Long-term care facilities

Make sure you understand the facility’s visitation policy and any safety precautions you can take to keep your loved ones and other residents safe. This is especially important if your family member is in a shared room.

Getting tested for COVID-19 before you visit loved ones in a long-term care facility is a good way to know you’re keeping them safe. However, sometimes a negative test result gives people a false sense of security. You still need to take safety precautions before and after you get tested. Wear a mask, wash your hands often for 20 seconds with soap and water, and physical distance as much as possible. This is especially important for people planning to visit loved ones in a higher-risk living environment like a long-term care facility.

Important things to remember about COVID-19 testing:

• COVID-19 has a long incubation period. You can still get the virus up to 14 days after being exposed.
• You can be exposed to COVID-19 right before or after you get tested, so make sure you still wear a mask and physical distance
• Rapid antigen tests work best for people who have symptoms of COVID-19. If you don’t have symptoms but test positive with a rapid antigen test, you should have a confirmatory PCR test within 24-48 hours and then isolate right away until you get your results.
• The facility may ask you to provide a negative COVID-19 test result before your visit. It is important to follow any safety precautions or procedures the facility asks of you.

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching his or her own mouth, nose, or their eyes. This is not thought to be the main way the virus spreads. From what we know, COVID-19 can live on surfaces for hours to days. Warmer temperatures and exposure to sunlight may reduce the amount of time the virus lives on objects. We are still learning many things about COVID-19 and how it spreads.

You may want to consider not bringing gifts to your loved ones this year. Some facilities may not allow visitors to bring gifts into the facility, food or drinks in particular. Gifts should also have a mini quarantine to make sure there aren’t germs on the package or gift wrapping. When people bring food or drinks to share with their loved ones, it is more likely people will remove their masks. Respiratory droplets can be spread easily when people are eating or drinking.

Make sure you know and follow the facilities guidelines about gifts. If the facility allows and you decide to bing gifts, there are some important things you should know:

• Prepackaged or pre-wrapped gifts are safest (anything that can be wiped down with disinfecting wipes).
• Homemade food should be in a container that can be wiped down (like a cookie tin).
• Homemade food should be left in the office for 2 days before it is given to the resident.

There is a growing amount of data showing the benefits to older adults of sharing and recording stories. Research shows that writing down or reminiscing about family history improves self-esteem and reduces stress and anxiety.

The chance to tell their stories can also improve cognition and make older adults less likely to be depressed. “Writing shakes people out of their same old stories and makes them think differently about their lives,” says Hope Levy of There’s Always Hope, a San Francisco-based Geriatric Consulting firm.

“Writing one’s story not only boosts self-esteem and reduces stress and anxiety, it is also a powerful tool for a senior—or anyone—to visualize and create their future,” Levy says.

• Make sure you understand the facility’s visitation policy and any safety precautions you can take to keep your loved ones safe. If your family member is in a shared room, make sure you understand the facility’s procedures and steps you can take to keep everyone safe.
• Outdoor visits are much safer for your loved ones than indoor ones. Outdoor visits lower the chance family members may expose residents to COVID-19. Hold any visits outdoors as much as possible.
• Both residents and visitors should wear face masks at all times during the visit. 
  • You can wear a cloth face mask, or in some situations, the facility may prefer to provide visitors with a face mask. It is important to follow any safety procedures outlined by the facility.
• In situations where a resident should not wear a face mask for medical reasons, or refuses to wear one, the facility will set up a visitation area that includes a clear, physical barrier (like a plexiglass type barrier) to prevent the spread of respiratory droplets. 
• If your family member isn’t wearing a mask, you won’t be able to physically touch him or her. You will need to stay at least 6 feet away. We understand this is hard and upsetting, but our goal is to make sure your loved one stays as safe as possible.
  • To protect the safety of residents, any visitor who is not physical distancing (staying at least 6 feet from residents) will be asked to leave the facility. 
• Eye protection or face shields AND face masks are required for indoor visitation if the county positivity rate is higher than 5%. This provides an additional level of protection to residents, visitors, and staff. Wearing eye protection or a face shield do not mean you don’t need to physically distance.
• If you aren’t able to physically distance (keep 6 feet between you and the resident) you should also wear a gown and gloves.
• Children are not necessarily excluded from visiting long-term care facilities, but children must follow the same safety precautions and procedures. Children must stay with a responsible adult at all times. Children who are not following visitation guidelines will be asked to leave the facility.
• The facility will need to limit the number of visitors each resident has at one time and the number of visitors in the facility at one time, based on the size of the building and the physical space.
•  Schedule visits ahead of time to help the facility plan to have enough supplies and personal protective equipment available for staff and visitors. 
  • Planning your visit ahead of time helps avoid any frustration or disappointment for you or your loved ones. 
  • Facilities may have to ask visitors to reschedule their visit if they do not have enough supplies or PPE for staff and visitors.
• Visits will likely be for a scheduled amount of time to allow all residents the opportunity to have in-person visitors.
• Your visit may take place in a designated area to reduce the number of people moving around the facility. 
• You won’t be able to just walk around the facility and in the halls. You may need to go right to your family member’s room after you enter the facility. 
• Visits may not be allowed during mealtimes, depending on the number of staff and amount of PPE available. 
• Wash your hands for 20 seconds with soap and water or use hand sanitizer with at least 60% alcohol, right before you enter the facility. If you are not able to wash your hands or use hand sanitizer before entering the facility, wash your hands right away once you enter. Wash your hands after you finish your visit and before you leave.

Outdoor visits
Outdoor visits are much safer for your loved ones than indoor ones. Outdoor visits lower the chance family members may expose residents to COVID-19. Hold any visits outdoors as much as possible.

Indoor visits
When outdoor visits are not possible because of weather conditions or other factors, facilities will try to let you visit your loved ones indoors as much as possible. Facilities can only allow indoor visits if there have been no new cases of COVID-19 in the facility and it is not currently conducting outbreak testing. Make sure you understand the facility’s visitation policy and any safety precautions you can take to keep your loved ones and other residents safe. This is especially important if your family member is in a shared room.

Things to know about indoor visits:

• You should practice physical distancing as much as possible during your visit (stay 6 feet away from your family member). It is safest for your loved one to avoid physical contact with people who live outside the facility as much as possible. Try to just use verbal greetings rather than hugs or handshakes, which have a higher risk of spreading COVID-19.

• The facility will need to limit the number of visitors each resident has at one time and the number of visitors in the facility at one time, based on the size of the building and the physical space.

• Visits will likely be for a scheduled amount of time to allow all residents the opportunity to have in-person visitors.

• Your visit may take place in a designated area to reduce the number of people moving around the facility.

• You won’t be able to just walk around the facility and in the halls. You may need to go right to your family member’s room after you enter the facility.

• If your family member is in a shared room, make sure you understand the facility’s procedures and steps you can take to keep everyone safe.

Alternatives to in-person visits
There may be times it is unsafe to allow visitors into the facility. In these situations, it is important to find other ways for you to visit with your loved ones. If the facility can’t allow visitors, you may be asked to use other ways to visit, such as:

• Virtual communications (phone, video-communication, etc.)

• Email, text, or phone updates from the facility

Everyone who visits a long-term care facility will be screened for symptoms of COVID-19 and have their temperature taken before being allowed to enter the facility. You will be asked to sign in with your name, date, time of visit, and contact information.

DO NOT visit a long-term care facility if:

• You are sick or have symptoms of COVID-19. (insert symptoms graphic somewhere)
• You tested positive for COVID-19 and have not been released from isolation. 
• Were told you were exposed to someone who tested positive for COVID-19 in the last 14-days, even if you test negative after your exposure. You must finish your 14-day quarantine before you can visit family members in long-term care facilities.

County positivity rates
Facilities located in counties where rates of positivity are high may not allow for visitation.

End-of-life situations are often used as examples of compassionate care situations. However, there are other types of compassionate care situations as well, such as residents who are:

• Struggling with the change in environment and lack of family support after having recently come to live in a long-term care facility from living with their family.
• Grieving after a friend or family member recently passed away. 
• Experiencing weight loss or dehydration and needs help and encouragement to eat or drink, that was previously provided by family or caregivers. 
• Experiencing emotional distress, rarely speaks, and cries more often (when the resident had rarely cried in the past).
• Preparing to transition home and family or caregivers need more training to meet the resident’s needs after discharge. 

Essential support visitor
Some visitors provide consistent and essential support to residents for daily living activities that require physical contact, such as feeding, dressing, or personal hygiene.

Every resident may designate one essential support visitor. The essential support visitor may be chosen by the resident or the resident’s power of attorney. The facility will have specific policies for designated essential support visitors. Make sure you know and understand the facility’s essential support visitor policies, as these can change. 

Designated essential support visitors should agree to:  

• Limit your own social exposure to COVID-19 and abide by all public health orders.
• Complete infection prevention education provided by the facility. 
• Wear all of the same personal protective equipment (PPE) as facility staff.
• Participate in all routine screening and outbreak testing on the same schedule as facility staff (testing for designated essential support visitors will be paid for by the facility).

• Weddings
• Funerals
• Reunions
• Holiday visits with family
• Shopping
• Going to the store for items that are provided by the facility

It is the resident’s right to leave the facility, but residents and family may need to quarantine after a resident leaves. Alternative visits are safer than leaves of absences. Safer options are: in-person visits, both outdoor and indoor, and virtual visits. It is important that residents, families, and facility administration coordinate leaves of absences, so the facility is able to safely quarantine residents after a leave of absence.

• Limit interactions with others for 14 days before leaving and encourage family members to do the same.
• Know what to expect and make a plan to limit contact with others. 
• Make sure in advance that no one the resident will be visiting has a respiratory illness or has had close contact with a person who tested positive for COVID-19 in the past 14 days.
• Know and understand how to prevent the spread of COVID-19.
• Wear a mask around other people, both indoors and outdoors.
• Keep as much physical distance as possible from other people (at least 6 feet) and avoid hugs and handshakes.
• Anyone who gets any COVID-19 symptoms, even if they are mild, should isolate from other people right away and get tested as soon as possible.
• Be tested and quarantine returning to the facility. 
• Follow all public health orders to avoid bringing the virus to the facility upon return.

All long-term care facility residents are at increased risk of severe illness from COVID-19 based on their age and residence in a communal setting. Other underlying health conditions can increase individual risk even more.

Gatherings present a risk not only for the resident’s health, but also the health of other residents and staff if a resident brings the virus back into the facility. The risks and benefits of leaving the facility must be weighed carefully. The risk of disease is higher in communities where more people have the virus.

• The resident’s health status
• Recommendations from his or her healthcare provider
• If the resident and others will be wearing masks and practicing physical distancing
• The rate of COVID-19 in the broader community
• If the resident can be protected from being exposed to the virus in the location where he or she is going
• If the people who will be there might be sick or have a high risk of having been exposed to the virus