Communication and Visitation – New Way of Southwest Louisiana

COMMUNICATION AND VISITATION

At the time of intake, a communication and visitation plan will be developed and agreed upon by family and other members of the treatment team. Changes will be made when necessary. This plan will include a discussion of the various types of contact you will be allowed during placement. Final authority for the communication and visitation plan rests with New Way. Parental guidance may include telephone contact with families, friends, and visitation at the PRTF. Contacts listed with written permission from the parent/guardian will be used; all others will not be allowed to contact resident. New Way reserves the right to add restrictions of the use of speaker phones to monitor residents who may be at risk of harm for self or others through being in a room unmonitored and otherwise making unmonitored phone calls. The same applies to visits with parents in person, as supervision is also necessary for safety. This decision will be based upon the clinical evaluation and/or clinical observations of risk factors. Residents will contact family weekly on speaker phone or in person for family therapy. In addition, residents will be allowed one additional 5 minute call weekly- unless restrictions are placed on the treatment plan for the safety of self or others. In such a case, speaker phone will be used. This will be based on a clinical decision and not for any form of punishment. Again, this decision will be based upon the clinical evaluation and/or clinical observation on risk factors and will be added in the individualized treatment plan. New Way will build effective community integration with proper consent by adding additional visitation opportunities, when necessary use of Skype for special circumstances with judicial system. Visitors are asked to call in advance. They may visit residents on the swing/rocking chairs in the covered patio area outside of the main building. When weather does not permit, they may visit in the visitors’ room in the PRTF building. No parents are allowed to bring any items from home that does not come packaged directly from a company in a box except at the point of admission, where all items are immediately washed for protection from COVID-19. Nurses will take temperatures of all visitors and screen visitors. Visitation logs must be completely filled out by visitors upon entry and departure. Appropriate identification such as a driver’s license or legal identification card must be presented, and that individual must be on the resident’s contact list . Any visitors with a fever will be asked to leave. Visitors will remain six feet away from residents and staff at all times and all visitors, staff, and residents must wear masks at all times. Residents who test positive for COVID-19 and therefore cannot have face to face visits will have virtual communications: phone calls and when possible video-communication through their therapists. Therapists will keep families up to date. No residents will be allowed to leave the facility for a home pass at this time due to the dangers of COVID-19 and of the potential of spreading infection.

Symptoms that are mild and our PCP, Dr. Aswell or his medical staff recommends the resident is not required to transfer to a hospital will remain at New Way as long as we are able to follow the infection prevention and control practices recommended by the CDC.

If the resident develops more symptoms and is required to transfer to a hospital for a higher level of care, New Way will provide for such needs. Prior to transfer, nurses will alert medical services of the resident’s diagnosis, parent/caregiver’s name and phone number, and precautions taken including wearing a facemask during transfer. Medications will be taken with the resident and appropriate clothing. If the resident does not require hospitalization and can be discharged to his home, (in consultation with state public health authorities) if deemed by the treatment team as medically, clinically, and socially appropriate. The resident will be informed with what to expect during the transfer and will be provided with any needed devices, aids, or supportive equipment. New way shall place a facemask on the resident and isolate him in a room. The door shall not be closed due to appropriate supervision to prevent harm to self or others.

When should staff or residents seek medical attention: Look for emergency warning signs of COVID-19. Anyone showing signs should seek emergency medical immediately: Trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face. This list does not include all possible symptoms. Nurses must call Dr. Chuck for any other symptoms that are severe or concerning to them.

Call 911 or call ahead to Mercy Regional Hospital’s ER. Notify the operator that you are seeking care for someone who has or may have COVID-19

Acceptance of Residents: New Way will only accept a resident with COVID-19 only if we are able with resources, space and man power to follow CDC guidelines. The safety of all residents will be considered in this decision depending on their current individualized needs to avoid placing them at any risk. If we cannot follow these guidelines, it must wait until these precautions are discontinued. New Way will admit any residents that we normally admit who are not symptomatic, including individuals from hospitals where a case of COVID-19 was/is present if we are able to adhere to the infection prevention and control practices recommended by the CDC.

We reserve our back bedroom that is separate from the rest of the facility for residents coming or returning from the hospital.

Such residents and any residents who test positive for COVID-19 will no longer isolate for 14 days but will instead isolate for 10 days after symptoms first appeared – just as long as 24 hours have passed without a fever and without the help of fever-reducing medications and if key symptoms, like coughing and shortness of breath have improved. If 10 days have passed since the first positive test and the resident has not developed symptoms, he can discontinue isolation. Because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of the quarantine may be shorter or longer than 10 days after the first positive test in accordance with CDC guidelines and the recommendations of Dr. Aswell and his office.

Clarification due to new guidelines: Staff who had prolonged contact with a patient, visitor or other colleague with confirmed COVID-19 who was not wearing a face mask, eye protection or other PPE should exclude from work for 14 days after last exposure. Monitor themselves for fever or symptoms consistent with COVID-19. Arrange for medical evaluation and testing.

In determining the time period when the person could have been infectious, for individuals with confirmed COVID-19 who developed symptoms, consider the exposure window to be two days before symptom onset through the time period when the individual meets criteria for discontinuation of transmission-based precautions. For those diagnosed but never developed symptoms, consider the period beginning 2 days after their exposure until they meet criteria for discontinuing precautions. If the date of exposure cannot be determined, use a starting point of 2 days positive to the positive test through the time period when the individual meets criteria for discontinuation of protocols.

PHONE USE RULES:

Remember to be polite when talking on the phone.
Phone calls can be made and received after 8:00 a.m. and up to fifteen minutes before bedtime on week days and before 10:00 p.m. on weekends. All phone calls must be made with staff permission.
Many people will be using the phone—please limit the number of calls and leave a reasonable amount of time in between calls. The length of calls will be limited to five minutes unless other arrangements were made in advance with the staff.
Extra time on the phone may be requested.
No calls from school are allowed except to the facility.
No calling cards, cell phones or pagers are allowed.

VISITATION

Immediate family/significant others/and appropriately identified peers with permission from the resident’s legal guardian, residents, and staff are welcome to visit at designated times or upon approved request. All visitors are asked to call in advance for infection control planning so that we do not have excessive numbers of people in a room at a given time. All requests for special visitation must be approved in advance by the administrative team. No outside food or drink is allowed. All visitation will take place only when deemed clinically appropriate and in compliance with Louisiana federal laws and court orders. Visitation times are from 1:00 p.m.-3:00 p.m. on Saturdays or Sundays. On Sundays, family are encouraged to attend spiritual based services at church with residents and spend the day at New Way after services with them. Visits may also be scheduled during the week when more feasible and allows for more face to face family therapy when available.

COVID-19 Precautions: New Way of Southwest Louisiana will follow the most current CDC guidance as follows in the upcoming information taken from CMS. We will screen and triage all visitors who enter the facility for signs and symptoms of COVID-19 and deny entry of those with signs or symptoms (regardless of their vaccination status). Visitors who are at high risk for severe illness from COVID-19, such as older adults and those with underlying medical conditions, should be strongly discouraged from entering the facility.

Regular hand hygiene is critical and should consist of washing hands with soap and water for at least 20 seconds. When hand washing is not possible, use an alcohol-based hand sanitizer (ABHS) with at least 60% to 95% alcohol. Remind all visitors to keep their hands away from their face.

Visitors should wear face coverings while in the facility or visiting the resident/patient outdoors. Use commercial or homemade face coverings/mask that have at least two layers of finely woven cloth that fit snugly around edges (covering mouth and nose or a disposable mask with multiple layers of non-woven material and a nose wire that fits snugly around edges (covering mouth and nose). If communicating with individuals who are deaf or hard of Page 2 of 11 hearing, it is recommended to use a clear mask or cloth mask with a clear panel. Residents should wear a face covering or facemask (if tolerated) during a visit and whenever leaving their room. Face coverings should not be placed on anyone who has trouble breathing or is unable to wear a mask due to a disability, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. In addition to the categories described above, face coverings should not be placed on children under two years of age.

Social distancing (also called “physical distancing”) of at least six feet between persons (approximately 2 arm-lengths between persons) for visitors or individuals who do not live together within the care facility. Physical distancing should be utilized in combination with face coverings/facemasks and regular hand hygiene. New Way will limit both the number of visitors and the number of visits (maximum visitors occurring simultaneously to support safe infection prevention actions (e.g., maintaining social physical distancing). We can accommodate 3 visitors per resident and possibly allow two residents to have visitors at one set time.

Routine cleaning and disinfecting frequently touched surfaces in the facility and designated visitation areas after each visit. Visitors are asked to sit on wipeable services to allow effective cleaning after visits to protect all residents and staff .

Movement of visitors in these facilities will be restricted. Visitors should limit their movement to see only the client/resident they are visiting and should not go to other locations in the facility.

Resident and staff testing should be conducted in accordance with applicable state, local, and facility policies, procedures, and CDC guidance.

Limit and monitor points of entry to the facility to the main door only.

Visitors who are unwilling to adhere to the recommended principles of COVID-19 infection prevention should not be permitted to visit in person or should be asked to leave. All visitation should be person-centered, supportive of quality of life, and considerate of clients /residents’ physical, mental, and psychosocial well-being. By following a person-centered approach and adhering to these recommended principles, visitation can occur more safely based on this guidance.

Outdoor Visitation: While taking a person-centered approach and adhering to the recommended principles of COVID-19 infection prevention, outdoor visitation is preferred even when the client/resident is fully vaccinated against COVID-19, and can be conducted in a manner that reduces the risk of contracting COVID-19. Outdoor visits generally pose a lower risk of transmission because of increased space and airflow; therefore, visits should be held outdoors whenever practicable. To ensure the highest level of protection for clients/residents, however, wearing of a face covering/mask is recommended and maintaining social distancing is recommended for all visitors and patients/residents, even during outdoor visits. Outdoor visitation should be facilitated routinely unless weather considerations. New Way will also limit the number of individuals visiting per client/resident at the same time as predicated on the size of the outdoor space.

*The CDC defines “Fully Vaccinated” as a person who has received the required dose or doses of a COVID-19 vaccine and that individual has reached the post-vaccine period where the vaccine is at maximum effectiveness, at least 14 days after the second dose in a two-dose series or 14 days after one dose of a single-dose vaccine.

Indoor Visitation: Indoor visitation will be limited under the following scenarios: • Unvaccinated clients/residents

Residents with confirmed COVID-19 infection whether vaccinated or unvaccinated until they have met the criteria to discontinue transmission-based precautions, and

Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

New Way will consider how the number of visitors per client/resident at one time and the total number of visitors in the facility at one time (based on the size of the building and physical space) may affect the ability to maintain the core principles of infection prevention. New Way will schedule visits for a specified length of time to help ensure all residents are able to receive visitors. During indoor visitation, New Way will limit visitor movement in the facility. Visitors should not walk around different halls of the facility. Rather, they should go directly to the designated visitation area. Visits for residents who share a room should not be conducted in the resident’s room. If the resident is fully vaccinated, he can choose to have close contact (including touch) with his visitors in accordance with CDC guidelines. Visitors should physically distance from other residents and staff in the facility.

Indoor Visitation during an Outbreak

To detect cases swiftly, we remind facilities to adhere to CDC 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 clients/residents or staff is identified, a facility should immediately begin outbreak testing, and suspend all indoor visitation (except that required under federal civil rights law, including disability rights law), until at least one round of facility-wide testing is completed. Visitation may resume based on the following criteria: • If the first round of outbreak testing reveals no additional COVID-19 cases in other areas (e.g., units) of the facility, then visitation may resume for residents in areas/units with no COVID-19 cases. However, the facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing..

If the first round of outbreak testing reveals one or more additional COVID-19 cases in other areas/units of the facility.

Also, in all cases, visitors will be notified about the potential for COVID-19 exposure in New Way if they are permitted to visit). We note that compassionate care visits are allowed at all times for any resident (vaccinated or unvaccinated), regardless of the above scenarios. Routine testing is essential to maintaining the health and safety of residents/clients, staff, and visitors. Similarly, CMS encourages all clients/residents and staff to become vaccinated when they have the opportunity. New Way will continue to assess symptoms of all staff (in each shift), each client or resident (daily), and all persons entering the facility, such as vendors, volunteers, and visitors, for signs and symptoms of COVID-19.

Visitor COVID-19 Testing and Vaccination: New Way will make an effort when feasible to screen visitors for their current status and exposure for COVID-19.

Compassionate Care Visits

While end-of-life situations have been used as examples of compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life situations, reference: Nursing Home Visitation-COVID-19, but are not limited to, the following:

A client/resident who was living with their family before recently being admitted to an ICF/IID or PRTF, and is struggling with the change in environment and lack of physical family support. • A client/resident who needs cueing and encouragement with daily care needs such as eating, drinking, or hygiene previously provided by family and/or caregiver(s).

A client/resident, who is used to talking and interacting with others, is experiencing emotional distress, seldom speaking, or crying more frequently

Allowing a visit in these situations would be consistent with the intent of “compassionate care situations.” In addition to family members and caregivers, any individual that can meet the client/resident’s needs, such as clergy or laypersons offering religious or spiritual support, can conduct compassionate care visits.

Required Visitation

Except for ongoing use of virtual visits, facilities may still restrict visitation due to our parish’s COVID-19 test positivity rate, the facility’s COVID-19 status, a client’s/resident’s COVID-19 status, visitor symptoms, lack of adherence to proper infection control practices, or other relevant factor related to the COVID-19 data. Residents who are on transmission-based precautions for COVID-19 should only receive visits that are virtual, through windows, or in-person for compassionate care situations, with adherence to transmission-based precautions. However, this restriction should be lifted once transmission-based precautions are no longer required per CDC guidelines, and other visits may be conducted as described above.

1.Any staff who has known or suspected signs of COVID-19 while on-the-job. If so,these steps should be taken: a. Inform the facility’s leadership and include information on individuals, equipment, and locations the person has come into contact with within the 48 hours before symptom onset, put on a facemask, self-isolate outside of the facility

Has new signs or symptoms of a respiratory infection, such as a fever, cough, or difficulty breathing.

Had close contact with someone who is positive for COVID-19 infection, someone who is considered a person under investigation (PUI) for COVID-19, or someone with respiratory illness, even if not experiencing symptoms.

For those individuals who do not meet the three criteria above, New Way will allow entry but will require visitors and staff to wear a face covering/mask.

For those clients/residents that are not able to have visitors or outside HCP visits because of their high-risk medical status, or for those clients/residents that test positive for COVID-19 infection, New Way will offer alternative means of communication by phone calls or by assigning dedicated staff as primary contacts to families and caregivers for inbound calls and conduct regular outbound calls to keep families and caregivers up to date.

If a resident requires assistance to ensure effective communication (e.g., a qualified interpreter or someone to facilitate communication) and the assistance is not available. New Way will allow the entry into the facility of a person to interpret or facilitate. Federal disability rights law also requires effective communication for individuals with disabilities: These obligations do not preclude facilities from imposing legitimate safety measures that are necessary for safe operations, such as requiring such individuals to adhere to the recommended principles of COVID-19 infection prevention.

Communal Activities and Dining

If unvaccinated clients/residents are present during communal dining or activities, then all clients/residents should use face coverings when not eating and unvaccinated clients/residents should physically distance from others.