outdoor visitation

Taking a measured approach to resuming visitation and group activities, advocating for COVID-19 vaccines, continuing visitor screenings, and requiring masking and social distancing are among the recommendations that AMDA – The Society for Post-Acute and Long-Term Care Medicine is making to long-term care facilities as operators consider lessening restrictions that in many places have been in effect for almost a year.

With the availability of three vaccines against SARS-CoV-2, AMDA said Monday that optimism is mounting about the possibility of resuming group activities, including communal dining and visitation. 

Its recommendations come not long after the American Seniors Housing Association asked the nation’s governors to begin easing “harmful” visitation restrictions in senior living communities based on rising resident vaccination rates and as senior living communities across the country slowly begin to reopen their doors. Many states are implementing essential caregiver and compassionate caregiver programs to allow residents to designate family members to visit during a public health emergency.

AMDA Executive Director Christopher E. Laxton said that communities have to take a thoughtful approach to reopening to balance the risks of COVID-19 with the negative effects on activity and visitation restrictions. 

“Effective vaccines and therapeutics against COVID-19 are a significant step towards a post-pandemic world,” Laxton said. “A return to ‘normal,’ though, will not be immediate. Vaccine delays, vaccine hesitancy, admission of new, unvaccinated residents, and ongoing community COVID-19 cases conspire to prolong the threat of COVID-19.”

Parameters affecting the risk of COVID-19 transmission in congregate care settings include community spread, personal protective equipment, testing, staff member and resident cohorting, and the ability to quickly identify and isolate active cases.

AMDA said that several knowledge gaps around vaccination also present challenges, including vaccine efficacy among older adults living in long-term care settings, viral shedding and transmission following vaccination, the duration of protection against symptomatic and asymptomatic infections, virus variants and herd immunity. 

With COVID-19 transmission and vaccination knowledge ever evolving, AMDA offered a set of interim recommendations for long-term care settings to develop individual policies and procedures, including:

  • Adopt a measured approach.
  • Advocate for staff, residents, visitors and essential caregivers to be vaccinated against COVID-19 and influenza.
  • Schedule and supervise visits with residents in designated areas to ensure mask-wearing and effective hand hygiene until visitors become accustomed to new policies and procedures.
  • Continue screening visitors for COVID-19. Perform rapid results antigen testing, when available, for anyone exhibiting symptoms, or ask each visitor to present documentation of a recent negative SARS-CoV-2 test.
  • Require visitors to wear medical-grade masks issued by the community, practice effective hand hygiene and only allow visitors to see one resident per day. 
  • Develop policies and procedures that align with local and state health departments, the Centers for Disease Control and Prevention, and the Centers for Medicare & Medicaid Services, including policies and procedures for compassionate care and essential caregivers.