On June 28, 2013 the Center for Clinical Standards and Quality/Survey & Certification Group through CMS issued a Memorandum regarding “Access and Visitation Rights in Long Term Care (LTC) Facilities.” The memorandum states it is a “reminder” to providers and surveyors that LTC facilities must ensure that all individuals seeking to visit a resident be given full and equal visitation privileges, consistent with resident preference and within reasonable restrictions that safeguard residents.
The interpretive guidelines for F172 states that residents have the right to receive family and non-family visitors and that facilities must provide 24 hour access to all individuals visiting with the consent of the resident. However the regulation also states that certain visitors may be subject to “reasonable restrictions” imposed by the facility that protect the security of all the facility’s residents such as denying access to those engaged in disruptive behavior.
So what does this mean and how is it interpreted? It isn’t clear how surveyors will determine what types of behaviors are considered disruptive or how to evaluate whether a restricted visitation policy is appropriate. That said, it is critical that your facility policy meet the basic requirements of the regulations and that exceptions to the policy be well documented.
If you feel that a visitor is behaving in a way that may put your residents or staff at risk you are required and entitled under the regulations to limit visitation privileges. It is recommended that first:
- Clearly document what the behaviors are that increase risk
- Discuss what steps were initiated prior to limiting the visitation privileges
- Document what education was provided to the visitor/s and the resident regarding expectations of visitors
- Contact legal counsel prior initiating any type of restrictions that may interfere with resident rights/choice
- Consider discussing concerns with the local ombudsman prior to initiating any type of restrictions
- Educate the resident on the risks associated with their visitors behaviors
- Consult with the resident and/or DPOA to discuss options to provide limited visitation
- Consider meeting with the resident and family counsel groups on a regular basis to discuss the policy on facility expectations for safe and unrestricted visitation
Remember, everyone in your care is at risk if a visitor does not adhere to the facility policy regarding visitor expectations. Review your policy to ensure it is clear and not overly restrictive; postings are also a great way to share expectations and one-on-one education may be helpful for those visitors requiring additional guidance.
Remember, your home is home to your residents. Let’s work together to assist in providing a comfortable environment that can be shared with loved ones in an unrestricted manner while avoiding regulatory citations. If you need additional assistance in reviewing and/or updating your current policy please contact your HealthCap Risk Manager.