Please note: Visitation hours vary but are usually 8am to 8pm.
🕐 An ALF must screen all individuals who enter the facility prior to entry (except for emergency personnel), including staff at the start of their shift, any visitors, new residents, and residents returning to the facility for:
🕐 Fever, defined as a temperature of 100.4 Fahrenheit and above.
🕐 Signs and symptoms of COVID‐19, see attached screening log on pages 40‐42 for example of questions asked during screening process. Some communities may require different screening logs to be in use mandated by their local Health Departments. Texas no longer requires screening logs to be retained as of 4/3/22 for visitors and/or staff but still requires the screening to take place. Residents need to be screened once daily in FL/GA for COVID‐19 symptoms Texas Residents are no longer required to be screened unless exposed to COVID‐19, symptomatic, or under quarantine per CDC guidelines.
🕐 If a resident meets any of the screening criteria, implement increased infection control measures including quarantine as applicable and monitor for symptoms of COVID‐19 according to State and Local guidelines. (Use CDC quarantine tool to determine if needed and length of quarantine) https://www.cdc.gov/coronavirus/2019‐ncov/if‐you‐are‐sick/quarantine.html
🕐 All visitors must wear a medical mask (no cloth masks allowed), no masks are required in Texas at this time unless an outbreak occurs. If an outbreak occurs, then masks will be required until under control.
🕐 The screening log might contain protected health information and must be protected in accordance with applicable state and federal law. The information should include at least:
the date, the person’s name, current contact information, and the data from the screening (presence or absence of fever and symptoms). assisted living facility is not required to screen emergency services personnel entering the facility in an emergency.
Post signage at all entrances of the facility reminding individuals not to enter the facility prior to being screened. Do not restrict surveyors. HHSC is constantly evaluating their surveyors to ensure they don’t pose a transmission risk when entering a facility.
For example, surveyors might have been in a facility with COVID‐19 cases in the previous 10 days, but because they were wearing PPE effectively per the CDC guidelines, they pose a low risk to transmission in the next facility and must be allowed to enter.
However, there are circumstances under which surveyors should not enter, such as if they have a fever or any additional signs or symptoms of illness and must still be screened at the sign in log.
Persons providing critical assistance must be allowed to enter the facility provided they pass required screening.
• Family members and loved ones of residents at the end‐of‐life;
• Essential caregivers;
• Emergency responders (do not screen in an emergency);
• Persons with legal authority to enter, including:
o Government personnel performing their official duties, including HHSC
surveyors whose presence is necessary to ensure the ALF is protecting the health
safety of residents and providing appropriate care;
o Law enforcement officers (do not screen in an emergency) and
o Representatives of the Long‐term Care Ombudsman’s Office and representatives
of Disability Rights Texas; and
• Providers of essential services which include contract doctors, contract nurses, home health and hospice workers, health care professionals, contract professionals, clergy members and spiritual counselors, whose services are necessary to ensure resident health and safety.
This list is not exhaustive. A facility must use its best judgment to determine which persons are “essential” to protect the health and safety of a resident.
ALFs must allow all residents who are COVID‐19 negative to have personal visitors. Visits can occur where adequate space is available as necessary to ensure physical distancing between other residents and visitors, including the resident’s room. The facility must ensure a comfortable and safe outdoor visitation area, considering outside air temperature and ventilation.
Visitors and residents are no longer required to wear masks or face coverings or PPE in Texas ONLY, unless working with a COVID‐19 positive/symptomatic/COVID‐19 unknown or Local/State mandated. Florida and Georgia are still requiring masks at this time.
Visits are not required to be scheduled in advance. An ALF can have scheduled visits and unscheduled visits. ALFs can schedule personal visits in advance or permit personal visits that are not scheduled in advance, or both. Scheduling in advance must not be so restrictive as to prohibit or limit visitation for residents.
See Expansion of Reopening Visitation at 26 TAC §553.2003 (Texas) for all requirements.
All ALFs must:
● offer a complete series of a one‐ or two‐dose COVID‐19 vaccine to residents and staff and document each resident’s choice to vaccinate or not vaccinate (“Offer” in this context means to administer, arrange/assist, OR educate/give information about the COVID‐19 vaccine AND document the resident’s choice to vaccinate or not vaccinate);
● allow visitors of any age;
● develop and enforce written policies and procedures related to visitation, including whether visitors and residents must wear a face mask, face covering, or appropriate PPE during visits.
● inform residents and visitors of the facility’s infection control policies and procedures related to visitation.
● limit the movement of visitors through the facility to minimize interaction with other persons. ● give all residents equal access to personal visitors, end‐of‐life visitors and essential caregivers. ● ensure comfortable and safe outside visitation areas, considering outside air temperature and ventilation.
● provide hand‐washing stations or hand sanitizer to visitors and residents before and after visits. ● facilitate visits in a way that allows cleaning and cleaning and sanitizing common visitation areas.
Salon Services Visitors
An ALF can allow a salon services visitor (barber, beautician, or cosmetologist providing hair care or personal grooming services to a resident) to enter the facility to provide hair care or personal grooming services to COVID‐ 19 negative residents.
The salon requirements for salon visits.
(A) inform the salon services visitor of applicable policies, procedures, and requirements; (B) maintain documentation of the salon services visitor’s agreement to follow
policies, procedures and requirements;
(C) maintain documentation of the salon services.
(D) document the identity of each salon services visitor in the facility’s records;
(E) prevent visitation by the salon services visitor if the resident has an active COVID‐19 infection; (F) cancel the salon services visit if the salon services visitor fails to comply with
the facility’s policy regarding salon services visits.
(j) If an executive order or other direction is issued by the State and or Local government, the President of the United States, another applicable authority, that is more restrictive than this rule the community in that area will abide by that rule.
The ALF can ask about a visitor’s COVID‐19 vaccination status but must not require any visitor to provide documentation of their COVID‐19 vaccination status as a condition of visitation or to enter the facility. A personal visitor may refuse to provide information about their vaccination status. Sodalis is NOT currently requiring vaccinations. A facility is a private business and should consult with their Legal and Human Resources area to address state and federal mandates regarding vaccines.
See below for the visitors allowed according to resident COVID‐19 status
Essential Caregivers (EC) ALFs are required to allow for all residents with any COVID‐19 status Personal Visitors (not EC) ALFs are required to allow for residents with COVID‐negative status End‐of‐Life Visitors ALFs are required to allow for all residents with any COVID‐19 status Providers of Critical Assistance ALFs are required to allow for all residents with any COVID‐19 status Salon Service Visitors ALFs can allow for residents with COVID negative status
See Attachment 1: ALF COVID‐19 Response Infographics &
Flowcharts, for visual aids outlining ALF response activities. Comply
with all CDC guidance related to infection control.
Establish infection control zones to keep resident cohort groups
separate from each other and to limit movement of staff between
the separate zones.
● Cold Zones for COVID‐19 negative residents
● Warm Zones for monitoring residents with unknown COVID‐19 status
● Hot Zones for COVID‐19 positive residents
An ALF must have spaces for staff to doff and dispose of PPE used in a warm zone or hot zone, and wash hands or use hand sanitizer before entering a cold zone in the facility:
Maintain a two‐week supply of PPE. Make necessary PPE available in areas where care is provided to residents with COVID‐19 and residents with unknown COVID‐19 status. Put a trash can near the exit inside the resident room to make it easy for staff to discard PPE prior to exiting the room.
Cleaning and Disinfecting
Increase environmental cleaning. Clean and disinfect all frequently touched surfaces such as doorknobs/handles, elevator buttons, bathroom surfaces/fixtures, remote controls, and wheelchairs.
Make sure EPA‐registered hospital‐grade disinfectants are available. Refer to List N on the EPA website for EPA‐registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against COVID‐19.
Provide supplies for recommended hand hygiene. Have alcohol‐based hand sanitizer with 60–95 percent alcohol easily accessible. Make sure sinks are well‐stocked with soap and paper towels for handwashing.
Review your infection control policies and procedures. Review your emergency preparedness and response plan and update as needed.
Ensure that any emergency plans specific to hurricanes or other natural disasters account for COVID‐19.
Staff must always wear proper PPE when caring for residents with COVID‐19 or unknown COVID‐19 status.
Assisted living facilities should minimize the movement of staff between facilities whenever possible.
To encourage staff who are ill to stay home ALFs should enforce sick leave policies that do not penalize them with loss of status, wages, or benefits per company policy.
Require staff with symptoms of COVID‐19 to report sick by phone or other virtual method consistent with facility policy. Staff must not enter the facility until they meet the current CDC Guidance Risk Assessment at: https://www.cdc.gov/coronavirus/2019‐ ncov/hcp/guidance‐risk‐assesment‐hcp.html
If a staff member has a confirmed case of COVID‐19 they must not enter the facility until they meet the current CDC return to work criteria. (Go to link listed above)
Staff must always wear a facemask while inside the facility at all times in Florida and Georgia. At this time Texas is face mask free unless there’s an outbreak or deemed otherwise by Local/State mandate. Staff should not use cloth face coverings while inside the facility. The CDC does not consider cloth face coverings to be PPE, nor adequate to prevent the spread of COVID‐19. Develop a staffing contingency plan to implement if a significant number of staff are unavailable to work. Enforce sick leave policies for ill staff and health care providers.
If a staff member has a confirmed case of COVID‐19 they must not enter the facility until they meet the current CDC return to work criteria. Use this link‐ Guidance‐Risk Assessment.
Per CDC guidance, asymptomatic staff who have higher risk of exposure do may not need to be restricted from work.
Web Links are highlighted in yellow
Guidance‐Risk Assessment and CDC Strategies to Mitigate Healthcare Personnel
Staffing Shortages recommendations for Healthcare Personnel During the COVID‐19
Pandemic for possible exceptions and additional information.
Note: If a staff member was diagnosed with a different illness (e.g., influenza) and
was never tested for COVID‐19, base their return to work on the criteria associated
with that diagnosis, use above Guidance Risk Assessment.
Ask residents to report if they feel feverish or have symptoms of respiratory infection and coronavirus. Actively monitor all residents upon admission and at least daily for fever and symptoms of COVID19 in accordance with State and Local guidance. If a resident has fever or symptoms, implement increased infection control measures including quarantine as applicable.
Unknown Status or Overnight Stays out of Community
Residents with unknown COVID‐19 status must be quarantined per the CDC guidance on https://www.cdc.gov/coronavirus/2019‐ncov/if‐you‐are‐sick/quarantine.html
All other residents who are new admissions, readmissions, or spent one or more nights away from the ALF, are considered to have unknown COVID‐19 status. Use the link above to work through whether the resident needs to be quarantined or not per the CDC recommendations.
Per CDC guidance, an asymptomatic resident who is either fully vaccinated or had COVID‐19 in the previous three months and has fully recovered, does not have to quarantine, even if they had close contact with someone who has COVID‐19.
Keep in mind that quarantine does not mean the resident must remain in their room for the duration of the quarantine period. Daily monitoring is a must, as well as following infection control protocols.
If no symptoms develop during daily monitoring, quarantine can end after day 10 without testing; or after day 7 with a negative COVID‐19 test result (test must occur on day 5 or later). Continue to monitor the resident for a total of 14 days after potential exposure.
Fully vaccinated people who do not quarantine should still watch for symptoms of COVID‐19 for 14 days following an exposure. If they experience symptoms, they should be clinically evaluated for COVID19, including testing for COVID‐19, if indicated.
Leaving and returning
Residents have the right to leave and return to the facility for any reason, and the facility cannot restrict residents from exercising this right. The facility has a responsibility to inform residents of the increased risk of contracting COVID‐19 and the importance of safety precautions like avoiding crowds, washing hands often and maintaining physical distancing from others whenever possible, so ensure that the resident is making an informed decision.
A resident who leaves the ALF and returns the same day is not necessarily considered to have unknown COVID‐ 19 status. The resident’s COVID‐19 status is the same as it was when they left.
Activities and Dining
Entertainers, families and volunteer groups can enter the facility if they and the ALF adhere to the following: ● The ALF must screen each person entering the facility prior to entry. Only persons who pass the screening can enter the facility.
● The ALF must document visitors in a log at the entrance of the facility
● All individuals who enter the facility for the purposes of activities or dining are
bound by the rules for personal visitors
Some examples of visitors joining in activities and dining:
● A small group, such as members from a local club or a group of high school
students who volunteer to participate in an activity with residents, such as
putting up decorations or putting on a performance.
● Family joining a resident for a meal at an individual family table that is adequately distanced from other residents’ family tables.
● ALF staff taking residents in community buses to an event or an outing
Memory Care Units and Alzheimer’s Certified Units
Infection prevention strategies to prevent the spread of COVID‐19 are especially challenging to implement in dedicated memory care units and Alzheimer’s certified units where numerous residents with cognitive impairment reside together. These residents can have a difficult time following recommended infection prevention practices.
Changes to resident routines, disruptions in daily schedules, use of unfamiliar equipment, or working with unfamiliar caregivers can lead to fear and anxiety, resulting in increased depression and behavioral changes such as agitation, aggression, or wandering.
Follow recommended guidance below from the CDC for considerations regarding residents with dementia, in memory care or Alzheimer’s certified units.