Table 2.

Suggested Visitor Guidance as Developed Through a Delphi Consensus Process

Minimum Criteria to Welcome Visitors All staff, residents, and visitors engage in basic hand hygiene and physical distancing in public, shared spaces. All staff wear a medical-grade mask while in the nursing home. All residents and visitors wear a face covering when in shared, public spaces. If a resident or visitor does not own a face covering, one must be provided by the nursing home. The facility has sufficient disinfecting supplies (hand sanitizers, soap, detergent, etc.) and adequate personal protective equipment (gloves, gowns, masks, face shields/goggles). A written isolation and cohorting plan is in place. A written screening and testing plan with adequate capacity for implementation is in place. A written contact tracing and outbreak investigation plan is in place.

Screening All persons entering the nursing home (staff, visitors, volunteers, and vendors) undergo the same entrance screening process, including a temperature check and answering an exposure and symptom questionnaire by a trained entrance screener. Visitors that do not comply with the screening procedure are not allowed to enter.

Visit Logistics Visitors and volunteers can sign up to visit a resident for a defined time period using an electronic process. The nursing home maintains a sign-in log that includes contact information (name, phone number, e-mail address) of visitors and volunteers to help with contact tracing in the event of an exposure. A nursing home may need to limit the number of indoor visitors to no more than 2 visitors at one time to allow physical distancing between visitor groups. Visit frequency and the number of visitors a nursing home is able to accommodate would depend on the physical space, availability to visit outdoors, and personal protective equipment (PPE) availability.

Infection Prevention Strategies Visitors must be guided to the designated visit area to limit interactions with patient care areas, staff, or other residents. Gloves and a gown with associated hand hygiene are required if visitors wish to engage in limited physical contact with a resident, such as hugging, hand holding,or direct resident care such as assistance with meals. The nursing home must provide gloves and gowns for this purpose.

Location The nursing home should designate areas for indoor and outdoor visits. Ideally the visits would occur outside, conditions permitting. Indoor areas should be accessible without walking through a resident care area, must be disinfected between scheduled visits, and should be large enough to facilitate physical distancing between visit groups.

Essential Family Caregiver A nursing home should allow each resident or surrogate decision maker to choose essential family caregivers who, along with the surrogate decision maker, would have priority to frequently visit a resident, for example, to provide complex care, aid in feeding, or redirect and reassure those residents living with dementia who have responsive behaviors.

Symptomatic Residents Visiting a resident with or without symptoms who has a positive, unknown, or pending COVID-19 test result requires the following steps: 1. The visitor must participate in an informed consent discussion with leadership regarding the risks of potential exposure to COVID-19 and whether they outweigh the benefits of a visit. Additionally, visitors should be counseled to understand the COVID-19 test status and encouraged to wait for a pending test result to return prior to a scheduled visit. 2. The nursing home must provide education and training so that the visitor can demonstrate appropriate donning/doffing of PPE, including a mask, gowns, gloves, and possibly a face shield. 3. The visitor must agree to wear the recommended PPE during the visit and follow all infection prevention and control procedures within the nursing home.

Compassionate Care, End-of-Life Visits The nursing home should make every attempt possible to work with visitors of residents who are seriously ill, receiving care focused on comfort, and approaching end-of-life. Specifically, facilities may waive the visitor limits, offer extended hours, and offer an in-person room visit to help facilitate the psychosocial well-being of the resident and family members.