Visitors and visitation guidelines – prior to 5/6/21

Below is historical information. Information on this page may be useful but some NH DHHS guidance is no longer in force. For current guidance, please see Reopening, and visit the NH DHHS COVID-19 web page for Long Term Care Facilities.

Visiting, indoor and outdoor

For answers to many questions, see NH DHHS Bureau of Infectious Disease Control’s Long Term Care Facilities Visitation Frequently Asked Questions for Families and Residents as well as the Bureau’s Reopening Guidance for LTCFs.

Q: Can we allow visitors from out of state? What about kids? (short answers: yes, but please see details below and the official guidance linked to below).

Q: Should we allow visitors?

A: That depends on the phase your facility is in. The NH Bureau of Infectious Disease Control issued guidance on phased reopening including visitors, activities, meals, etc.

The link above includes a chart of the phases with guidelines for each as well as information about indoor, outdoor, and compassionate care visits, as well as “essential support visitors,” non essential personnel (like salon staff) and animal visitors. The guidance includes detailed recommendations, screening protocols, and requirements for before, during and after visits. It also explains how to move through the phases. DHHS notes the guidance is for “LTCFs, including nursing homes, assisted living facilities, and other residential care facilities.”

Visitors from out of state should also consider any travel restrictions and quarantine rules they might need to follow when they return home.

Updated NH Bureau of Infectious Disease Control guidance on phased reopening for LTCFs notes: “Visitation is generally restricted to adults and children who are able to comply with mask wearing. If a facility determines that special circumstances justify relaxing this requirement, it may allow visitors younger than 2 years old on a case-by-case basis.”

You can find links to CMS’s county positivity data (one measure that determines phases) on the NH Covid Alliance Senior Support Team public page.

Or, on the CMS website, see Nursing Home Data page by scrolling down to the COVID-19 section. Note that your phase is determined by county positivity rate, even if you are in a city that has its own data on the DHHS dashboard. Again, these data sources are in one place on the NH Covid Alliance Senior Support team main page.

For further sources of information on indoor and outdoor visits see:

The Center for Medicare & Medicaid Services (CMS) issued a memo which “provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.” They also note that:

“While taking a person-centered approach and adhering to the core principles of COVID-19
infection prevention, outdoor visitation is preferred even when the resident and visitor are fully vaccinated* against COVID-19. Outdoor visits generally pose a lower risk of transmission due to increased space and airflow. Therefore, visits should be held outdoors whenever practicable.”

DHHS notes that “CMS mandates that facilities may not restrict visitation without a reasonable clinical or safety cause.

If you are a Medicare certified facility and want to know if your reason for restricting visitation meets this criteria, contact the NH Health Facilities Administration Certification office at 271-9499.

End-of-life and compassionate care visits

Q: What are the recommendations for end-of-life visits and compassionate care visitation?

A: Compassionate care visits including end-of life have been permitted in all phases throughout the pandemic and is included in guidance on visits in different phases of reopening.

NH Bureau of Infectious Disease Control provided guidance on this and other COVID-19 related end-of-life care questions earlier in the pandemic – and updated this in December to note that out of state end-of-life visitors should follow NH COVID travel guidance.

CMS guidelines suggest end-of-life visitors (including family, clergy, bereavement professionals, etc.) practice hand hygiene, wear masks, and be screened for illness.

In those guidelines CMS also outlines different compassionate care scenarios related to psychological and/or emotional well-being.

AMDA’s (The Society for Post-Acute and Long-Term Care Medicine) resource guide, recommends instructing visitors in cough etiquette and asking them not to touch surfaces (see p. 48).

For more on COVID-19 and end-of-life decisions, see Coalition for Compassionate Care of California’s COVID Conversations, and Advocate Health’s Advance Care Planning During COVID-19 Toolkit.

Essential support and social isolation concerns

Q: What is an Essential Support visitor?

NH Bureau of Infectious Disease Control guidelines define Essential Support Visitor as someone “who can provide consistent support to the resident in activities of daily living
(ADLs). Every resident can designate one essential support visitor chosen by the
resident, or the resident’s power of attorney, if activated, to provide emotional and
other support. These are intended to be the same visitor, who agrees to limit their own
possible social exposure to and has been educated regarding COVID-19 safety.”

This definition follows the NH Commission on Aging Issue Brief on Social Isolation in Long-Term Care During the COVID-19 Pandemic includes feedback from residents and families and a variety of suggestions, including defining at least one “Essential Support Person” for each LTC resident. The brief also suggests screening residents for social isolation.

See also: Activities, Internet, connectivity, broadband for virtual visits, Keeping families and residents informed and connected, Reopening, Self care and mental health support

This page updated 5/7/21

Information is changing rapidly as the COVID-19 outbreak evolves. Please take the links on these pages, especially the NH DHHS, which coordinates the COVID-19 response in our state, and other public health resources such as your local public health department, the CDC and WHO to find the latest guidance and recommendations.

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