As vaccination rates increase among senior living residents and staff, states are following the federal government’s lead in relaxing restrictions.

The California Department of Public Health updated its guidance in early March to expand opportunities for close contact, indoor, in-room visitation, as well as infection control measures for fully vaccinated residents and visitors. An “all facilities letter” indicates that long-term care facilities can adjust visitation guidelines according to their specific needs. 

Following Centers for Medicare & Medicaid Services and Centers for Disease Control and Prevention guidance, California is allowing in-room visitation for fully vaccinated residents regardless of county COVID positivity rates, although visitors in high community spread counties will need to produce a negative COVID-19 test before visits. Visitors also will be required to wear masks and socially distance.

Compassionate care visitation also must be permitted, the state said, although visitors will be screened for COVID-19 symptoms, undergo routine testing at least weekly, wear a surgical mask while in a building and restrict their movement to a resident’s room or other location designated by the facility. 

Communal dining, group activities and non-essential personnel and contractor services can resume as long as masking and social distancing practices are followed.

Similarly, the North Carolina Department of Health and Human Services updated its visitation guidance for assisted living communities and other long-term care facilities to allow in-person visitation in most circumstances. In addition to updating its guidance, the department also rescinded a previous order restricting visitation in those settings. The updated guidance no longer requires quarantining for fully vaccinated residents and lifts work restrictions for caregivers who are fully vaccinated.

In South Carolina, all assisted living communities and nursing homes now required to allow outdoor visitation under updated guidelines announced Friday. All facilities also are required to allow indoor visitation, with few exceptions.

Michigan also issued visitation guidance for residential facilities on Friday. Facilities are advised to schedule visits but limit their duration and limit visitor movement, conduct health screenings, wear masks and follow safe hygiene practices, practice physical distancing, staff accordingly, optimize outdoor spaces, encourage outdoor visitation whenever
possible, and conduct point-of-entry testing of visitors whenever possible.

Pennsylvania, Minnesota and Indiana also are urging the state’s senior living and other long-term care facilities to implement visitation guidance issued by CMS, which includes allowing compassionate care visits. The guidance allows fully vaccinated residents to have close contact with visitors wearing masks and allows indoor visitation at all times, regardless of vaccination status of the resident or visitor.

Exceptions exist, however, including limited visitation for unvaccinated residents living in counties with a 10% or higher COVID positivity rate or living in facilities with 70% or less of residents vaccinated. In addition, COVID-positive residents and those in quarantine should refrain from visitation until they meet criteria to be released from quarantine. 

Minnesota also allows vaccinated residents to visit with other vaccinated individuals outside of their communities without requiring quarantine on their return, including attending worship services or other events, or shopping or eating in public establishments. The Minnesota Department of Health encouraged those outings to take place in counties with a positivity rate of less than 5%.

The New York State Department of Health also released new guidance for visitors at assisted living communities, allowing visits in private homes. But the Empire State Association of Assisted Living said that strict rules remain, including shutting down all visitation with a single positive case in a facility. Visits in private homes also require everyone to be masked and socially distanced. The number of visitors is limited, and COVID-19 screenings remain in place.

North Dakota rescinded two executive orders from Gov. Doug Burgum, giving assisted living communities more latitude in decision-making around visitation. With more than 85% of the state’s long-term care residents fully vaccinated, the state has shifted to locally driven decisions in assisted living communities. The state also is providing testing supplies to all long-term care facilities as they transition to a post-vaccination phase.

Burgum rescinded two executive orders requiring assisted living communities to conduct routine COVID-19 testing of residents and staff members. Facilities are strongly encouraged to collaborate with the states’ Vulnerable Population Protection Plan team and follow the continuing recommendations on testing, service and visitation in accordance with CDC guidance.

Essential caregiver training

Oklahoma is reopening visitation at assisted living communities and other long-term care facilities to visitors who complete state-certified essential caregiver training.

The updated “life-altering” guidelines from Gov. Kevin Stitt and Health Commissioner Lance Frye, M.D., allows residents to designate one or more essential caregivers for in-person visits. Those caregivers need to undergo a 15-minute, state-provided online training before visitation can begin.

“This new guidance is life-altering for Oklahomans living in long-term care centers and their family members who have been separated for so long,” Deputy Commissioner of Health Innovation Travis Kirkpatrick said in a statement.

The enhanced visitation plan has different requirements, depending on the vaccination status of both the resident and the visitor. If both are fully vaccinated, then masking still is required, and proof of vaccination must be provided. If neither is vaccinated, then a mask and proof of a negative COVID-19 test or an on-site rapid test may be required for a supervised, no-contact visit. If only one of them is vaccinated, then a mask and proof of a negative COVID-19 test is required for a non-supervised contact visit.

The state is providing long-term care facilities with personal protective equipment for visitation, as well as access to rapid COVID-19 tests “to give a holistic approach to prevention.”

Some states are rescinding previous orders regarding visitation and directing communities to follow recent guidance updates from the CMS and CDC.

Vaccination expansion

The Ohio Department of Aging launched a COVID-19 Vaccine Maintenance Program to continue providing vaccines to assisted living communities and nursing homes as the federal long-term care vaccination program ends. The intent is to vaccinate new employees and residents, as well as provide additional vaccination opportunities to anyone who was not vaccinated during initial on-site vaccination clinics. 

Ohio Gov. Mike DeWine said that 77% of assisted living communities and 93% of nursing homes have signed up with the state for those additional vaccines through local pharmacies. The program has delivered 16,000 additional doses to those facilities, with an additional 30,000 doses scheduled through the end of March.

Pennsylvania’s Department of Human Services also recently announced that the state expanded its partnership with Rite Aid Pharmacy to vaccinate 9,000 older adults and individuals with disabilities participating in the state’s home and community-based long-term services and supports program. 

The effort will extend vaccine access through vaccination clinics in March and April. More than 397,000 vaccine doses were administered in Pennsylvania through the federal Pharmacy Partnership for Long-Term Care, and more than 20,000 vaccines were administered through the Rite Aid partnership to residents and staff of long-term and congregate care settings.

Invalidating fines

Florida Gov. Ron DeSantis recently invalidated fines that local governments have used against businesses violating COVID-19 rules. The order did not cancel fines for violating state orders or those issued to assisted living communities, hospitals or other healthcare providers, however. 

The Orlando Sentinel reported that a few local governments reported issuing approximately $1.9 million in fines since the beginning of the pandemic. It was unclear whether DeSantis’ the order allows businesses to recoup fines they’ve already paid. 

DeSantis previously suspended the collection of fines against individuals in September.