BC Creates Guidance on Visitation in Long-Term Care and Assisted Living

BC Creates Guidance on Visitation in Long-Term Care and Assisted Living

April 19, 2021

BY Sara Pon

Introduction

In 2021, the BC government made several changes and clarifications on the long-term care (LTC) and assisted living (AL) visitor rules. This blog outlines some of the new rules, new orders, and points of interpretation listed in the guidance.

• On January 7, 2021 the BC government released guidance on visits in LTC and AL. This guidance did not change any of the rules in the existing LTC and AL COVID-19 policy. The guidance was intended to clarify the existing visitor policies and create more consistency between facilities.
• On February 5, 2021 the Provincial Health Officer (PHO) issued a public health order entitled Visitation and Visitor Appeal and Review Order.
• On April 1, 2021 expanded social visits went into effect, set out in the updated guidance on visits.

 

Social Visit Guidance

Beginning April 1^st, social visitation expanded. The social visit changes are as follows:

• There will no longer be only one designated social visitor;
• Each resident will be allowed to have 2 adult visitors and one child under 18 visiting at one time indoors;
• The visitors can be different people for each visit, as long as it is two adults at a time;
• Visits can occur in the resident’s room without staff being present;
• If the room is shared, visits can occur in the room if there is enough space to allow adequate physical distance from the other resident;
• Visits can still occur outside, and more visitors can be present, determined by the current PHO guidance on how many people can gather outdoors together (currently 10);
• Residents and visitors can now touch, such as hug and hold hands, as long as they are following infection control measures and wearing PPE;
• Each resident must get a visit at least once per week for a minimum of 60 minutes; and
• Visitors are allowed to use the washrooms inside the facility during the visit.

 

The guidance states what infection control measures must be taken:

• Visits must be booked in advance;
• A list of visitors must be maintained for contact tracing;
• All visitors must be screened for illness;
• Visitors must stay home if sick;
• Visitors must wear a medical mask, both indoors and outdoors;
• Visitors must follow hand hygiene and respiratory etiquette; and
• If a resident has additional infection precautions needed, visitors will be taught how to put on the extra PPE.

 

There are a few other changes:

• Residents can now leave the facility for family visits and outings that are not essential;
• Residents do not have to isolate after returning from an outing;
• Residents do not have to go through a 14-day isolation when they are admitted to a facility;
• Facilities must post the visitor rules, appeal process, and contacts for the site administrator on all entrances and on their public website; and
• Facility operators must conduct monthly reviews of their social visit policy to make sure it complies with the visitor policy and practice requirements.

 

Essential Visit Guidance

The guidance describes essential visits as “necessarily linked with an essential need that could not be met in the absence of the essential visit. Facility staff will determine if a visit is essential.” Essential visits are allowed when the residence has an active COVID-19 outbreak.

• Staff must make the decision in partnership with the resident or substitute decision-maker;
• When making a decision, staff should consider clinical assessment, virus transmission risks, the facility environment, physical distancing capabilities, and available PPE;
• When essential visit requests are denied, the resident’s family must be communicated with, including informing them of how to appeal the decision; and
• If essential visits are not granted, the staff should consider other ways to meet the resident’s needs.

 

Essential visits are allowed for compassionate care, which includes during critical illness and end of life:

• Critical illness is a life-threatening condition or significant health change that is expected to cause complications within the next 12-24 hours, such as a stroke or heart attack;
• To be considered end-of-life, death must be imminent, such as when a resident has a score of 30% or lower on the Palliative Performance Scale or is bed bound; and
• If a resident’s death is imminent, families can have extended visits or a vigil, the details of which are made in consultation with the care team.

Essential visits are allowed when the visit is paramount to the resident’s physical care and mental well-being:

• Visits for physical care means that a resident need additional support to sustain their health and this need is listed in the resident’s care plan; and
• Visits for a resident’s mental well-being means a resident’s mental health is acutely deteriorating and the visit would improve well-being, such as when the resident is experiencing dementia with behavioral issues, anxiety, depression, or delirium.

 

Essential visits include visits for supported decision-making, including:

• When the resident needs a person to speak on their behalf;
• When a resident needs support to articulate their wishes;
• When a substitute decision-maker needs to make significant decisions (including a representative, an attorney under a power of attorney, or the Public Guardian and Trustee); and
• Updating advanced care planning documents.

 

The guidance provides more details on the rule of having only one essential visitor:

• Switches to who is the essential visitor should be considered on a case-by-case basis when there are special circumstances, such as the essential visitor moving away or is ill;
• Essential cultural practices and spiritual needs should be considered; and
• Additional essential visitors can be considered on a case-by-case basis when there are special circumstances.

The guidance notes that the visitor policy cannot address every possible situation, and when the solution is uncertain, decision-makers should use a person- and family-centred approach, and use cultural safety and humility.

 

Appeal Process

The guidance outlines the review process for decisions about essential and social visitor status.

1. Health authority or facility staff make the initial decision about essential visitors;
2. Visitors or family can get an immediate review of the decision from an administrator;
3. Visitors or family can request a further review from their health authority’s Patient Care Quality Office (PCQO); and
4. As a last stage of review, any unresolved complaints are sent to the PHO, who makes the final decision in consultation with the regional Medical Health Officer (MHO).

 

The guidance provides the following details in regard to the appeal process:

• Information on the complaint process and contact for the designated decision-maker and site administrator must be posted at the entrance to the facility and on the facility’s website;
• Each facility must have an administrator on call at all times to immediately review any visitor status decisions; and
• Appeals to the PCQO must be resolved in a timely manner, and the contact must work with the family and operator to resolve the complaint.

 

Visitation Order Provisions

The public health order has five points relevant to visitation in LTC:

• All facilities must follow the guidance, discussed above;
• The appeal and review process applies to people who have had their visitor status revoked;
• A resident can have both an essential visitor and a social visitor;
• The names of a resident’s essential and social visitors must be listed in the care plan; and
• During a reconsideration, the PHO or MHO can request a resident’s records and personal information, and this must be provided to them.

The order also states that the MHO can make visitation orders for their geographic region that are more restrictive than the existing orders. This can be for the whole geographic area, for part of the geographic area, for a class of facility, or for a single facility. This is to allow the MHO to adapt to the local circumstances and risks.

 

Resources

COVID-19 Policies

• BC Long-Term Care and Assisted Living COVID-19 Policies
• BC Guidance on Visits to Long-Term Care and Assisted Living
• BC Public Health Orders

 

Patient Care Quality Offices

• Provincial Health Services Authority
• Vancouver Coastal Health
• Fraser Health
• Island Health
• Interior Health
• Northern Health
• Providence Health Care