VISITATION POLICY UPDATE

DURING COVID PANDEMIC

UPDATED:  3/11/2021

QSO-20-39-NH (REVISED 3/10/21)

BACKGROUND:

(for the purposes of this policy, “Nursing Home” also applies to the Personal Care units.)

• In March 2020, CMS issued memorandum QSO-20-14-NH providing guidance to facilities on restricting visitation of all visitors and non-essential health care personnel.  This led to our “lockdown status” here at Saint John XXIII Home (SJ23).

•  In May 2020, CMS released Nursing Home Reopening Recommendations, which provided additional guidance on visitation for nursing homes.

•  In June 2020, CMS also released a document on visitation, which expanded on previously issued guidance on topics such as outdoor visits, compassionate care situations, and communal activities.  This led to our patio visits and later visits inside within Roncalli Center here at SJ23.

• In September 2020, CMS released (QSO-20-39-NH) COVID VISITATION standards related to; Prevention Core Principals, Indoor visits, outdoor visits, outbreak standards, etc.  This document has been our “standard” here at SJ23 since being released.

KEY DEFINITIONS:

• FULLY VACCINATED:  Fully vaccinated refers to a person who is ≥ 2 weeks following receipt of the second dose in a 2 dose series, or ≥ weeks following receipt of one dose of a single dose vaccine, per the CDC’s Public Health Recommendations for Vaccinated Persons.

• UNVACCINATED:  Individuals who do not meet ALL standards of the FULLY vaccinated definition above.

NEWEST VISITATION UPDATE:  (3/10/21)

• In March 2021, CMS released (QSO-20-39-NH revision).  This document acknowledges the impact that social isolation may have on the well-being of nursing home residents.  It further acknowledges the progress that has been made related to the COVID VACCINATION of residents and staff members of health care facilities.  At the time of this release, SJ23 had a resident vaccination rate of >95%.  
• VISITATION will now be determined by the following:
  • COVID status of the UNIT(s) within SJ23.  (Green = visitations)
  • Mercer County COVID positivity rate. (under 10%)
  • Vaccination % of residents across our campus (greater than 70%)
  • Vaccination status of an individual resident (see unvaccinated exceptions).

** Note, CMS has removed the standard of stopping visitation solely due to the Mercer County positivity rate.  As well as, implemented standards that may be implemented should an outbreak occur at SJ23, through RISK ASSESSSMENT by unit  (nursing home, personal care, special needs). 

CORE PRINCIPLES OF COVID-19 INFECTION CONTROL:

MUST CONTINUE to be followed at all times.

• SCREENING:  of all who enter SJ23 for signs/symptoms of COVID (temperature and questions/observation for signs of COVID).
• DENIAL OF ENTRY: for those with signs/symptoms or those who have had close contact with someone with COVID infection in the prior 14 days (regardless of the visitors vaccination status).
• HAND HYGIENE:  (use of alcohol-based hand rub is PREFERRED).
• FACE COVERINGS: Required at all times regardless of vaccination status. (cover mouth AND nose)
• SOCIAL DISTANCING: at least 6’ between persons.
• VISITOR EDUCATION:  signage displayed related to expectations of visitors.
• CLEANING/DISINFECTING:  cleaning process of designated visitation areas after each visit.
• PPE USE:  proper use of PPE by staff and visitors.  (residents recommended to wear mask but not required).
• COHORTING:  facility must have a plan in place to respond to COVID cases / COVID care.
• TESTING:  Resident and Staff testing must be conducted as per testing requirements based on County positivity and facility positivity rates.

Visitors who are unable to adhere to the core principles of COVID-19 infection prevention should not be permitted to visit or should be asked to leave

INDOOR VISITATION:

SJ23 will permit INDOOR visitation for all residents regardless of vaccination status.  At this time, we will continue to offer “visitation stations” within Roncalli Center.   We have recreated our “stations” to improve the visitation experience. 

Indoor/Outdoor Visitation Standards:

• Visitation will be limited to 2 visitors per resident per visit.
• All visitors will be required to adhere to the CORE PRINCIPLES.
• Residents will be encouraged to wear masks during visits (not required).

We will continue to utilize the “scheduled visits” process to help organize the visits, overcome resident room assignment obstacles and maintain infection control standards.  In an attempt to not disrupt meal times, visitations will continue to occur between the lunch and evening meals.  We have increased the number of “stations” for visitation, to allow for multiple visits weekly for each resident.  In addition, we have removed the “barrier screens” to allow for better communication but still encourage 6’ social distancing.  This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated.  However, we acknowledge the toll that separation and isolation has taken.  We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one.  Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor, while wearing a mask and performing hand hygiene before and after the visit.  Regardless, visitors must physically distance from other residents AND staff in the facility.  Visits can be scheduled by calling 724-981-3200 between the hours of 9am – 9pm.  Our goal is to continue to move toward visitation within resident rooms.  However, keeping a focus on risk management, we will continue to restrict the location of visitation until the vaccine is more readily available within our community. 

OUTDOOR VISITATIONS:

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 WILL be held outdoors whenever practicable. However, weather considerations (e.g., inclement weather, excessively hot or cold temperatures, poor air quality) or an individual resident’s health status (e.g., medical condition(s), COVID-19 status) may hinder outdoor visits. For outdoor visits, SJ23 will utilize the “front porch”, as a safe outdoor space for visitation.  When conducting outdoor visitation, all appropriate infection control and prevention practices should be adhered to.

VISITATION EXCEPTIONS:   

Circumstances when visitation will be limited due to a HIGH RISK of COVID transmission.  The following scenarios will require INDOOR/OUTDOOR visitation to be RESTRICTED:

• For Unvaccinated residents:  if the Mercer County COVID positivity rate is greater than 10% AND less that 70% of SJ23 residents are Fully Vaccinated.
• For COVID positive residents:  whether vaccinated or unvaccinated, will not be permitted visitors until they have met the criteria to discontinue Transmission-Based precautions.
• For Residents in QUARANTINE:  whether vaccinated or unvaccinated, will not be permitted visitors until they have met criteria for release from Quarantine.
• VIRTUAL VISITS:  In the event that any of the above situations arise, visitation should be limited to virtual visits, telephone calls and window visits for those residents impacted.

INDOOR VISITATION DURING AN OUTBREAK

This section is a significant deviation from the prior standards

.

An outbreak exists when a new nursing home onset of COVID-19 occurs (i.e., a new COVID-19 case among residents or staff). This guidance is intended to describe how visitation can still occur when there is an outbreak, but there is evidence that the transmission of COVID-19 is contained to a single area (e.g., unit) of the facility. To swiftly detect cases, SJ23 will continue to adhere to CMS regulations and guidance for COVID-19 testing, including routine staff testing, testing of individuals with symptoms, and outbreak testing.

When a new case of COVID-19 among residents or staff is identified, SJ23  will immediately begin outbreak testing and suspend all visitation (except that required under federal disability rights law), until at least one round of facility-wide testing is completed.

Visitation can resume based on the following criteria:

•  If the first round of outbreak testing reveals no additional COVID-19 cases in other areas (units) of SJ23, then visitation can resume for residents in areas/units with no COVID-19 cases. However, SJ23 will suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing.  For example, if the first round of outbreak testing reveals two more COVID-19 cases in the same unit as the original case, but not in other units, visitation can resume for residents in areas/units with no COVID-19 cases.

•  If the first round of outbreak testing reveals one or more additional COVID-19 cases in other areas/units of the facility (e.g., new cases in two or more units), then SJ23 will suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.

While the above scenarios describe how visitation can continue after one round of outbreak testing, SJ23 will continue all necessary rounds of outbreak testing. In other words, this guidance provides information on how visitation can occur during an outbreak, but does not change any expectations for testing and adherence to infection prevention and control practices. If subsequent rounds of outbreak testing identify one or more additional COVID-19 cases in other areas/units of the facility, then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.

NOTE: In all cases, visitors will be notified about the potential for COVID-19 exposure in the facility  (appropriate signage regarding current outbreaks within front lobby area), and adhere to the core principles of COVID-19 infection prevention, including effective hand hygiene and use of face-coverings.

VISITOR TESTING and VACCINATION

Visitor testing and vaccination will not take place at SJ23.  We do encourage visitors to be tested on their own prior to coming to the facility (within 2-3 days), however, this is not a requirement.  Similarly, we encourage visitors to become vaccinated when they have the opportunity.  During visits, the “Screening tool” has been updated to include visitor vaccination status.  While we would appreciate visitors answering the question, we will not require such as a condition of visitation.

COMPASSIONATE CARE POLICY

The changes made regarding visitation as stated in QSO-20-39-NH does not impact Compassionate Care visitation.  See Compassionate Care policy.

COVID UPDATE: Edition #27 (2/24/2021)

* By: Kirk Hawthorne

As we approach the 1 year anniversary of our “initial COVID lockdown” here at Saint John XXIII Home, we recognize that so much has changed over the past year. Yet here we are with heavy hearts, and at long last, HOPE.

Mercer County “COVID positivity rate” has dropped below 10%. As a facility, we have gone through 6 consecutive cycles of testing all staff without any new COVID cases. We have been able to vaccinate all residents and staff, who desired to be vaccinated. We continue to work through plans to vaccinate any new residents and/or staff members. As you can imagine, this is a tedious adventure, as we are not able/permitted to vaccinate on our own. Yes, we are COVID free at this time. So, while there is HOPE, we must ALL continue to practice safe standards of wearing a mask, physical distance and frequent handwashing. Please keep in mind that while the vast majority of residents and staff have been vaccinated, this does not give us the green light to simply re-open. This re-opening will be a step by step process, much of which will mirror what happens in the general community.

We will begin the transition to “Step 2 of re-opening” on March 1st, 2021.

On March 1st, 2021, we will once again test ALL staff. Providing these results bring no new positive cases, we will proceed with reopening. The “Beauty Shop” will resume services starting on March 2nd. Resident visitation will start on March 3rd, in Roncalli Center. The initial visitation schedule will be Wednesdays and Fridays, from 12:45pm to 4:45pm. You may begin scheduling visits immediately by calling the facility at 724-981-3200, between the hours of 9am-9pm.

Please remember that we will continue to require mask use at all times. Visits will be 30 minutes in duration and limited to 2 people per visit. Each visitor will be required to complete a “COVID screening questionnaire” and have their temperature taken, with each visit. We are able to accommodate 25 visits per day, however, we anticipate a high demand, so, we ask that you only schedule 1 visit per week.

As required, we will continue to test all staff on a weekly basis (Mondays). As per the direction from the Department of Health, should we have a new positive case amongst staff or residents, we will be required to return to “lockdown status” immediately. With this in mind, we ask that everyone make good decisions related to their visit. Please use caution, if you do not feel well or have potentially been exposed, please do not come in for a visit. We are excited that our residents will finally get to see their loved ones again. Thank you in advance for your patience, cooperation, understanding, support and prayers!

COVID UPDATE: 2/11/2021 – Edition #26

* By: Kirk Hawthorne, Administrator

As we migrate into 2021, the search for the new normal continues. The challenges this virus creates related to our day to day activities, providing care/services, constant testing, continuous mitigation efforts and loss of normalcy are significant. On a daily basis, the entire crew at Saint John XXIII Home, strive to provide the best care possible, as well as, search for normalcy for our residents, family members and staff members alike. We are ALL anxious to resume family visitations.

We have been fortunate to make a great deal of progress regarding COVID vaccine administration on our campus. As of today (2/11/21), 87% of our resident population has received BOTH doses of the Pfizer vaccine. An additional, 7% of the residents will receive their second dose on February 26, 2021. This is a significant step in the right direction.

As mentioned in the past “COVID UPDATES”, words can not express my/our appreciation, respect and gratitude to each and every staff member (HERO) that works at Saint John XXIII Home. The selfless acts of love, kindness and compassion, that we all witness every day is uplifting and reassuring. With that in mind, we continue to offer the vaccine to our staff members as well. Thus far, approximately 75% of the staff has been vaccinated, with more to follow.

We continue to test staff twice weekly. Yes, even those who have been vaccinated. Over the past two weeks, we have completed 350 staff tests, with ZERO staff testing positive for COVID-19. In addition, weekly resident testing has been completed. As with staff, we continue to test residents who have been vaccinated. Over the past two weeks, we have had no additional positive cases amongst our residents.

As a Country, we wait to see how the vaccination process will impact our ability to re-establish normalcy, as a healthcare entity, we are also waiting for new/updated direction to safely move forward. We have implemented the following measures, based on the current standards. On 2/10/21, our entire campus returned to a “Green Zone”, as we no longer have active COVID cases on campus. As of today, the Mercer County positivity rate has decreased to 6.7% (Yellow). Effective immediately, we will return to WEEKLY testing of staff each Monday. Providing we have no new positive cases AND Mercer County stays below 10%, we will be able to gradually resume “scheduled visitation” with family members and return “non-essential” staff (ie- Beauty shop). Again, providing we meet all of the above criteria, our goal is to resume visitation the week of February 22nd. However, if at any time, we experience a new positive case (“outbreak”), we will be required to return to lockdown status, cease visitation and resume our current testing cycle(s) based on the current rules/guidelines.

As a facility, we want to thank everyone for their continued support, encouragement and prayers. We will continue to post updates on FaceBook, facility website and in paper form, it does appear that better days are on the horizon. Be Safe and Thank you!

COVID UPDATE: 1/22/2021 (Edition #25)

(provided by- Kirk Hawthorne, Administrator)

The past few weeks have been filled with a great deal of heartache and pain, here at Saint John XXIII Home. We continue to battle this virus on a daily basis. The impact of the virus on the residents and staff members who have tested positive, ranges from being asymptomatic to death, with most cases being somewhere in between. Perhaps the greatest challenge is the speed at which symptoms change. Our staff, has been amazing, providing compassion and love throughout this entire process. We also greatly appreciate the outpouring of love, encouragement and support.

At this time, our Special Needs unit and the Personal Care unit are COVID free (Green Zones). Our nursing home currently has 48 positive cases. Those individuals who have tested positive within the nursing home, all remain in isolation (Red Zone). We continue to monitor all residents closely for signs and symptoms of COVID. Should a sign or symptom be identified, we will conduct Point of Care testing (Antigen testing) immediately. Our weekly surveillance testing of residents (non-positive) continues as well. We remain in daily contact with the PA-DOH/RRCHP/RCAT.

We have been working closely with the RRHCP/RCAT staff for contact tracing, infection prevention, zone formulations, protocol/process reviews, etc. In fact, the RRHCP/RCAT Rapid Response Infection Prevention team has been on=site the past two days. These folks are the experts and we’re gracious enough to come on-site to assist us.

In an effort to properly mitigate our current outbreak, with the direction of the RRHCP, we anticipate that our current Red Zone will remain in place through 1/31/21. This will allow the entire nursing home to “return” to a Green Zone on 2/1/2021. Please continue to utilize the virtual visit opportunities through our Activities Department.

The timing of this outbreak and the duration of isolation (Red Zone) will impact the delivery of the vaccine. Individuals that are currently positive with COVID and/or remain in isolation (Red Zone) are not permitted to receive the vaccine, due to the possibility of further spread. With that in mind, we have established additional vaccination clinic dates with CVS pharmacy. (Dates: 1/27, 2/5, 2/17, 2/26) Members of Saint John XXIII Home staff will be contacting you, regarding your loved ones vaccine “cycle”.

These are very difficult, trying and emotional times. We have many residents, family members and staff who are ill, struggling emotionally and need your prayers, love and support at this time. Please pray for all who have been inflicted with this virus and those who continue to work endlessly to mitigate it as well. Try to be safe

COVID UPDATE: 01/08/2021 (Edition #24)

* By Kirk Hawthorne

At long last the vaccine has arrived at Saint John XXIII Home. On Wednesday, a crew of pharmacists from CVS pharmacy, arrived at the facility at 11am and administered the PFIZER vaccine to 87 residents and 63 staff. The CVS crew is scheduled to return to the facility on January 27th for an additional vaccination clinic. Protocols have been established for residents and staff to be monitored for any side effects from the vaccination process. At this point, we are seeing minor symptoms (sore arm) from the vaccine. This is a major step in the right direction.

At the beginning of the week, we were able to return the Special Needs Unit and the Personal Care unit to a Green Zone. The health impact that this virus causes varies greatly by individual. At present, the effects of the virus are decreasing daily and residents seem to be on the rebound.

Unfortunately, we continue to battle this virus here at Saint John XXIII Home. Residents within the nursing home and personal care home were tested this week. In total, 8 nursing home residents and 4 staff members tested positive for COVID this week. We have established a Red Zone within the nursing home for those who have tested positive. A yellow zone has been implemented for those residents who tested negative on 1/7/21, as a measure of caution. Everyone is doing well and signs/symptoms are minor at this time. Please keep our residents, their families and our staff members in your thoughts and prayers.

We will be monitoring all residents for signs and symptoms of COVID and will test should symptoms arise. We will also continue our surveillance testing of residents and staff next week. Staff will be tested again on Monday (1/11/21). The resident testing date will be determined based on staff results and any resident symptom identification.

This virus continues to spread throughout our community. We are being diligent in our attempt to prevent, mitigate and now treat the impact of this virus. Words can not express OUR gratitude for the outpouring of love, support, encouragement and trust during these times. We have lost residents, loved ones, family members, friends and co-workers as a result of this virus. Our staff members continue to place themselves in potential “harm’s way” out of love, respect, dedication and determination. Please continue to pray for our residents and their family members, as well as, our incredible staff who are truly hero’s during these unprecedented times. We ask that you help us by doing your part to slow the spread of the virus. Please continue to pray for our residents, staff and the family members of everyone involved.