ALF Access During COVID-19
Anecdotally, at this time home health providers are often denied access to their patients who reside in assisted living facilities (ALFs). The rationale of ALFs is that denial of access is necessary in order to void exposure to COVID-19. The experience of skilled nursing facilities (SNFs) with multiple infections and deaths from the virus may increase ALFs commitment to denial of access.
The Centers for Disease Control and Prevention (CDC) has issued guidelines for ALFs entitled “Considerations When Preparing for COVID-19 in Assisted Living Facilities.” These guidelines are clearly based, in part, on the CDC’s expectation that patients who need skilled services from home health agencies will continue to receive them. First, the CDC points out that:
Because staff at many of these facilities are generally not trained to provide medical care, their access to and training to use recommended personal protective equipment (PPE) and their ability to care for residents with COVID-19 is limited…
The CDC, therefore, goes on to say out that personnel from home health agencies who wear all recommended PPE may assist ALFs to regularly check on residents’ health. In addition, ill residents may be able to remain at ALFs if they can remain isolated in their apartments and if home health agency personnel can provide the level of care needed with access to PPE. The guidance further states that if home health agencies cannot provide care to residents who have the virus, then these residents should, of course, be transferred to hospitals or other appropriate care sites.
It is certainly clear that ALFs should limit or deny visitors’ access to their facilities, but, according to the CDC, “visitors” do not include clinical personnel from home health agencies. Guidance from the CDC makes it clear that home health agencies should be active participants in the ongoing care of residents, including residents who are ill with COVID-19.
The failure of ALFs to follow CDC guidance in this regard may have significant adverse consequences for ALFs. The denial of needed skilled services provided by home health agencies to residents may result in enforcement action against ALFs by state licensure boards, especially if patients’ conditions worsen or go untreated altogether.
Likewise, ALFs may be targeted by patients and their families alleging negligence or perhaps even wrongful death because home health personnel could not provide needed care. Legal counsel for patients and their families may rely on guidance from the CDC to show that national standards of care do not support denial of access to residents by home health agencies.
By the same token, home health agencies cannot maintain residents on census if they cannot visit them over an extended period of time. Home health agencies must work directly with ALF Administrators to gain access and document their efforts to do so. In the meantime, to the extent that virtual visits are appropriate, they should be used to the maximum extent possible.
Receipt of needed skilled care by ALF residents is serious business, especially during the pandemic. The efforts of ALFs to protect residents by denying access to home health agencies are surely misplaced.
Elizabeth E. Hogue, Esq.