Since early in the pandemic there have been strict rules that bar in-person visits within nursing care facilities. A client spoke with me recently asking about the parameters for the end-of-life exception to the restrictive policy. The State has adopted a policy, but each facility sets the hours and procedures. Facilities are classified according to their “outbreak status,” which has to do with a variety of factors, including how recently they had any COVID-19 cases, how many cases, and their capability to isolate the active cases within the facility. Only facilities that are at Phase 1 or better can allow in-person visits. There are “end of life” and “compassionate” exceptions to the no-visits policies. The State’s official position is:“End-Of-Life Visitation. During end-of-life situations, healthy visitors are permitted indoor visits within long-term care facilities, assisted living residences, dementia care homes, pediatric transitional care homes, and comprehensive personal care homes.“Healthy is defined as individuals with no signs of respiratory illness such as fever, cough or shortness of breath. They should not have had contact with anyone with or suspected of having COVID-19 or any respiratory illness and individuals should be wearing the appropriate protective equipment. For a full list of safety requirements refer to Department of Health Executive Guidance 20-017.The nursing home resident does not necessarily have to be enrolled in hospice, or “on hospice” as most people say. If the medical staff has determined that the individual is clinically close to death, in severe emotional distress due to isolation, losing weight, or has undergone a severe recent life transition such as s/he recently had to move into the facility or s/he has just suffered the loss of a close family member, the compassionate visitation exclusion can be called upon. The State’s website says:” The term “compassionate care situation” does not exclusively refer to end-of life situations. Examples include:“A resident who was living with their family before recently being admitted to a nursing home, the change in their environment and sudden lack of family can be a traumatic experience. Allowing a visit from a family member in this situation would be consistent with the intent of the term “compassionate care situations.” Similarly, allowing someone to visit a resident whose friend or family member recently passed away, would also be consistent with the intent of these situations.
- A resident receiving hospice care whose health status is sharply declining, or when a resident is not enrolled in hospice, but their health status has sharply declined.
- A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
- A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).”