POLICY: The facility will allow in-person visitation at all times unless the resident/representative objects. Solaris HealthCare visitation policies and procedures are easily accessible from the homepage of its website.

PROCEDURE: The facility will:

• Designate the Nursing Home Administrator/Designee as responsible for adherence to the visitation policies and procedures.
• Recommend facilities, residents, and families adhere to the core principles of infection prevention to mitigate risk associated with potential exposure to contagions.

◦ Encourage staff, resident & visitors to remain up to date with all recommended immunizations.
◦ Encourage staff, residents, and visitors to use facemask; however, not required if no communicable infection is detected.
◦ Perform hand hygiene by using an alcohol-based hand rub or soap and water.
◦ Encourage individuals to avoid touching their face and use proper cough etiquette.
◦ Encourage residents and visitors to maintain social distance and limit movement in the facility.
◦ Clean and disinfect high frequency touched surfaces in the facility often and disinfect visitation areas after visits.
◦ Minimize large gatherings.
◦ Encourage testing for respiratory viruses to reduce the risk of severe illness and lower the chances of spreading a virus to others.
◦ Work with the state and/or local Health Department when an outbreak occurs.

• Allow indoor (outdoor visitation can also be considered as it has a lower risk of potential exposure to contagions) visitation at all times and for all residents unless the resident objects. Examples include and are not limited to:

◦ Permit in-person visitation for end-of-life situations.
◦ Permit in-person visitation at all times for a resident who was living with family before being admitted to the SNF’s care and is struggling with the change in environment and lack of in-person family support.
◦ Permit in-person visitation at all times for a resident that is making one or more major medical decisions.
◦ Permit in-person visitation at all times for a resident that is experiencing emotional distress or grieving the loss of a friend or family member who recently died.
◦ Permit in-person visitation at all times for a resident that needs cueing or encouragement to eat or drink which was previously provided by a family member or caregiver.
◦ Permit in-person visitation at all times for a resident who used to talk and interact with others and is seldom speaking.

• Not require visitors to show or provide proof of any vaccination or immunization status.
• Permit residents that choose to have close contact (including touch) with their visitor to do so.
• Not limit the frequency and length of visits for residents, the number of visitors, or require advance scheduling of visits.

◦ Ensure the right to private and uncensored communication, including, but not limited to, visiting with any person of the resident’s choice at any time (between the hours of 9 a.m. and 9 p.m.at a minimum), and overnight visitation outside the facility with family and friends in accordance with facility policies, physician orders, and Title XVIII (Medicare) and Title XIX (Medicaid) of the Social Security Act regulations, without the resident’s losing his or her bed.

▪ The facility shall make provisions to extend visiting hours for caregivers and out-of-town guests, and in other similar situations.

◦ Unless otherwise indicated in the resident care plan, Solaris shall, with the consent of the resident, permit recognized volunteer groups, representatives of community-based legal, social, mental health, and leisure programs, and members of the clergy access to the facility during visiting hours for the purpose of visiting with and providing services to any resident.

• Follow this guidance for visitors with recent infections and exposures:

◦ Provide guidance (e.g., posted signs at entrances) about recommended actions for visitors who have contagion exposure.
◦ Request visitors with confirmed contagious infections or compatible symptoms defer non-urgent in-person visitation until they meet CDC criteria for healthcare settings to end isolation.
◦ Encourage visitors that have had close contact with someone with contagious infection to wear a well-fitting facemask for source control or defer non-urgent in-person visitation until they are confident, they are not contagious.

• Offer well-fitting facemasks or other appropriate source control, if available.
• Ensure visitation is conducted in a manner that does not increase risk to other residents, including:

◦ Encourage physical distancing during peak times of visitation and large gatherings.
◦ Visitors who are unable to adhere to the core principles of infection prevention should not be permitted to visit or should be asked to leave.

• Follow Community Transmission and Masking and PPE Requirements
• Follow the recommendations below for visiting residents in isolation or quarantine:

◦ Residents with a contagious infection should be encouraged to limit in-person visitation while they are infectious. Counsel residents and their visitor(s) about the risks of an in-person visit. Encourage use of alternative mechanisms for resident and visitor interactions such as video-call applications on cell phones or tablets, when appropriate.
◦ Before visiting residents, visitors should be made aware of the potential risk of visitation and precautions necessary in order to visit the resident.
◦ Visits should occur in the resident’s room and the resident, and their visitor should wear a well-fitting facemask, if tolerated.

• Follow the guidelines below for visiting during a contagious outbreak investigation:

◦ Visitors should be made aware of the potential risk of visiting during an outbreak investigation.
◦ Visitors should wear face coverings or masks during visits and visits should ideally occur in the resident’s room. Visitors should only go to and from the resident’s room and/or designated visiting areas.
◦ Visitors should physically distance themselves from other residents and staff, when possible.

Required Visitation

1. Will not restrict visitation without a reasonable clinical or safety cause, consistent with 42 CFR 483.10(f)(4)(v).
2. Facilitate in-person visitation consistent with the applicable CMS regulations.

a. The resident has the right to receive visitors of his or her choosing at the time of his or her choosing, subject to the resident’s right to deny visitation when applicable, and in a manner that does not impose on the rights of another resident.

3. Make the visitor, residents, and/or their representative aware of the potential risk of visiting and necessary precautions related to contagious infections in order to visit the resident.
4. Residents can choose to have close contact (including touch) with their visitor and are encouraged to wear a well-fitting face mask and perform hand-hygiene before and after.

a. Regardless, visitors should physically distance themselves from other residents and staff in the facility.

Infection Control and Education for Visitors

1. Screening

a. Visitors are required to sign-in during the entrance process and asked to refrain from visiting if they have flu/cold/COVID-like/communicable disease symptoms.
b. Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine for any communicable illness, will not be permitted to enter the facility.

2. Personal Protective Equipment

a. Facial Coverings

i. In accordance with the Florida Statutes §408.824 and the standards set forth in the Florida Administrative Code 59AER23-1 and -2, Solaris HealthCare has adopted the following policy regarding the use of facial coverings for infection control by its residents, visitors, staff members and others coming into the facility.

1. Solaris HealthCare does not require the universal use of facial coverings by persons in order to gain access to, entry upon, service from, or admission to the facility or otherwise discriminate against persons based on their refusal to wear a facial covering.
2. Persons who freely choose to wear facial coverings while within the Solaris HealthCare facility may do so based upon their personal preference.
3. Facial coverings remain an important intervention in preventing respiratory bacterial and viral transmission. Solaris HealthCare and its health care practitioners may choose to require a resident to wear a facial covering only when the resident is in a common area of the facility and is exhibiting signs or symptoms of or has been diagnosed as having an infectious disease that can be spread through droplet or airborne transmission.
4. Solaris HealthCare and its health care practitioners may choose to require a visitor to wear a facial covering only when the visitor is:

a. Exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission.
b. In sterile areas of the facility or an area where sterile procedures are being performed.
c. In a resident or clinical room with a resident who is exhibiting signs or symptoms of or has a diagnosed infectious disease that can be spread through droplet or airborne transmission; or
d. Visiting a resident whose treating health care practitioner has diagnosed the patient with or confirmed a condition affecting the immune system in a manner which is known to increase risk of transmission of an infection from employees without signs or symptoms of infection to a resident and whose treating practitioner has determined that the use of facial coverings is necessary to the resident’s safety.

ii. Opt-Out Requirements of 59AER23-2 when Facial Coverings are Being Required.

1. Solaris HealthCare will follow the regulations of 59AER23-2 for persons requesting to opt-out of wearing a facial covering.
2. Health care practitioners who choose to require a facial covering for any resident will provide for the opting-out of wearing a facial covering that is in accordance with the Florida Patient Bill of Rights and Responsibilities, section 381.026, F.S., including the following:

a. 381.026 (5) Responsibilities of Patients. – Each patient of a health care provider or health care facility shall respect the health care provider’s and health care facility’s right to expect behavior on the part of patients which, considering the nature of their illness, is reasonable and responsible.
b. 381.026 (4)(b)3. Rights Of Patients – A patient has the right to be given by his or her health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis, unless it is medically inadvisable or impossible to give this information to the patient, in which case the information must be given to the patient’s guardian, or a person designated as the patient’s representative. A patient has the right to refuse this information.
c. 381.026 (4)(b)4. Rights Of Patients – A patient has the right to refuse any treatment based on information required by this paragraph, except as otherwise provided by law. The responsible provider shall document any such refusal.
d. 381.026 (4)(b)5. Rights Of Patients – A patient in a health care facility has the right to know what facility rules and regulations apply to patient conduct.

3. Solaris HealthCare and its health care practitioners who choose to require a facial covering for any visitor will provide for the opting-out of wearing a facial covering when requested by the visitor if an alternative method of infection control or infectious disease prevention is available based upon the individual resident’s and visitor’s circumstance.
4. As a health care provider, Solaris HealthCare will allow an employee to opt out of facial covering requirements unless an employee is:

a. Conducting sterile procedures,
b. Working in a sterile area,
c. Working with a patient whose treating health care practitioner has diagnosed the patient with or confirmed a condition affecting the immune system in a manner which is known to increase risk of transmission of an infection from employees without signs or symptoms of infection to a patient and whose treating practitioner has determined that the use of facial coverings is necessary for the patient’s safety,
d. With a patient on droplet or airborne isolation, or
e. Engaging in non-clinical potentially hazardous activities that require facial coverings to prevent physical injury or harm in accordance with industry standards.

3. Infection Control Protocols

Access to the Long-Term Care Ombudsman

1. Provide the representatives of the Office of the State Long-Term Care Ombudsman with immediate access to any resident.

a. If an Ombudsman is planning to visit a resident who is in TBP or quarantine, the resident and the Ombudsman should be made aware of the potential risk of visiting, and the visit should take place in the resident’s room.
b. If the resident or the Ombudsman program requests alternative communication in lieu of an in-person visit, facility will, at a minimum, facilitate alternative resident communication with the Ombudsman program, such as by phone or through use of other technology.

i. The Ombudsman is allowed to examine the resident’s medical, social, and administrative records as otherwise authorized by State law.

Federal Disability Rights Laws and Protection & Advocacy (P&A) Programs

1. 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 Developmental Disabilities Assistance (DD Act) and Bill of Rights Act of 2000, and of the agency responsible for the protection and advocacy system for individuals with a mental disorder.

a. If the P&A is planning to visit a resident who is in TBP or quarantine 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.

2. Comply with federal disability rights laws.

a. For example, if communicating with individuals who are deaf or hard of hearing, it is recommended to use a clear mask or mask with a clear panel if they are visiting a resident who is in TBP or quarantine.

i. 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.

3. Permit entry into the facility of individuals that will ensure effective communication (e.g., a qualified interpreter or someone to facilitate communication).

Entry of Healthcare Workers and Other Providers of Services

1. Permit the entry of all healthcare workers as long as they are not subject to a work exclusion or showing signs or symptoms of contagious infection.

a. In addition to health care workers, personnel educating and assisting in resident transitions to the community should be permitted entry.
b. EMS personnel do not need to be screened so that they can attend to an emergency without delay.
c. These individuals should adhere to the core principles of infection prevention.

Survey Considerations

1. Not restrict access to surveyors.
2. Address questions about the process the state is using to ensure surveyors can enter a facility safely to the State Survey Agency
3. Nor permit entry of a surveyor if they have a contagious infection, signs, or symptoms of a contagious infection, or currently meet the criteria for quarantine.
4. Surveyors should also adhere to the core principles of infection prevention and adhere to any infection prevention requirements set by federal and state agencies including Executive Orders.