease or are unvaccinated. However, if the transmission level is low or moderate, the resident and all their visitor(s) are fully vaccinated and the resident is not moderately or severely immunocompromised, they may choose not to wear face coverings or masks and to have physical contact when in the resident’s room. Visitors should wear face coverings or masks when around other residents or healthcare personnel, regardless of vaccine status.
If the county’s level of community transmission is substantial or high, Dow Rummel encourages visitors to be tested on their own before coming to visit (e.g., within 2-3 days). Dow Rummel, along with CMS, strongly encourages all visitors to become vaccinated. However, visitors are not required to be tested or vaccinated as a condition of visitation.
While not recommended, residents who are on transmission-based precautions (TBP) or quarantine can still receive visitors. In these cases, visits should occur in the resident’s room and the resident should wear a well-fitting facemask (if tolerated). Before visiting a resident is on TBP or quarantine, visitors should be made aware of the potential risk of visiting and precautions necessary in order to visit the resident. Visitors should adhere to the core principles of infection prevention.
CMS and CDC continue to recommend residents and visitors adhere to the core principles of COVID-19 infection. This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated. However, we acknowledge the toll that separation and isolation has taken. We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved ones. Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) in accordance with CDC’s recommendations – “Unvaccinated residents may also choose to have physical touch based on their preferences and needs, such as with support persons for individuals with disabilities and visitors participating in certain religious practices, including end-of-life situations. In these situations, unvaccinated residents (or their representative) and their visitors should be advised of the risks or physical contact prior to the visit.
Indoor Visitation During an Outbreak
An outbreak investigation is initiated when a new onset of COVID-19 occurs (e.g., a new COVID-19 case among residents or staff in a building). When a new case of COVID-19 among residents or staff is identified, contact tracing will be done immediately to determine what procedures need to be followed including outbreak testing. To swiftly detect cases, the facility should adhere to CMS regulations and guidance for COVID-19 testing, including routine staff testing, testing of individuals with symptoms, and outbreak testing. Outbreak testing should occur by following Dow Rummel’s Testing Policy and Procedure.
While it is safer for visitors not to enter the facility during an outbreak investigation, visitation will still be allowed. Visitors should be made aware of the potential risk of visiting during an outbreak investigation and adhere to the core principles of infection prevention. If residents or their representatives would like to have a visit during an outbreak investigation, they should wear face coverings or masks during visits, regardless of vaccination status, and visits should ideally occur in the resident’s room.
Compassionate Care Visits
Compassionate care visits are allowed at all times. Since visitation is now allowed at all times for all residents, there are few scenarios when visitation should be limited only to compassionate care visits. In the event a scenario arises that would limit visitation for a resident (e.g., a resident is severely immunocompromised and the number of visitors the resident is exposed to needs to be kept to a minimum), compassionate care visits would still be allowed at all times.
Communal Activities, Dining, and Resident Outings
While adhering to the core principles of COVID-19 infection prevention, communal activities and dining may occur amongst residents. Visitors can accompany a resident to activities and dining if physical distancing can be maintained from other residents. Book clubs, crafts, movies, exercise, and bingo are all activities that can be facilitated with alterations to adhere to the guidelines for preventing transmission. Bus trips should be offered while adhering to the core principles of COVID-19 infection prevention.
Residents are allowed to leave Dow Rummel as they choose. Should a resident choose to leave, the staff should remind the resident and any individual accompanying the resident to follow all recommended infection prevention.
Upon the resident’s return, may take the following actions based on the county’s spread:
- Screen residents upon return for signs or symptoms of COVID-19.
- If the resident or family member reports possible close contact to an individual with COVID-19 while away, test the resident for COVID-19, regardless of vaccination status. Place the resident on quarantine if the resident has not been fully vaccinated.
- If the resident develops signs or symptoms of COVID-19 after the outing, test the resident for COVID-19 and place the resident on Transmission-Based Precautions, regardless of vaccination status.
- Dow Rummel may test unvaccinated residents without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time, such as over 24 hours.
- Dow Rummel may quarantine unvaccinated residents who leave the facility if, based on an assessment of risk, uncertainty exists about their adherence or the adherence of those around them to recommended infection prevention measures. Refer to Procedure to Follow for Residents Returning from a Personal Leave document.
- Monitor residents for signs and symptoms of COVID-19 daily.
Residents who leave the facility for 24 hours or longer should generally be managed as a new admission or readmission, as recommended by CDC. See Procedure to Follow for New Admissions or Readmissions for Residents Returning from the Hospital or Medical Visits. Please note that there are exceptions to quarantine, including for fully vaccinated residents.
Healthcare Workers, Volunteers and Other Services
To protect residents and staff, Dow Rummel requires staff to be fully vaccinated against Coronavirus with federally approved (including Emergency Use Authorization) vaccines. Staff refers to any individuals that work or volunteer routinely in the facility, regardless of clinical responsibility or resident contact. This includes individuals under contract or other arrangements (e.g., medical directors, hospice and dialysis staff, therapists, mental health professionals, barbers, beauticians, or routine/weekly volunteers). All healthcare workers, those providing other services, and volunteers should adhere to the core principles of COVID-19 infection prevention and must comply with COVID-19 testing requirements.
EMS personnel do not need to be screened so they can attend to an emergency without delay.
Occasionally (less than weekly) volunteers will be allowed to come in and provide services as long as they are either fully vaccinated or can show proof of a negative COVID test within the last 3 days. If they want to be tested at Dow Rummel, they will need to make arrangements ahead of time to be tested. Dow Rummel encourages all volunteers to receive the COVID vaccine, for their safety and the safety of our residents and staff. If the volunteer comes to Dow Rummel on at least a weekly basis they would be considered a routine volunteer. Their vaccine status should be reported to our Infection Control nurses for reporting purposes and will be required to adhere to Dow Rummel’s mandatory vaccine protocols. All volunteers should adhere to the core principles of COVID-19 infection prevention, including wearing a mask as required, and must comply with any COVID-19 testing requirements.
Access for Other Professionals
Long Term Care facilities are not permitted to restrict access to surveyors based on vaccination status, nor ask a surveyor for proof of his or her vaccination status as a condition of entry. Surveyors should not enter a facility if they have a positive viral test for COVID-19, signs or symptoms of COVID-19, or currently meet the criteria for quarantine. Surveyors should also adhere to the core principles of COVID-19 infection prevention and adhere to any COVID-19 infection prevention requirements set by federal and state agencies.
Dow Rummel must provide representatives of the Office of the State Long-Term Care Ombudsman with immediate access to any residents. If an ombudsman is planning to visit a resident who is in TBP or quarantine, or an unvaccinated resident in a county where the level of community transmission is substantial or high in the past 7 days, the resident and ombudsman should be made aware of the potential risk of visiting, and the visit should take place in the resident’s room. Representatives of the Office of the Ombudsman should adhere to the core principles of COVID-19 infection prevention. If the resident or the Ombudsman program requests alternative communication in lieu of an in-person visit, staff will, at a minimum, facilitate alternative resident communication with the Ombudsman program, such as by phone or through use of other technology. Dow Rummel will also allow the Ombudsman to examine the resident’s medical, social, and administrative records as otherwise authorized by State law.
Dow Rummel will allow immediate access to a resident by any representative of the protection and advocacy systems, as designated by the state, and as established under the Development Disabilities Assistance and Bill of Rights Act of 2000 (DD Act), and of the agency responsible for the protection and advocacy system for individuals with a mental disorder (established under the Protection and Advocacy for Mentally Ill individuals Act of 2000). Protection and Advocacy programs authorized under the DD act protect the rights of individuals with developmental and other disabilities and are authorized to “investigate incidents of abuse and neglect of individuals with developmental disabilities if the incidents are reported or if probable cause to believe the incidents occurred.” If the P&A is planning to visit a resident who is in TBP or quarantine, or an unvaccinated resident in a county where the level of community transmission is substantial or high in the past 7 days, the resident and P&A representative should be made aware of the potential risk of visiting and the visit should take place in the resident’s room. Facilities much comply with federal disability rights laws. For example, if communicating with individuals who are deaf or hard of hearing, it is recommended to use a clear mask or masks with a clear panel. Face coverings should not be placed on anyone who has trouble breathing or is unable to wear a mask due to a disability, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. In addition, if a resident requires assistance to ensure effective communication (e.g., a qualified interpreter or someone to facilitate communication) and the assistance is not available by onsite staff or effective communication cannot be provided without such entry (e.g., video remote interpreting), the facility must allow the individual entry to interpret or facilitate, with some exceptions. This would not preclude Dow Rummel from imposing legitimate safety measures that are necessary for safe operations, such as requiring such individuals to adhere to the core principles of COVID-19 infection prevention.