May 21 MDHHS Order Visitation in Residential Care Facilities
By Jeanne E. Murphy, ICLE | 05/24/21

On May 21, 2021, the Michigan Department of Health and Human Services (MDHHS) issued an order, effective immediately, under the Public Health Code, setting out protocols for visitation to address the threat to public health caused by COVID-19. This order rescinds and replaces an order issued on March 17, 2021. The new order requires residential facilities to comply at all times with Centers for Medicare and Medicaid Services (CMS) guidance applicable to nursing homes included in CMS memorandum QSO-20-39-NH.

Principles for preventing infection. The guidance in CMS memorandum QSO-20-39-NH stresses the importance of best practices to reduce the risk of COVID-19 transmission.

  • All who enter must be screened for signs and symptoms of COVID-19, and entry must be denied to those who have symptoms (except for EMS personnel).
  • Hand hygiene is required, with alcohol-based hand rub being preferred.
  • Face coverings should be worn and social distancing observed.
  • Instructional signage should be used in the facility.
  • After each visit, the facility should clean and disinfect visitation areas.
  • Staff must use appropriate personal protective equipment.
  • Residents should be separated into cohorts through the use of separate areas dedicated to COVID-19 care.
  • Residents and staff should be tested pursuant to CMS memorandum QSO-20-38-NH.

Indoor visitation. The guidance in CMS memorandum QSO-20-39-NH provides that indoor visitation should be allowed at all times and for all residents except that indoor visitation should be limited for the following:

  • unvaccinated residents if the facility’s COVID-19 county positivity rate is greater than 10 percent and fewer than 70 percent of the facility’s residents are fully vaccinated
  • residents with confirmed COVID-19 infection
  • residents in quarantine

Health care workers who are not employees of the facility but who provide direct care to the residents must be permitted to come into the facility as long as they do not have exposure to COVID-19 or show signs or symptoms of COVID-19 after being screened.

Visitation considerations. Facilities should consider the following:

  • how the number of visitors per resident at one time and the total number of visitors at one time may affect the ability to maintain the principles of infection prevention
  • scheduling visits for a specified length of time

Communal activities. Residential facilities must make efforts to allow communal dining and group activities for residents who are not in isolation or not under observation for symptoms of COVID-19. Dining and group activities must provide access to hand hygiene and, when a resident who is not fully vaccinated is present,

  • ensure adequate physical distancing (six feet between participants) and
  • require participants to wear masks, if able, when not eating or drinking.

Outdoor visitation. Visits should be held outdoors whenever practicable. All appropriate infection control and prevention practices should be adhered to.

Residential care facilities include homes for the aged, nursing homes, adult foster care facilities, hospice facilities, substance use disorder residential facilities, and assisted living facilities. It does not include independent living facilities.

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