THe Wesley Community as seen from the air. A series of buildings, including two 14 story towers, surrounded by an abundance of green areas.

Wesley Health Care Center and NYS Off-Site Visit Guidelines

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Please see the following PDF attachments related to off-site visitation and the steps required by the NYS Department of Health and Wesley Health Care Center to have a resident leave the facility for social visits.

NYS DOH Nursing Home- Resident Departing from Facility Guidance-11-24-2020

Wesley Health Care Center Off Site Visit Guidelines 11-24-20

Wesley Health Care Center

“Guidelines for Residents and Families for Departing Wesley Health Care Center”

Policy: Some residents of long-term care facilities are hoping to visit with loved ones off-site. At the same time, COVID-19 continues to be a risk, with COVID-19 cases on the rise in many communities.  The prevalence of COVID-19 presents a risk that residents who leave, and then return to, their respective residence/building will bring new infections into the facility. Due to the vulnerability of the people we serve and the risk of transmission in congregate living environments, it is expected that long-term care will highly discourage residents from leaving the premises. This is in keeping with guidance issued by the New York State Department of Health (“DOH”) and the Centers for Medicare and Medicaid Services (“CMS”), including the guidance issued by CMS on or about November 24, 2020, entitled “Guidelines for Residents and Families For Departing Wesley Health Care Center” which was addressed to “Nursing Homes, Residents, and Resident Family Member(s)/Representative(s)”. This is also in keeping with the facility’s current policies on resident- initiated leaves and/or discharges.

Procedure:

  1. In the event that a resident or duly authorized representative makes a request for the resident to leave the facility, for purposes of visiting family and friends or otherwise, the representative of the facility will explain to the individual making the request the extreme risks associated with the resident leaving the  facility  and/or going out  into  the community. Such explanation must  outline the following:
    • a) Risks of the resident being exposed to and/or being infected with COVID-19 while off-site;
    • b)Risks associated with the resident exposing or infecting others with COVID-19 while off-site
    • c) Risks of infecting other residents and staff of the Wesley Health Care Center upon the resident’s return to the facility; and
    • d) The precautions that will be taken by the facility to ensure the health and safety of the resident and others at the facility upon the resident’s return (in accordance with sections 4 and 5 of this policy).
  2. If a resident or resident representative insists on leaving after having been explained the risks of doing so, including those expressly set forth above, such leave shall be deemed to be a leave against medical advice, and the facility will inform the resident or resident representative that the leave will be deemed as such. The facility will follow its current policies and protocols on leaves against medical advice, which, among other things, require that prior to making the determination that the leave is against medical advice and/or permitting the resident to leave the facility, the Facility will:
    • a) Determine the resident’s capacity or the representative’s authority to make health care decision;
    • b) Through the resident’s attending physician or other licensed health care professional acting within the  scope  of  their  practice,  explain  to  the  resident  or  authorized  representative  the  risks associated with the resident’s leave against medical advice (both general risks based on the resident’s condition, as well as risks relating to COVID-19);
    • c) Document, in the resident’s medical record, the decision made by the resident or authorized representative, and indicate whether this was an informed decision;
    • d) Review the resident’s medical information, including his or her comprehensive care plan, and consult with the resident’s attending physician as may be needed to determine whether the resident can take leave from the facility and what precautions may need to be in place to ensure a safe and otherwise appropriate leave;
    • e) Orient the resident and/or the resident’s authorized representative as to necessary precautions and/or other actions to be taken to ensure the safety and health of the resident;
    • f) Provide to the resident (or authorized representative) the appropriate Consent and Release form entitled “Temporary Leave of Absence of Resident Against Medical Advice” and request that the resident (or authorized representative) signs the document.

These items must be clearly documented and recorded. In the event that the resident or authorized representative refuses to comply or cooperate with the items set forth above, such refusal should also be clearly documented.

3. As part of the orientation required by item 2.e of this policy, and in relation to informing as to precautions to guard against exposure to, transmission of, and/or being infected with COVID-19, the facility will:

  • a) Encourage the resident to wear a facemask while out in the community;
  • b) Discuss the importance of handwashing, offer hand sanitizer if available;
  • c) Ask residents and/or family members to acknowledge receipt of this notification, and sign an ‘off- site safety pledge’ as a reminder of the importance of adhering to infection prevention practices, including adhering to travel quarantine requirements.
    • c-1) In accordance with the NYS Travel Advisory and its associated guidance, residents who intend to travel to a non-contiguous state or internationally should be notified to follow NYS Travel Advisory guidelines requiring quarantine and two negative tests within the required timeframes.

4. For a resident who leaves against medical advice  for any length of time and intends to return to the facility, will require the following:

  • a) The resident’s COVID status will be updated to UNKNOWN;
  • b) Quarantine or minimize contact to the extent safely possible prior to their return to the facility.
  • c) Test negative immediately (within 24 hours) prior to return to the facility.
    • Prior to the resident’s return, a COVID-19 test that shows that the resident is negative for COVID-19 (results must be submitted to the facility for approval to return and should be submitted to the Admissions the Coordinator);
  • d) Upon resident’s return, resident will:
    • Be placed  in  the  appropriately  designated  quarantine/cohort  unit  on  quarantine  with transmission-based precautions for a period of at least 14 days;
    • Be tested at least three times during the 14-day quarantine period at the facility, including on the first day (upon return) and the last day that a resident must be quarantined.

5. In connection to the resident’s isolation/quarantine, the resident:

  • a) May be required to change rooms, roommates and/or units depending on cohort circumstances;
  • b) May need to be relocated to a semi-private room in order to appropriately manage the cohort process;
  • c) Will undergo Enhanced Monitoring for fever and signs and symptoms of respiratory infection for 14 days;
  • d) Will be placed on Isolation in their room, door closed, with required masking during all care during a 14-day period.
    • By definition, quarantine requires the Resident to remain in their room with the door closed throughout the two-week quarantine period. This can be very isolating and stressful for any Resident; it can be made worse for an individual with cognitive impairment since they cannot understand or process why this is happening to them. Continuous staff redirection back to a quarantine room does also add exposure risk to all other Residents of that unit.
    • Will not be able to partake in communal dining, visitation or activities during the 14-day period.
    • Test residents for COVID-19 and influenza if the resident develops signs or symptoms of COVID-19 or influenza or if the resident had a confirmed or possible exposure to COVID-19 or influenza while outside a nursing home.

Questions regarding this policy or the facility’s measures to prevent the transmission of COVID-19 directed to the Administrator.

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