COVID – 19 VISITATION
Updated: April 1, 2021
Author: Cindy Brown
Monday – Friday: 3pm – 7pm
Saturday and Sunday: 10am – 2pm
Separation of patients and their loved ones during a hospitalization can cause significant stress and anxiety, and the opportunity to visit hospitalized patients must be done in a manner that continues to prevent the spread of COVID-19 and ensure the health and wellbeing of patients, staff, and visitors. In recognition of this need to ensure a safe environment of care for our patients, staff and community in general, hospital visitation is restricted to a 4 hour block with 2 visitors during those 4 hours.
The New York State Department of Health (NYSDOH) issued visitor limitation guidance to hospitals to protect and maintain the health and safety of both patients and staff during the ongoing novel coronavirus (COVID-19) outbreak.
MEDICALLY NECESSARY/SUPPORT PERSON – The person is essential to the patients care.
NYSDOH allows us to permit a patient support person at the patient bedside for:
- Patients in labor and delivery;
- Pediatric patients;
- Patients for whom a support person has been determined to be essential to the care of the patient (medically necessary) including patients with intellectual and/or developmental disabilities and patients with cognitive impairments including dementia. Cognitive impairment may also be temporary as in a patient needing emergent treatment in the ED. (Example not all inclusive: patient with altered mental status due to a multitude of conditions such as stroke, TIA, shock, sepsis, major trauma, drug overdose, altered electrolyte imbalances, etc.) See under procedure section for details.
Clergy will be permitted as a support person. If the patient already has a support person and a visitor in their room one will need to leave to allow clergy in. Clergy are not permitted in COVID rooms unless patient is at end of life and approved by House Supervisor.
VISITOR– The person is non-essential to the patient’s care. The patient care need can be managed by staff at the hospital. This person is there for the comfort of the patient. Visitor “status” is typically, but not always associated with inpatients due to the nature of their extended stay.
IMMINENT END OF LIFE SITUATION – Situation where death is imminent as determined by medical provider and anticipated within the next 24 hours.
NOTE: A PATIENT IS NOT A VISITOR
Determine if the person is a Visitor or Medically Necessary/Support Person to the patient’s care. House supervisor should be contacted to make the decision if there are any questions.
Support people and visitors must undergo symptom and temperature checks upon entering the facility, and shall be denied entry if they report significant COVID-19 exposure, during the prior 10 days, or symptoms in the past 72 hours, and/or have a temperature equal to or greater than 100.0 degrees Fahrenheit. Suppose visitors or support people have traveled from another country. In that case, they will need to quarantine for ten days before being allowed in the hospital or have a test 3 days before coming to NY and four days after arrival to end quarantine sooner. Must provide proof of negative test; the hospital will not accept a pending test. Most would get their tests back on day 6-7, so could potentially be allowed in 3 days sooner. IDENTIFY ALTERNATIVE METHODS FOR COMMUNICATION WITH SUPPORT PERSONS TO ENSURE PATIENT NEEDS ARE MET. FOR END OF LIFE PATIENTS, CONTACT HOUSE SUPERVISOR. May not enter if on isolation or quarantine by their local health department
Upon entry into the facility all support people will be provided a badge that must be worn at all times.
Name and contact information, the date(s) of the visit, and the name of the patient(s) seen are maintained in an electronic format by the facility.
Follow entry screen protocol at all designated entrances.
All visitors must adhere to the following policies and practices:
- Visitors must wear face coverings at all times.
- Visitors may be provided with and asked to wear additional appropriate personal
protective equipment, depending on the disease the patient has, as recommended by the
Department, the Centers for Disease Control and Prevention (CDC), and hospital policy.
- Visitors must be advised regarding how to perform meticulous hand hygiene and how to wear the PPE and must adhere to such procedures.
- Visitors who fail to wear a mask and other PPE will be asked to leave the facility.
- Visitors must undergo symptom and temperature checks upon entering the facility and shall be denied entry if they report significant COVID-19 exposure or symptoms during the prior 10 days or have a temperature equal to or greater than 100.0 degrees Fahrenheit.
- Once in the facility, visitors must remain in the patient’s room throughout the visit except when directed by hospital staff to leave during aerosol-generating procedures or other procedures during which visitors are usually asked to leave.
- All visitors must be greater than 18 years of age except in rare exceptions as determined by the hospital.
- Provide written information to visitors and/or discuss the potential risks and benefits of the visitor’s presence with the visitor and, depending upon the patient’s condition, the patient.
- Collect name and contact information for visitors, the date(s) of their visits, and the name of the patient(s) visited and maintain this information in an electronic format.
In addition, hospitals will ensure that following allowances are made:
Labor and Delivery
- Two support persons, including a doula if requested, may accompany the patient throughout labor, delivery, and the postpartum period, including recovery, until discharge to home. The support persons can be the patient’s spouse, partner, sibling, parent, or other persons of their choice.
- Pediatric patients may have two designated support persons with them.
Patients with Intellectual and/or Developmental Disabilities (I/DD)
- Patients with intellectual and/or developmental disabilities (I/DD) and patients with cognitive impairments including dementia, may designate two support (one person at a time) to remain with them through their hospitalization. An additional visitor may also be with the patient during hospital-designated visiting hours.
End of life situations
o For patients in imminent end-of-life situations, the NYSDOH considers two family members and/or legal representatives at a time as a support people who should be permitted at the patient bedside. The NYSDOH defines imminent end-of-life situations as a patient who is actively dying, where death is anticipated within less than 24 hours. One to two people may be present at bedside at end-of-life.
For patients for whom a support person has been determined to be essential to the care of the patient (medically necessary) including patients with intellectual and/or developmental disabilities (I/DD), and patients with cognitive impairments including dementia, the NYSDOH considers one support person at a time as essential to patient care in the emergency room or during hospitalization. For these hospitalized patients, especially with prolonged hospitalizations, the patient or family/caregiver may designate two support people. This support person can be the patient’s family, caregiver, or another person they chose. This restriction must be explained to the patient and support person in plain terms, upon arrival or, ideally, prior to arriving at the hospital. Hospital staff should ensure that patients fully understand this restriction, allowing them to decide who they wish to identify as their support person. Individuals age 70 years or older, are not encouraged to be support persons at this time due to increased risk of COVID-19 infection. Note: In the ED a patient may have one support person present. They will not be permitted to accompany the patient to the floor unless they continue to meet the definition of a support person as outlined above.
- Patients that are positive for Covid-19 and PUI’s (patients under investigation for Covid-19) will not be allowed visitors unless it is an end-of-life circumstance. Staff will instruct visitor on proper application of PPE (personal protection equipment) if it is an end-of-life visit
Hospital staff must screen the support person for symptoms of COVID-19 (e.g., fever, sore throat, runny nose, cough, shortness of breath, muscle aches, or diarrhea) and conduct a temperature check prior to entering the clinical area and every twelve hours thereafter for the remainder of their presence at the bedside.
If a support person has confirmed or suspected COVID-19 or presents with or develops symptoms of COVID-19, they should be excluded from the facility. There are no exceptions to this rule. In this situation, through informed decision making the patient and family may choose to select a different support person. Signage will be placed at all hospital entries and parking lots to inform visitors of new COVID – 19 visitation restrictions. This policy will be posted, and made available.
Use alternate methods of communication for patients in the hospital as appropriate to individual patient ability and medical status (audio, visual). This may include use of electronic devices with video ability that are hospital owned, or patient owned devices. CDC recommendations for cleaning will occur after each patient use.
Any person with questions or concerns regarding the COVID – 19 visitation restriction policy will be referred to leadership.
The HIPAA Privacy Rule allows patient information to be shared to assist in nationwide public health emergencies, and to assist patients in receiving the care they need. This is important to consider when visitation is suspended and use of alternative remote methods of communication with family and friends is utilized.
Under Pandemic Public Health Crisis hospitals will not be penalized for failing to comply with HIPAA and the following requirements are waived to facilitate communication and patient care.
- to obtain a patient’s agreement to speak with family members or friends involved in the patient’s care • the requirement to honor a request to opt out of the facility directory
- the requirement to distribute a notice of privacy practices
- the patient’s right to request privacy restrictions
- the patient’s right to request confidential communications
The HIPAA Privacy Rule for releasing the minimum necessary for the care and treatment of a patient remains. Should detailed or complex medical information need to be relayed to a patient’s family or friend, medical staff should make effort to directly convey this information.
References: HIPAA requirements found in 45 CFR NYSDOH Health Advisory March 18, 2020 update March 21, 2020 and update April 10, 2020. Centers for Disease Control and Prevention Coronavirus Disease 2019 Guidance. NYS DOH Health Advisory on Visitation, March 18, 2020, March 21, 2020 and April 10, 2020 and June 17, 2020.