HarborChase recognizes the critical role family members and other close, outside caregivers have in the care, support and advocating for residents. All residents may designate an individual who is committed to providing companionship and/or assistance with activities of daily living. All residents may choose or request an essential caregiver without regard to race, color, religion, sex (including gender identity and transgender status), age, national origin, disability, or veteran status. The goal of such a designation is to help ensure residents continue to receive individualized, person-centered care. Qualifying components of designating an EC include:

• EC provides personal care needs (ADLs) or emotional support
• EC provides services/support that are included and part of service plan

Definition of Essential Caregiver:

An individual who provides services and/or assistance with activities of daily living to help maintain or improve the quality of care or quality of life for a community resident. Care or services provided by essential caregivers will be identified in the plan of care or service plan, and may include bathing, dressing, eating, and/or emotional support.

Essential Caregiver Visitation Acknowledgment Form

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Personal Service Plan Form

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Essential Caregivers should be allowed entry provided they pass the community screening criteria and comply with community policies for entry. Such criteria may include community-provided testing for COVID-19. Essential Caregivers shall wear a surgical mask and other PPE as appropriate, consistent with the most recent CDC guidance for health care workers and in compliance with community infection control standards. Additionally, essential caregivers must be advised of and acknowledge the risk created by frequency and duration of close contact.

Goals:

• Detect concerns and advocate on behalf of the resident.
• Observe and communicate important details and changes in a resident’s condition/behaviors.
• Assist the resident in management of complex or critical information.
• Provide emotional support and help honor the resident’s personal values and preferences of care.
• Help resident deal with difficult transition or loss, upsetting event, making major medical decision, or end-of-life.
• Alleviate caregiving tasks for staff and providers.
• Preserve and promote quality of life for residents.
• Help promote/maintain a sense of continuity, identity, and autonomy for residents.

HarborChase will allow at a minimum in-person visitation for at least 2 hours daily and may allow exceptions to the 2-hour visitation on a case-by-case basis for end-of-life.

Process:

1. HarborChase will provide the agency for Health Care Administration (ACHA) with a copy of the community’s essential caregiver visitation standard with their initial licensure application, renewal application and/or change of ownership application.
2. The resident must be consulted about their wishes to determine whom to designate as the Essential Caregiver. If resident is deemed mentally incapacitated, the POA or designated Health Care Surrogate will make the decision of designating EC. Consider persons such as a family member, outside caregiver, friend, or volunteer who provided regular care and support to the resident prior to the pandemic.
3. All new residents will be asked if they would like to identify an Essential Caregiver upon move-in.
4. Residents may express a desire to designate more than one EC based on their past involvement and needs (e.g., more than one family member previously split time to provide care for the resident).
5. Residents may designate one essential caregiver.
6. All residents will be allowed to update as requested the named Essential Caregiver of record within two (2) business days of request.
7. The community must maintain a visitor log for signing in and out and shall work with the resident and EC to identify a schedule of no less than 2 hours per day, or until caregiving tasks are completed, for the EC to be in the building.
8. Ensure scheduling of EC visits considers numbers of EC in the building at the same time. The community may establish time limits as needed to keep residents safe.
9. Utilize the EC to provide care and emotional support in the same manner as prior to the pandemic, or in whatever manner necessary, as resident health care or psychological conditions may have changed.
10. Residents are allowed in-person visitation in all the following circumstances, unless the resident objects including:
    1. End-of-life situations
    2. A resident who was living with family before moving into community is struggling with the change in environment and lack of in-person family support.
    3. The resident is making one or more major medical decisions.
    4. A resident is experiencing emotional distress or grieving the loss of a friend or family member who recently died.
    5. A resident needs cueing or encouragement to eat or drink which was previously provided by a family member or caregiver.
    6. A resident who used to talk and interact with others is seldom speaking.
11. HarborChase has designated a central point of entry where the EC signs in and is actively screened for symptoms of COVID-19 or to entering the building, in the same manner as community associates. All visitors shall enter through front entrance and be provided screening tools per concierge.
12. The EC must wear all necessary personal protective equipment (PPE) per current CDC guidance while in the building, and must perform frequent hand hygiene. The community should ensure hand sanitizing stations and alcohol-based hand rubs are accessible.
13. HarborChase’s Director of Resident Care or nurse designee will support infection prevention and control training. Training and education must be completed prior to EC provision of services. The community must educate the EC on how to don/doff necessary PPE appropriately, use of masks, hand sanitation and social distancing. This can be accomplished utilizing posters or printed materials demonstrating key instructions to reinforce safe practices and observing return demonstrations for competency. EC must sign an acknowledgement certifying completion of training and adherence to the facility’s infection prevention and control policies that is also signed by the Executive Director.
14. The EC must inform the community (Executive Director or designee) if they develop a fever or symptoms consistent with COVID-19 within 24 hours of last visit to the resident.
15. The community must allow evening and weekend visits that accommodate the EC who may be limited by work or childcare barriers.
16. Direct the EC to provide care in the resident’s room, or in community-designated areas within the building, while allowing for auditory privacy. The EC must limit movement in the community. The EC may take the resident outside for a walk during their time with the resident; pushing a wheelchair is an acceptable activity.
17. The EC must maintain social distancing of at least 6 feet with staff and other residents while in the building.
18. This standard need NOT prohibit essential caregiver visits if the specific resident to be visited is quarantined, tested positive, or showing symptoms of a communicable disease. Visits in these circumstances will likely require a higher level of PPE than standard surgical masks. The general visitation requirement that the community has in place, (i.e., no new community-onset cases of a communicable disease (COVID-19)) is not applicable to visitation by Essential Caregiver visitors.
19. Essential Caregiver visitors may have physical contact with the resident during visitation if they wear appropriate PPE. Essential caregiver visitors must wear PPE per community infection control standards. The PPE required must be consistent with the most recent CDC guidance for healthcare workers. At HarborChase, essential caregiver visitors shall wear the same PPE that staff wear to provide care or services to the resident.
20. HarborChase is not required to provide ‘facility-provided’ COVID-19 testing and only if it is based on the most recent CDC and FDA guidance. The cost of this testing cannot be passed on to the visitor.
21. The community may restrict or revoke EC status if the EC fails to follow social distancing, use PPE, or other COVID-19 related rules of the community. Prior to restriction/revocation, the community, EC and resident should discuss an attempt to mitigate the concerns.
22. Community will notify and inform residents, their representative, and recurring visitors of any change in the visitation standard.

For more information about Essential Caregiver Visitation guidelines or to report a concern, please contact Sheila Wilson, Vice President of Health & Wellness at swilson@haronline.net.