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Ombudsman Outlook
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March 2021 | Volume 7, Issue 3

In this issue:

COVID-19: Visitation Updates and What it Means for Long-Term Care Ombudsman Programs

On March 10, 2021 the Centers for Medicare & Medicaid Services (CMS) updated their previous visitation guidance, in light of the introduction and impact of vaccines, expanding visitation in nursing homes in many situations. The updated guidance is effective immediately. Some important changes from the previous guidance include:

Indoor Visitation Should Be Allowed At all Times (with a few exceptions).

While outdoor visitation continues to be preferred, the guidance states “facilities should allow indoor visitation at all times and for all residents (regardless of vaccination status), except for a few circumstances when visitation should be limited due to a high risk of COVID-19 transmission (note: compassionate care visits should be permitted at all times).” Indoor visitation should be limited when:

  • A resident is unvaccinated and the nursing home’s county positivity rate is more than 10% and less than 70% of residents are vaccinated.
  • Residents have a confirmed COVID-19 infection.
  • Residents are in quarantine.

The guidance allows facilities to schedule indoor visits and limit the number of visitors and length of visits based on their ability to maintain the core principles of infection prevention. It also discourages in room visits for residents with roommates.

Physical Contact

While encouraging facilities, residents, and families to adhere to the core principles of COVID-19 infection prevention, the guidance allows fully vaccinated residents to have close contact, including touch, with their visitors while wearing masks and following proper hand hygiene rules. Fully vaccinated residents can now hug their loved ones.

Indoor Visitation During an Outbreak

If an outbreak is limited to one particular area or unit of a facility – which means, if, after a positive case is identified, outbreak testing determines that cases are all within one area or unit, then visitation may resume in other parts of the facility. Compassionate care visitation and visits under federal disability rights law are always permitted.

Visitor Testing and Vaccination

CMS encourages visitors to become vaccinated when they can and acknowledges that facilities may encourage testing, however, they state that visitors should NOT be required to be vaccinated or tested or show proof of such as a condition of visitation.

The rest of the guidance, including Compassionate Care and Required Visitation and Access to Long-Term Care Ombudsman remains unchanged from the September 17th guidance.

What This Means for Ombudsman Access

Long-Term Care Ombudsman programs continue to have immediate access to any resident, but, as before that access does not have to be in-person access. In-person access can be limited due to infection control concerns in the same way access to other visitors is limited (refer to specific scenarios shared in the memo for limiting indoor visitation). However, it cannot be limited without reasonable cause. As with other visitors, Ombudsman programs do not have to be vaccinated to resume in-person visits.

Updated Guidance from the Centers for Disease Control and Prevention (CDC)

The CDC recently updated their Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes to include additional information about vaccines, physical distancing, visitation, and quarantine. Guidance about New Admissions and Residents who Leave the Facility includes the following about residents that briefly leave the facility:

  • In most circumstances, quarantine is not recommended for residents who leave the facility for less than 24 hours (e.g., for medical appointments, community outings with family or friends) and do not have close contact with someone with SARS-CoV-2 infection.
    • Quarantining residents who regularly leave the facility for medical appointments (e.g., dialysis, chemotherapy) would result in indefinite isolation of the resident that likely outweighs any potential benefits of quarantine.

For more information on COVID-19 for Ombudsman programs visit the NORC website.

Learn more »

New and Updated Resources

NEW! Enhancing Your Advocacy Toolbox: Protecting Residents from Nursing Facility-Initiated Discharges

Complaints regarding nursing facility-initiated discharges have been the most common type of complaint received by the Long-Term Care Ombudsman program for the last nine years. To assist Ombudsman programs when working with residents facing a facility-initiated discharge, the National Ombudsman Resource Center produced this new resource titled, Enhancing Your Advocacy Toolbox: Protecting Residents from Nursing Facility-Initiated Discharges. This resource blends pertinent federal nursing home requirements and surveyor guidance with action steps for representatives to consider. We encourage Ombudsman programs to use this resource as a basic guide for using federal regulations and guidance to address common issues related to facility-initiated discharges. 

NEW! 2021 NORC Evaluation Results

At the start of 2021, NORC sent a planning and evaluation questionnaire to all State Ombudsmen and program representatives and we received over 300 responses. The responses help NORC evaluate the success of its activities and materials and provide NORC staff with key information in planning for future tasks. This email is based on the results of this questionnaire and includes common responses and links to what we have available.

NEW! Webinar Materials on Using Data to Strengthen Your Nursing Home Advocacy

Richard Mollot, Executive Director of the Long Term Care Community Coalition presented to State Long-Term Care Ombudsmen on Using Data to Strengthen Your Nursing Home Advocacy. Richard shared data and ideas for using data for systems advocacy as well as with family councils to set goals.

NEW! January, February, and March NORC Notes

NORC Notes is a monthly email reminder of available resources on the NORC website and tips for how your program can use them. The January issue reviewed our new resource to address nursing facility-initiated discharges, the February issue highlighted family and resident council resources, and the March issue shared new and updated COVID-19 resources and webpages. Sign-up to receive NORC Notes.

UPDATED! PowerPoint on The Who, What, Where, Why, and How of the Long-Term Care Ombudsman Program

The PowerPoint, The Who, What, Where, Why, and How of the Long-Term Care Ombudsman Program, has been updated to include 2019 NORS data. This presentation reviews the program responsibilities required by federal law so the information is applicable in every state. Users will gain an understanding about what the Long-Term Care Ombudsman Program (LTCOP) does, who the LTCOP serves, and how to contact the program. LTCOP representatives can use this presentation when training potential program representatives, during Resident Council and Family Council meetings, community education, and in-services for facility staff. View the slides as a PDF or PPT.

UPDATED! Long-Term Care Ombudsman Program Infographic

This Ombudsman program infographic has been updated with 2019 NORS data to give a brief overview of the work Ombudsman programs do and the impact they have around the nation. View and download the printable infographic here.

TA Hot Topic: Working with Families During Challenging Situations

What tips for effective communications and strategies do you have when working with families during challenging situations?

The tips and strategies below are from the resource, Working with Families: Tips for Effective Communication and Strategies for Challenging Situations. Read more on this topic here.

The Coronavirus Disease (COVID-19) is an unprecedented pandemic. In our lifetime, we have never been in the situation of dealing with so many variables impacting us, our families, employers, family caregivers, and residents of long-term care facilities. In addition to the general stress of this pandemic, the way Ombudsman programs operate has been significantly impacted due to the temporary in-person visitation restrictions.

In-person visitation restrictions imposed to reduce the spread of COVID-19 required facilities, families, and Ombudsman programs to adapt quickly. The restrictions may increase family member’s feelings of stress and helplessness since they cannot interact with their loved ones in-person and observe their environment.

Below are resources, tips, and strategies to help Ombudsman representatives improve their skills in working with families during challenging situations.

Learn more »

National Ombudsman Reporting System (NORS) Corner

The Administration for Community Living (ACL) is seeking public comment regarding revisions to the collection requirements for the National Ombudsman Reporting System (NORS). ACL shared proposed revisions to the NORS Tables below (revisions are in red font).

NORS Table One
NORS Table Two
NORS Table Three

Comments on the collection of information must be submitted electronically by 11:59 p.m. (EST) or postmarked by May 10, 2021.

The notice for comment is available in the Federal Register.

Links to the revised tables and instructions for submitting comments are available on the ACL website.

News from the Network

Tennessee State Ombudsman, Quiteka Moten, Testifies During the U.S. Senate Committee on Finance Hearing on COVID-19 in Nursing Homes

Ohio Ombudsman, Bob Vines, Interviewed on Nursing Home Protocol During COVID-19

DC State Ombudsman, Mark Miller, Quoted in USA Today on the Updated CMS Visitation Guidance

Connecticut Statewide Coalition of Presidents of Resident Councils Provide Support for S.B. 973 Video

Michigan State Ombudsman, Salli Pung, Interviewed on Nursing Home Visitation During COVID-19

New Jersey State Ombudsman, Laurie Brewer, Interviewed on the Impact of COVID-19 and Social Isolation

Washington State Ombudsman, Patricia Hunter, Interviewed on Social Isolation

Minnesota Ombudsman, Cheryl Hennen, Discusses COVID-19 Vaccine and Visitation Complaints

Volunteer Management: National Volunteer Week April 18-24, 2021

What is your program doing to recognize the volunteers who give their time to visit and advocate with and for individuals that live in long-term care facilities? The week of April 18 to 24, National Volunteer Week, is a perfect time to reach out and say thanks for volunteering with your program and making a difference in the lives of the residents.

Learn more »

Quick Tips: COVID-19 Vaccine Resources

As COVID-19 vaccinations continue, it is important for Ombudsman program representatives to understand the vaccination process in their state. Ombudsman programs can share information and resources about the vaccines, the distribution process, and residents’ rights and encourage facilities to share information and hold educational sessions for residents and their families/legal representatives that include a discussion of risks, benefits, possible side effects, and rights.

Visit NORC’s new COVID-19 Vaccine webpage for more information and click the learn more below for common questions and answers, examples of Ombudsman program resources, resources for facilities, videos to educate staff and residents on vaccine safety systems, and post vaccine considerations.

Learn more »

Events

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April 18-24, 2021: National Volunteer Week - Learn more »

April 27, May 11, and May 25: COVID-19 Recovery and Reentry: TA Open Dialogue Webinars - Learn more »

May 2021: Older Americans Month - Learn more »

June 15, 2021: World Elder Abuse Awareness Day (WEAAD) - Learn more »

November 3, 2021 - November 5, 2021: Consumer Voice Annual Conference - Learn more »

Read past issues of the Ombudsman Outlook on the NORC website. If you did not receive this email directly and would like to sign-up to receive NORC emails please fill out the form on our website. If you would like to receive The Voice (the Consumer Voice weekly e-newsletter) automatically sign-up on the Consumer Voice website. If you have any questions, challenges, or article suggestions related to long-term care Ombudsman advocacy and program management, please let us know.

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