Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO:
KRS
216.510(1)
NECESSITY, FUNCTION, AND CONFORMITY: 2021 Ky. Acts chapter 3,
sec. 1, subsection (4) requires the cabinet to develop administrative
regulations and guidelines authorizing and regulating visitation by family
members or legal guardians, or outside caregivers, friends, or volunteers who
provided regular care and support to the resident prior to the pandemic, and
who are designated as being important to the mental, physical, or social
well-being of the resident in a long-term care facility. 2021 Ky. Acts chapter
3, sec. 1, subsection (5) and Senate Bill 2, sec. 1 (2021 Special Session)
require the cabinet to develop administrative regulations and guidelines
authorizing and regulating visitation by family members or legal guardians, or
outside caregivers, friends, or volunteers who provided regular care and
support to the resident prior to the pandemic, and who are designated as being
important to the mental, physical, or social well-being of a resident in
critical situations such as end of life, or in the instance of significant
mental or social decline of the resident, or when exigent circumstances exist
regarding a resident in a long-term care facility. In accordance with 2021 Ky.
Acts chapter 3, sec. 1(4)(i) and 2021 Special Session Senate Bill 2, sec.
1(2)(g), long-term care facilities shall not be required to accept visitors
except in limited situations as set out in Section 4 of this regulation and as
allowed under guidance issued by the Centers for Medicare and Medicaid Services
for federally certified nursing facilities. This new emergency administrative
regulation establishes the process for long-term care facilities to follow if a
facility voluntarily implements an essential personal care visitor program
through January 31, 2022. Essential compassionate care and end of life
visitation shall be allowed at all times regardless of a resident's vaccination
status, the county's COVID-19 positivity rate, or an outbreak in the
facility.
Section 1. Definitions.
(1) "Essential personal care visitor" means a
family member, legal guardian, outside caregiver, friend, or volunteer who:
(a) Is eighteen (18) years of age or
older;
(b) Provided regular care
and support to a long-term care facility resident prior to the COVID-19
pandemic;
(c) Is designated as
being important to the mental, physical, or social well-being of the resident;
and
(d) Meets an essential need of
the resident, including companionship, assisting with personal care, or
positively influencing the behavior of the resident.
(2) "Facility-onset" means a COVID-19 case
that originates in a long-term care facility.
(3) "Long-term care facility" is defined by
KRS
216.510(1).
(4) "Outbreak" means one (1) new COVID-19
case among facility staff or one (1) new facility-onset case among residents. A
resident who is admitted with a COVID-19 diagnosis or who is confirmed
COVID-positive within fourteen (14) days of admission shall not be:
(a) Considered a facility-onset case;
or
(b) Constitute an
outbreak.
(5) "Personal
care" means assisting a long-term care facility resident with essential
everyday activities, which may include grooming, dressing, and
eating.
Section 2.
Essential personal care visitation.
(1) A
long-term care facility that implements an essential personal care visitor
program shall:
(a) Allow essential personal
care visitation as an exception from any prohibition against general visitation
during the COVID-19 pandemic; and
(b) Establish policies and procedures for the
designation of an essential personal care visitor, including a process for
changing the designation.
(2) A long-term care facility's designation
of an essential personal care visitor shall:
(a) Be made in consultation with, and upon
agreement by the:
1. Resident; and
2. Resident's representative, if applicable;
and
(b) Ensure that
there is no more than one (1) essential personal care visitor per
resident.
(3) A
long-term care facility:
(a) May require a
written agreement with an essential personal care visitor; and
(b) Shall determine when to suspend essential
personal care visitation based on a clinical or safety factor, including:
1. The county's COVID-19 positivity
rate;
2. An outbreak in the
facility;
3. The resident's
COVID-19 status; or
4.
Noncompliance by the essential personal care visitor with:
a. Safety protocols or other requirements
established by this emergency administrative regulation; or
b. Any policies and procedures the facility
deems necessary to keep staff and residents safe.
(4) An essential
personal care visitor shall:
(a) Assume the
risk of exposure to COVID-19 and other viruses;
(b) Limit visitation to the resident's room
or a facility-designated room within the building; and
(c) Limit his or her movement within the
facility.
(5) If the
resident has a roommate, an essential personal care visitor shall:
(a) Not enter the resident's room if the
roommate is there; and
(b) Be
prohibited from staying in the room for more than fifteen (15) minutes unless
otherwise approved by the roommate or roommate's representative.
(6) An essential personal care
visitor shall follow the same safety protocols required for long-term care
facility staff, including:
(a) Testing for
communicable disease, which may be the responsibility of the essential personal
care visitor. If testing is provided by the facility, essential personal care
visitors shall be tested on the same schedule as staff;
(b) Health screens, including screening for
signs and symptoms of COVID-19 and denial of entry of any individual with signs
and symptoms;
(c) Wearing a face
mask and using any other appropriate personal protective equipment
(PPE);
(d) Washing or sanitizing
hands regularly;
(e) Maintaining a
distance of six (6) feet from staff and other residents at all times. Social
distancing from the resident receiving an essential personal care visit may be
relaxed for a short period of time under certain circumstances, e.g., providing
assistance with a personal care activity; and
(f) Adhering to any other requirement the
facility deems appropriate in accordance with guidance from the Centers for
Disease Control and Prevention (CDC).
(7) A long-term care facility shall:
(a) Be responsible for verifying and tracking
the testing status of each essential personal care visitor;
(b) Schedule essential personal care visits
in advance or in accordance with a written agreement;
(c) Consider the number of other essential
visitors who will be in the building at the same time when developing a
visitation schedule;
(d) Establish
limitations on the visitation frequency and length of the visits to keep staff
and residents safe; and
(e)
Sanitize the area's high-frequency touched surfaces after the visit.
(8) An essential personal care
visitor shall inform the facility if he or she develops COVID-19 symptoms
within fourteen (14) days of the visit.
Section 3. Training.
(1) Each essential personal care visitor
shall complete facility-designated training.
(2) Training shall include information on the
core principles of COVID-19 infection prevention, including adherence to the
following:
(a) Screening of all who enter the
facility for signs and symptoms of COVID-19;
(b) Regular testing for COVID-19 in the same
manner as required for staff;
(c)
Wearing a face mask covering mouth, nose, and chin;
(d) Proper hand hygiene;
(e) Social distancing; and
(f) How to put on and take off necessary
PPE.
(3) A long-term
care facility may post signage throughout the facility that demonstrate key
instructions to reinforce safe practices.
Section 4. Essential compassionate care
visitation and end of life visitation.
(1) A
long-term care facility shall allow essential compassionate care visitation and
end of life visitation:
(a) As an exception
from any prohibition against general visitation during the COVID-19 pandemic;
and
(b) At all times regardless of:
1. A resident's vaccination status;
2. The county's COVID-19 positivity rate;
or
3. An outbreak in the
facility.
(2)
A compassionate care situation refers to any of the following scenarios, which
is not an exhaustive list as there may be other compassionate care scenarios:
(a) A resident is newly admitted to a
long-term care facility and is struggling with the change in
environment;
(b) A resident has a
change in status to palliative care as determined by an order from the
clinician;
(c) The emergence of a
condition or disease, or a failure to thrive situation in which a resident's
health is declining;
(d) Emotional
distress; or
(e) Significant mental
or social decline of the resident.
(3) End of life visitation refers to
visitation with a resident who:
(a) Has a
terminal condition or dementia-related disorder that has become advanced,
progressive, or incurable; and
(b)
Is in the active stages of dying, terminal within thirty (30) days.
(4) Essential compassionate care
visitation and end of life visitation shall be:
(a) Scheduled in advance unless a resident's
rapid decline makes advance scheduling impossible; and
(b) Conducted in the resident's room or a
facility-designated room in the building.
(5) If a private room is not available and
essential compassionate care visitation or end of life visitation occurs in the
resident's room with a roommate present, a partition shall be in place between
the living areas of the resident and the resident's roommate.
(6) Before an essential compassionate care
visit or end of life visit takes place, a long-term care facility shall
document the following:
(a) The resident's
status related to the need for an essential compassionate care visit or end of
life visit;
(b) Any interventions
employed to improve the resident's status and the outcome; and
(c)
1.
Verification that the resident has never been COVID-19 positive; or
2. If the resident has been COVID-19
positive, verification that the resident no longer requires transmission-based
precautions as outlined by the CDC.
(7) A resident receiving an essential
compassionate care visit or end of life visit shall:
(a) Wear a face mask covering mouth, nose,
and chin if medically feasible; and
(b) Practice appropriate hand hygiene before
and after the visit.
(8)
The long-term care facility shall:
(a) Screen
each essential compassionate care visitor or end of life visitor for signs and
symptoms of COVID-19 in the same manner as for facility staff, but testing of
compassionate care or end of life visitors shall not be required pursuant to
CMS Memorandum QSO-20-39-NH Revised, which may be downloaded from the following
Web address:
https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf;
(b) Provide alcohol-based hand sanitizer to
each essential compassionate care visitor or end of life visitor and
demonstrate how to use it appropriately; and
(c) Sanitize the area's high-frequency
touched surfaces after the visit.
(9) An essential compassionate care visitor
or end of life visitor shall:
(a) Be eighteen
(18) years of age or older;
(b)
Submit to screening for signs and symptoms of COVID-19 as required by
subsection (8)(a) of this section and be denied entry if the individual has
signs and symptoms;
(c) Be escorted
to and from the visitation area and agree not to leave the designated
visitation area;
(d) Wear a face
mask covering mouth, nose, and chin during the entire visit;
(e) Perform appropriate hand hygiene
immediately before and after the visit;
(f) Maintain a distance of six (6) feet from
staff and other residents at all times. Social distancing from a resident
receiving essential compassionate care visitation may be relaxed for a short
period of time;
(g) Meet any other
condition of visitation the facility deems necessary to protect resident health
and safety;
(h) Assume the risk of
exposure to COVID-19 and other viruses; and
(i) Not be permitted entry into the facility
or otherwise asked to leave if the visitor is not able to meet all of the
conditions of this subsection.
(10) An essential compassionate care visitor
or end of life visitor shall inform the facility if he or she develops COVID-19
symptoms within fourteen (14) days of the visit.
Section 5. Temporary Implementation of
Essential Visitor Programs. In accordance with 2021 Ky. Acts chapter 3, sec. 1
and Senate Bill 2, sec. 1 from the 2021 Special Session, this new emergency
administrative regulation shall remain in effect until January 31,
2022.
STATUTORY AUTHORITY: 2021 Ky. Acts chapter 3, sec. 1,
subsection (4), (5), Senate Bill 2, sec. 1 (2021 Special
Session)
