The Department of Health today is adopting federal guidance for visitation in long-term care facilities. The new guidance allows for indoor visitation at all times regardless of the vaccination status of the resident or visitor—except for a few circumstances where visitation should be limited due to high risk of COVID-19 transmission.
“As the spring holidays approach, we know it is essential for the health and well-being of long-term care residents that they visit with their loved ones,” said Health Commissioner Judith Persichilli. “The Department continues to work to balance expanding visitation while working to safeguard these vulnerable residents. But, the significant drop in outbreaks and the increasing vaccination rates are hopeful signs for residents, families and staff that allow us to adopt the federal guidance from the Centers for Medicare and Medicaid (CMS).”
Fully vaccinated residents can choose to have close contact (including touch and hugs) with a visitor if both the visitor and resident are wearing a well-fitting face mask. Compassionate care, essential caregiver, end-of-life visitation, and outdoor visitation can be permitted even when indoor visitation is otherwise restricted because of COVID-19 transmission.
According to the guidance, if the COVID-19 Activity Level Index (CALI score) is high or very high and less than 70% of the residents of the facility are fully vaccinated, indoor visitation should be limited for unvaccinated or partially vaccinated residents.
Indoor visitation of unvaccinated residents can take place regardless of CALI score if 70% of the residents in the facility are vaccinated. Currently, there are 367 facilities that meet that criteria.
Indoor visitation should also be limited for residents under quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
In addition, indoor visitation should be limited for residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue precautions.
When a new case of COVID-19 among residents or staff is identified, a facility should immediately begin testing and suspend visitation (except as required under federal disability rights law and Department guidance/directives) until at least one round of facility-wide testing is completed. Once this is completed, the following protocols must be followed:
- Indoor visitation during an outbreak or investigation can occur when there is evidence that the transmission of COVID-19 is contained to a single area of the facility as follows:
- If the first round of outbreak testing reveals no additional COVID-19 cases in other areas, then visitation can resume for residents in areas with no COVID-19 cases. However, visitation should be suspended in the affected areas until the facility meets the criteria to discontinue outbreak testing. If the first round of outbreak testing reveals two or more COVID-19 cases in the same area as the original case, but not in other areas, visitation can resume for residents in areas with no COVID-19 cases.
- If the first round of outbreak testing reveals one or more additional COVID-19 cases (among resident and/or staff) in other areas, then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing (no new cases in residents or staff identified for 14 days since last positive case).
Before allowing for indoor visitation, facilities must attest (a minimum of 72 hrs before) that they have a protocol to collect informed consent from the residents and visitors, have a location designated for indoor visitation, sufficient staff, a mechanism for appointments, and sufficient PPE and cleaning and disinfection supplies to permit visitation.
Commissioner Persichilli also announced a new initiative to vaccinate long-term care staff and residents and to offer education/outreach and vaccination to staff who have been hesitant to get vaccinated.
“Vaccination among residents is high, however only about half of long-term care staff have chosen to get vaccinated,” said Commissioner Persichilli. “We have provided webinars, videos and materials in multiple languages, but a new outreach effort is underway to offer education and vaccination.”
As part of the second phase of the federal Pharmacy Partnership for Long-Term Care (LTC) Program, two group purchasing organizations with affiliates in New Jersey – Managed Health Care Associates and Innovatix – will receive a proportion of vaccine through the program to distribute to their member long-term care pharmacies. New Jersey has worked closely with CDC to ensure at least 700 doses of Johnson and Johnson vaccine are available in the first week of this effort in New Jersey.
This initiative will provide direct access to the COVID-19 vaccine for staff and residents who were not vaccinated during their 3 on-site clinics as well as newly admitted residents and new staff. In addition, long-term care staff and residents are eligible statewide and can access vaccines on their own anywhere with appointments in the state
Some 270,421 doses of vaccine have been administered to residents and staff in long-term care facilities and other congregate settings—including HUD 202 senior housing and the facilities—as part of the Federal Pharmacy Partnership for Long-Term Care (LTC) Program. The state included as many high-risk congregate settings into that partnership as possible.
Through a supplemental federal partnership, Walmart conducted closed vaccination clinics for residents and staff members of Intellectual and Development Disability Group Homes. Through this effort a total of 5,594 residents and staff have been fully vaccinated.
The Executive Directive for Indoor Visitation can be found at: https://nj.gov/health/legal/covid19/3-22-21_ExecutiveDirectiveNo21-001_StandardsProtocolsVisitorsFacilityStaff.pdf
The memorandum sent to facilities regarding ED 21-001 can be found at:
Follow the New Jersey Department of Health on Twitter @njdeptofhealth, Facebook /njdeptofhealth, Instagram @njdeptofhealth and Snapchat @njdoh.