DES MOINES — Effective immediately, the Iowa Department of Inspections and Appeals (DIA) implements the same regulations for visitors at State-licensed and certified facilities as it has with nursing homes.
DIA received guidance from the Centers for Medicare and Medicaid Services (CMS) on Friday, March 13, outlining aggressive new recommendations for nursing home operations to prevent the spread of Novel Coronavirus (COVID-19) in vulnerable populations. DIA is now extending that same guidance for residential care facilities, assisted living facilities, adult day services, and children's services.
"DIA will do everything in its power to assist our health care partners and mitigate the spread of any disease, including COVID-19," said DIA Directior Larry Johnson, Jr. "The health and safety of these facility residents, staff, and visitors is paramount, and we must take quick and decisive action."
Restriction of Visitors
DIA and CMS recommend that facilities and programs can and should restrict all visitors, as well as non-essential health care personnel. Exceptions could be made for certain compassionate-care situations such as end-of-life; in those situations, visitors would be required to remain in a resident's room or apartment. Decisions about visitors entering a facility for end-of-life care should be made on a case-by-case basis; those visitors should be carefully screened and equipped with personal protective equipment (PPE), like masks. However, visitors who are experiencing fever, sore throat, cough, and/or shortness of breath should be restricted from visiting, even in end-of-life or compassionate-care situations.
Additionally, all group activities and communal dining should be canceled. Providers may utilize dining facilities for more than one person at a time as long as recommended personal space allowances (six or more feet apart) and all other appropriate infection-control practices are observed.
Staff Action and Education
Prompt detection, triage, and isolation of any residents, tenants, participants, or staff who have potentially been infected with COVID-19 are key in preventing the spread and unnecessary exposure to those who live and work in these facilities. DIA encourages facility and program staff to:
- Frequently monitor the CDC and IDPH websites for updated information regarding COVID-19;
- Review and follow the facility's infection-control practices to mitigate the spread of the virus and if necessary, develop new practices;
- Frequently and thoroughly clean and disinfect surfaces;
- Notify potential visitors via phone calls, letters, and signage to refrain from visiting until further notice (note: there will be few exceptions);
- Increase signage and remind staff, residents, and visitors of proper hand hygiene and cough/sneeze etiquette;
- Conduct active screening of residents, staff, and visitors for fever and respiratory symptoms;
- If, at the beginning of their shift, staff exhibit fever or respiratory issues, have them apply a mask and send them home to isolate;
- Remind residents, staff, and visitors to practice social distancing (no touching or hugging family members);
- Offer alternative means of communication for residents and their families, such as phone and video communication, and update families as situations and conditions change;
- Review and revise how interaction with vendors and the receipt of supplies will occur, as well as the interaction with emergency personnel and transportation providers. For example, have deliveries made at a dedicated location outside instead of the delivery person entering the building.
- Facilities program staff should follow CDC guidelines for restricting access to health care workers.
Federal regulations require that hospitals have written policies and procedures in place governing the visitation rights of patients, to include information about clinically-necessary or reasonable restrictions or limitations the hospital might need to institute and the reasons for those restrictions or limitations. CMS guidance identifies the concern for infection control as an example when restrictions might be warranted. Patients must be notified of their visitation rights as well as any restriction or limitation. The COVID-19 guidance memo released by CMS on March 4 for hospitals is available online.
Iowans who wish to learn more about Novel Coronavirus and how to prevent the spread of the virus should visit the Iowa Department of Public Health's website.
The Iowa Department of Inspections and Appeals is committed to protecting the health and safety of Iowans through regulation and oversight of health care, food, and gaming; application of administrative law; and investigation of Medicaid and welfare fraud.