Colorado Crisis Standards of Care
9/3/20 Meeting Materials:



Articles discussed:

  • Colorado to begin allowing indoor visitation at nursing homes as soon as next week
    Colorado Sun (Denver, CO), August 26, 2020
    Gov. Jared Polis announced Wednesday that Colorado will begin allowing in-person visitation at nursing homes and long-term care facilities as soon as next week. ... “It’s obviously a balance between ensuring that our older adults are protected, and allowing older adults to be with their loved ones,” Polis said. “This doesn’t mean that all of the sudden visits start like they did a year ago or six months ago. ... The state released draft guidance on Wednesday for how the visitations may be carried out. Under the guidance, indoor visitation would be allowed at facilities in counties that have less than or equal to an average of 25 new, active cases per 100,000 people in the prior 14 days. In counties with 25 to 175 new, active cases per 100,000 people over the prior 14 days, visitors will be required to get tested for COVID-19 and have the results returned in the 24 hours before their visit. ... Indoor visitation will not be allowed at facilities with active coronavirus outbreaks. (Summary per Hospice News Today, 8/29/20.)

  • CMS to Require COVID Tests for Hospice Staff Visiting Nursing Homes
    Hospice News, September 1, 2020
    Hospice staff visiting patients in nursing homes must undergo testing for COVID-19 at a frequency determined by the prevalence of the virus in their location. This is required under an interim final rule from the U.S. Centers for Medicare & Medicaid Services. While the final rule pertains specifically to nursing homes, it applies to any individuals employed by the facility, any individuals that have arrangements to provide services for the facility and any individuals volunteering at the facility. The agency cited hospice providers as an example of those who have arrangements to provide services. ... Nearly 18% of hospice care in the United States occurred in nursing homes during 2018, according to the National Hospice & Palliative Care Organization, exceeded only by private residences and assisted living facilities. (Summary per Hospice News Today, 9/1/20.)

  • DeSantis relaxes some visitation restrictions for long-term care facilities
    WJAX-TV (Jacksonville, FL), September 1, 2020
    Jacksonville, FL—Gov. Ron DeSantis on Tuesday announced changes in visitation guidelines for long-term care facilities in Florida that will allow loved ones to again visit those who are most vulnerable to the effects of COVID-19. ... Under the new guidelines, visitors have to wear personal protective equipment and then undergo screening that includes a temperature check, DeSantis said. All visitation must be done by appointment only, and long-term care residents can designate up to five visitors with two visitors at a time for visitation. There are no minors allowed in the facility at this time but could but allowed soon. No facility can allow visitors unless 14 days have passed without the onset of a new positive case in either a resident or staff member, DeSantis said. The only exception to the 14-day rule is for essential caregivers and compassionate caregivers. An essential caregiver is defined as an individual who provides health care services or assistance with daily life, like bathing, dressing and eating. A compassionate care visitor is a visitor intended to provide emotional support to help a resident face a difficult situation such as the end of life, a difficult transition or some kind of loss. ... DeSantis said facilities aren’t required to test visitors, but they can provide testing if they want to. ... The governor’s task force does not have a timeline right now on when these centers will allow full visitor access again. (Summary per Hospice News Today, 9/1/20.)

  • St. Croix Hospice launches weekly COVID-19 testing for all field staff
    PRNewswire, September 1, 2020
    Oakdale, MN—St. Croix Hospice has proactively launched weekly COVID-19 testing for all field staff as part of their enhanced infection control procedures. “Staff adherence to our superior infection control protocols have made a tremendous difference in limiting the spread of COVID-19,” says Mandy Cogswell, Chief Clinical Officer, St. Croix Hospice. “This weekly test will provide peace-of-mind to our field staff, our patients and their families, and healthcare workers at our partner facilities.” The move is another enhancement to the safety measures already in place as part of St. Croix Hospice’s Safe+Care Promise ( including full PPE (personal protective equipment) for all direct care staff; infection prevention education; and daily health self-screenings for all employees. ... In addition to the weekly COVID-19 testing for field staff, daily self-screenings, and full PPE required for all in-person patient visits, St. Croix Hospice also offers telehealth visits and provides smart tablets to partner facilities when requested to facilitate virtual admits and care. (Summary per Hospice News Today, 9/2/20.)

  • COVID and Research Universities - so much info, so little evidence, blog by Dr. Don Taylor, Duke University, 9/3/20.
    Cordt’s summary: Universities, even acclaimed Research Universities like Duke, approach COVID policies, testing, and public reporting individually. There are several multi-institutional research collaboratives (e.g., the Palliative Care Research Collaborative – PCRC), why haven’t Research Universities collaborated on COIVD policies, testing, and public reporting? Apply this to Colorado Hospices – can we collaborate on COVID policies, testing, and public reporting?

Additionally, CDPHE Indoor Visitation Guidance:

Residential Care Facilities (Skilled nursing facilities, assisted living residences, group homes, and intermediate care facilities)

On 9/3/20 Public Health Order 20-20 was updated to allow for indoor visitation for facilities that meet the criteria. In addition to the Public Health Order, CDPHE issued guidance for those indoor visits. The guidance also allows for visits from service providers such as beauticians, barbers, podiatrists, dentists, and therapists.

The guidance states facilities must meet the following criteria to implement indoor visitation:

  • Be located in counties that have less than or equal to an average of 25 new, active cases per 100,000 people over the prior 14 days or be in a county that is in the Protect Our Neighbors Phase. 
  • If in counties with 26 to 175 new, active cases per 100,000 people over the prior 14 days, visitors must provide documentation that they have had a negative COVID-19 test in the 48 hours preceding the visit (a PCR test or test approved by the State Lab or the FDA for use in asymptomatic people).
  • Visitation is not allowed in residential care facilities in counties with more than 175 new, active cases per 100,000 people over the prior 14 days.
  • Other criteria involve testing, outbreaks, personal protective equipment (PPE) supplies, and staffing.

When indoor visitation is implemented, visitors must:

  • Have taken a COVID-19 test and received a negative result within 48 hours of conducting the visit, if applicable, based on the degree of community spread.
  • Be fever-free, symptom free, and have no known exposure to COVID-19.
  • Be age 18 and older.
  • Schedule appointments in advance.
  • Wear masks and adhere to all facility visitation rules.