State of Iowa Updates Long-Term Care Facility Visitation Guidance

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

The Iowa Department of Public Health (IDPH) and the Iowa Department of Inspections and Appeals (DIA) are updating guidance for long-term care facilities to comply with new requirements from the Centers for Medicare and Medicaid Services (CMS). This updated guidance aligns with federal regulations to balance resident and staff safety with quality of life.

This guidance allows flexibility and additional clarity around allowable indoor visitation, allows increased access to important quality of life services such as access to barbers and beauticians, and it further expands the definition of ‘compassionate care visits.’ The term does not exclusively refer to end-of-life situations. Examples of other types of compassionate care situations include:

  • A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • 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).

The updated guidance provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents. Physical separation from family and other loved ones has taken a physical and emotional toll on residents. Residents may feel socially isolated, leading to increased risk for depression, anxiety, and other expressions of distress. Residents living with cognitive impairment or other disabilities may find visitor restrictions and other ongoing changes related to COVID-19 confusing or upsetting.

Nursing home residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends. In light of this, CMS revised their guidance regarding visitation in nursing homes during the COVID-19 public health emergency. Visitation may occur through different means based on a facility’s structure and residents’ needs, such as in resident rooms, dedicated visitation spaces and outdoors.   Except for ongoing use of virtual visits, facilities may still restrict visitation due to the COVID-19 county positivity rate, the facility’s COVID-19 status, a resident’s COVID-19 status, visitor symptoms, lack of adherence to proper infection control practices, or other relevant factors related to the COVID-19 public health emergency. However, facilities may not restrict visitation without a reasonable clinical or safety cause, consistent with federal regulations.

The new guidance is specifically targeted at long-term care facilities (e.g., nursing homes). Other facilities or congregate care settings, such as assisted living or residential care facilities, may choose to follow an independently developed framework for easing restrictions. Guidance from the Centers for Disease Control (CDC) regarding COVID-19 mitigation strategies for assisted living congregate settings can be found online:

The State has and will continue to collaborate with federal partners, long-term care associations, and stakeholders on how to responsibly ease restrictions in long-term care facilities while COVID-19 remains a concern in communities across the state.

This document addresses:

  • Visitation and Communal Activities 
  • Essential and Non-Essential Healthcare Personnel
  • Access to the Long-Term Care Ombudsman
  • Compassionate Care Visits
  • Cohorting and Dedicated Staff
  • Testing
  • Outbreak Definitions
  • Department of Inspections and Appeals Surveys
  • Until further notice, surveys will be restricted in areas with county positivity rate above ten percent to the below:
  • Investigation of complaints alleging there is an immediate serious threat to the residents’ health and safety (known as Immediate Jeopardy).
  • Revisit surveys to confirm the facility has removed any Immediate Jeopardy findings.
  • Focused infection control surveys.
  • Initial survey to certify that the provider has met the required conditions to participate in the Medicare (program).
  • Any other survey as authorized or required by CMS.
  • State based priorities, such as hot spots.

Additional information is found in Appendices A (testing supplies & PPE) & B (COVID-19 testing at State Hygienic Laboratory) – the last pages of this guidance.