Nursing Homes and Assisted Living Facilities Visitation in South Carolina: New DHEC Guidance and Enforcement

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The scope and State enforcement related to visitation in nursing home and assisted living facilities in South Carolina is controversial and evolving on a regular basis. In recent weeks the South Carolina Department of Environmental Control (DHEC) has added three more sets of guidance and requirements: A “Compassionate Care Visits Memo,” “DHEC Guidelines for Outdoor and Indoor Visitation,” and a “Public Health Order” requiring visitation reporting on a weekly basis (click here).

Nursing home and assisted living facilities understand the importance of visitation for their residents’ wellbeing and mental health, as well as the impact on their family members. On the other hand, the facilities have been working hard to understand state and federal guidance on how to safely conduct visitation and through various means:  in-person, window visits; outdoor visitation; video conferencing and telephone visits, etc.

Updated Outdoor and Indoor Visitation Guidance. DHEC updated its guidance on outdoor and indoor visitation on October 9, 2020. This guidance replaces DHEC’s “Guidelines for Outdoor Visitation” issued on September 1, 2020, and also includes guidelines for limited indoor visitation. Click here to see the “DHEC Guidelines for Outdoor and Indoor Visitation.”

As a starting point, DHEC emphasized that facilities may not restrict in-person visitation unless “a reasonable clinical or safety cause” is present. These clinical or safety causes include the facility’s COVID-19 status, the resident being in isolation or quarantine for COVID-10, the county’s positivity rate (greater than 10% for indoor visitation), or lack of adherence to infection control methods.

The guidance also sets forth criteria for restricting outdoor and indoor visitation, and reminds facilities that virtual and window visits remain permitted in all scenarios. A discussion of the compassionate care visits guidance is set forth next, along with the additional “Compassionate Care Visits Memo.”  In addition to guidance concerning outdoor and indoor visitation, the “DHEC Guidelines for Outdoor and Indoor Visitation” sets out related to “Core Principles of COVID-19 Infection Prevention,” “Facility Requirements,” “Resident Requirements,” and “Visitor Requirements.”

Compassionate Care Visits. As noted in the “DHEC Guidelines for Outdoor and Indoor Visitation,” compassionate care visits are allowed regardless of the facilities visitation status.  DHEC defines compassionate care visits to include not only end-of-life situations, but also instances in which a recently admitted resident is struggling with a changed environment and lack of physical family support, a resident who is grieving due to a friend or family member who recently passed away, a resident who needs encouragement to eat or drink, a resident who is experiencing emotional distress, seldom speaking, or crying more frequently, and other situations.

The new “Compassionate Care Visits Memo” recommends that nursing care and assisted living facilities establish a policy addressing compassionate care visits. Click here to see the “Memo.” Although DHEC emphasizes compassionate care visits “should not be routine,” both DHEC and CMS acknowledge compassionate care visits extend past end-of-life situations. 

Public Health Order Requesting Weekly Visitation Reports. In addition to the “Compassionate Care Visits Memo” and “DHEC Guidelines for Outdoor and Indoor Visitation,” DHEC also issued a “Public Health Order” on October 7, 2020 reminding nursing homes and assisted living facilities of their obligation to encourage visitation of residents with minimum restrictions. The Order also requires detailed weekly reports concerning visitation and, if visitation is not allowed, the reasons why visitation is not allowed. Click here to see the” Order.”

The “Public Health Order” clearly urges nursing homes and assisted living facilities to provide for visitation unless there is an objective reason to curtail it. With weekly reports due to DHEC, the State’s nursing homes and assisted living facilities will be under constant scrutiny as to whether the facilities are adjusting visitation policies quickly and appropriately.

Conclusion: Visitation continues to be a controversial topic, due to the need to balance residents’ wellbeing and mental health needs, as well as the impact on their family members, with the need to protect residents, staff, and visitors from the transmission and spread of COVID-19. While restrictions on visitation need to be imposed to protect residents, DHEC’s new “Public Health Order” is intended to ensure visitation is not unduly restricted. As a result, nursing home facilities and assisted care facilities must adjust visitation on an ongoing, almost daily, basis.