New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter D - Adult-Care Facilities
Part 485 - General Provisions
Section 485.18 - Personal and Compassionate Caregiving Visitation
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 485.18
Current through Register Vol. 46, No. 39, September 25, 2024
(a) This section shall apply to all adult care facilities, including every adult care facility regulated pursuant to Parts 487, 488 and 490 of this Title and Part 1001 of Title 10 of the NYCRR.
(b) Subject to the resident's right to deny or withdraw consent at any time, all adult care facilities must provide immediate access to any resident of visitors of their choice, including but not limited to immediate family or other relatives of the resident and any others who are visiting with the consent of the resident. Provided, however, that the facility may establish policies and procedures to establish reasonable restrictions on such visitation, including but not limited to: setting forth visitation hours; denying access to any visitor suffering from a communicable disease; terminating visitation with any visitor causing a threat to the health or safety of any resident; and setting a cap on the number of visitors allowed in the facility at any one time. Any such restrictions or limitations on visitation shall be communicated in writing to residents.
(c) Personal caregiving visitors.
(1) During a public health emergency
declared under section twenty-four or section twenty eight of the executive
law, the facility must continue to allow residents to access their designated
personal caregiving visitors, as defined in subdivision (1) of section 2801-h of the Public Health Law,
notwithstanding any restrictions or prohibitions relating to residential health
care facility visitation resulting from the declared public health emergency,
subject to the following restrictions:
(i) If
a facility has reasonable cause to believe that a resident will not benefit
from accessing their designated personal caregiving visitors, and such
reasoning has been documented in the resident's case management record, a
facility may require a health or mental health professional duly licensed or
certified in New York State under the Education Law, and who is not associated
with the facility, including but not limited to a physician, registered nurse,
licensed clinical social worker, psychologist, or psychiatrist, to provide a
written statement that the personal caregiving will substantially benefit the
resident's quality of life, including a statement from such medical provider
that the personal caregiving visitation will enhance the resident's mental,
physical, or psychosocial well-being, or any additional criteria evidencing a
benefit to quality of life as determined by the Department. Such written
statements shall be maintained in the resident's case management
record.
(ii) Notwithstanding any
provision of this paragraph, a facility may temporarily suspend or limit
personal caregiving visitors to protect the health, safety and welfare of
residents, if: the declared public health emergency is related to a
communicable disease and the Department determines that local infection rates
are at a level that presents a serious risk of transmission of such
communicable disease within local facilities; the facility is experiencing
temporary inadequate staffing and has reported such staffing shortage to the
Department of Health any other State or federal agencies as required by law,
regulation, or other directive; or an acute emergency situation exists at the
facility, including loss of heat, loss of elevator service, or other temporary
loss of an essential service. Provided, however, that in the event a facility
suspends or limits personal caregiving visitation pursuant to this
subparagraph, the facility shall notify residents, all designated personal
caregiving visitors, and the applicable Department regional office of such
suspension or limitation and the duration thereof within twenty-four hours of
implementing the visitation suspension or limitation. Additionally, for each
day of the suspension or limitation, the facility shall document the specific
reason for the suspension or limitation in their administrative records. The
facility shall further provide a means for all residents to engage in remote
visitation with their designated personal caregiving visitor(s), including but
not limited to phone or video calls, until such time that the suspension or
limitation on personal caregiving visitation has ended.
(iii) Notwithstanding any provision of this
paragraph, a facility may also prohibit a personal caregiving visitor from
entering if the facility has reasonable cause to believe that permitting the
personal caregiving visitor to meet with the resident is likely to pose a
threat of serious physical, mental, or psychological harm to such resident. In
the event the facility determines that denying such personal caregiving visitor
access to the resident is in the resident's best interests pursuant to this
subparagraph, the facility must document the date of and reason for visitation
refusal in the resident's case management record, and on the same date of the
refusal the facility shall communicate its decision to the resident and their
designated representative. Further, a facility may refuse access to or remove
from the premises any personal caregiving visitor who is causing or reasonably
likely to cause physical injury to any facility resident or
personnel.
(2) The
facility shall develop written policies and procedures to ask residents, or
their designated representatives in the event the resident lacks capacity, at
time of admission or readmission, or for existing residents within fourteen
days of the effective date of this paragraph, which individuals the resident
elects to serve as their personal caregiving visitor during declared local or
state health emergencies. A resident shall be entitled to designate at least
two personal caregiving visitors at one time.
(3) The facility shall maintain a written
record of the resident's designated personal caregiving visitors in the
resident's case management record, and shall document when personal caregiving
and compassionate caregiving is provided in the case management
record.
(4) As part of its ongoing
review of a resident's case management needs, the facility shall regularly
inquire of all current residents, or their designated representative if the
resident lacks capacity, whether the facility's current record of designated
personal caregiving visitors remains accurate, or whether the resident, or
their designated representative if the resident lacks capacity, wishes to make
any changes to their personal caregiving visitor designations. The facility
shall update the resident's case management record with the date the facility
sought updates from the resident and indicate any changes to the resident's
personal caregiving visitor designations therein. Such inquiries shall be made
no less frequently than every six months and upon a change in the resident's
condition; upon review of a facility's visitation policies and procedures, the
Department may also require the facility inquire of any resident whether the
facility's current record of designated personal caregiving visitors remains
accurate.
(5) The facility shall
require all personal caregiving visitors to adhere to infection control
measures established by the facility and consistent with any guidelines from
the Department, or in the absence of applicable Department guidance, consistent
with long term care facility infection control guidelines from the U.S. Centers
for Disease Control and Prevention. Such infection control measures may
include, but need not be limited to:
(i)
testing all personal caregiving visitors for any communicable disease that is
the subject of the declared public health emergency, which may include rapid
on-site testing or requiring the visitor to present a negative test result from
no more than seven days prior to the visit;
(ii) checking the personal caregiving
visitor's body temperature upon entry to the facility, and denying access to
any visitor with a temperature above 100 degrees Fahrenheit;
(iii) conducting health screenings of all
personal caregiving visitors upon entry to the facility, including screenings
for signs and symptoms of any communicable disease that is the subject of the
declared public health emergency or any other communicable disease which is
prevalent in the facility's geographic area, and recording the results of such
screenings;
(iv) requiring all
personal caregiving visitors to don all necessary personal protective equipment
appropriately, and providing such personal protective equipment to all personal
caregiving visitors; and
(v)
enforcing social distancing between persons during visitation, including
personal caregiving visitation, except as necessary to provide personal
caregiving by the personal caregiving visitor for the resident.
(6) The facility shall establish
policies and procedures regarding the frequency and duration of personal
caregiving visits and limitations on the total number of personal caregiving
visitors allowed to visit the resident and the facility at any one time. Such
policies shall not be construed to limit access by other visitors that would
otherwise be permitted under state or federal law or regulation. The facility
shall ensure its policies and procedures respect resident privacy and take into
account visitation protocols in the event a resident occupies a shared room. In
establishing frequency and duration limits, the facility policy shall ensure
that residents are able to receive their designated personal caregiving
visitors for the resident's desired frequency and length of time, and any
restrictions on that desired frequency and duration must be:
(i) attributable to the resident's clinical
or personal care needs;
(ii)
necessary to ensure the resident's roommate has adequate privacy and space to
receive their own designated personal caregiving visitors; or
(iii) because the desired visitation
frequency or duration would impair the effective implementation of applicable
infection control measures, including social distancing of at least six feet
between the visitors and others in the facility, having sufficient staff to
effectively screen all personal caregiving visitors and monitor visits to
ensure infection control protocols are being followed throughout, and having a
sufficient supply of necessary personal protective equipment for all personal
caregiving visitors.
(d) Compassionate caregiving.
(1) In the event a resident experiences a
long-term or acute physical, mental, or psychosocial health condition for
which, in the opinion of the resident, their representative, or a health care
professional (including but not limited to a physician, registered nurse,
licensed clinical social worker, psychologist, or psychiatrist), a
compassionate caregiving visitor would improve the resident's quality of life,
the resident or their representative shall designate at least two compassionate
caregiving visitors at one time, and the facility shall record such designation
in the resident's case management record. A resident's designated personal
caregiving visitors may also provide compassionate caregiving.
(2) Situations in which a resident is
eligible for a compassionate caregiving visitor include but are not limited to
the following:
(i) end of life;
(ii) the resident, who was living with their
family before recently being admitted to an adult care facility, is struggling
with the change in environment and lack of physical family support;
(iii) the resident is grieving after a friend
or family member recently passed away;
(iv) the resident needs cueing and
encouragement with eating or drinking, and such cueing was previously provided
by family and/or caregiver(s), and the resident is now experiencing weight loss
or dehydration; and
(v) the
resident, who used to talk and interact with others, is experiencing emotional
distress, seldom speaking, or crying more frequently (when the resident had
rarely cried in the past).
(3) Compassionate caregiving visitation shall
be permitted at all times, regardless of any general visitation restrictions or
personal caregiving visitation restrictions in effect in the facility.
Provided, however, that the facility shall require compassionate caregiving
visitors to be screened for communicable diseases prior to entering the
facility and visits must be conducted using appropriate social distancing
between the resident and visitor if applicable based on guidance from the
Department or the U.S. Centers for Disease Control and Prevention; if, however,
personal contact would be beneficial for the resident's well-being, the
facility shall establish policies and procedures to ensure such physical
contact follows appropriate infection prevention guidelines, including the
visitor's use of personal protective equipment and adhering to hand hygiene
protocols before and after resident contact, and that physical contact is
limited in duration.
(e) The Department shall have discretion to review and require modifications to a facility's personal caregiving visitation and compassionate caregiving visitation policies and procedures to ensure conformity with subdivisions (c) and (d) of this section and any applicable visitation guidelines issued by the Department or the Centers for Medicare and Medicaid Services.
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