Residents at South Carolina nursing homes and assisted living facilities now may receive visitors outdoors—provided the facilities meet specific new guidelines issued by the SC Department of Health and Environmental Control. 

South Carolina has joined many other states in severely restricting or largely eliminating visitations at long term care facilities during the COVID-19 pandemic. Such facilities are seen as particularly at risk, given the close living quarters and the vulnerabilities of many residents. However, as public health officials learn more about the virus and how it spreads, recommended precautions have evolved and DHEC is now allowing limited outdoor visitation at South Carolina’s long-term care facilities.

Significantly though, facilities must meet the following five requirements before they may offer limited outdoor visitation:

• Residents and staff must be screened for COVID-19 symptoms at least daily. These screenings must be documented.
• The facility must have adequate staffing and personal protective equipment (PPE).
• Facility officials must provide a written plan for limited outdoor visitation to DHEC’s Healthcare Quality Division. The plan should address how the facility may accommodate outdoor visitors safely, including masks, social distancing and sanitation of common areas.
• There have been no cases among staff or residents within the 14 days preceding visitation.
• Nursing homes must conduct COVID-19 testing per CMS requirements before outdoor visitation may begin. Community residential care facilities may start outdoor visitation before testing is in place, but testing must begin by Oct. 1.

Every item above must be met before outdoor visitation is permitted.

DHEC has defined certain “triggers” that will result in temporary suspension of visitation.  For example, if one or more cases is identified in residents and/or staff members, the facility must suspend visitation until it completes CMS testing protocols.  In that instance, visitation may resume only if fewer than three total cases have been identified. If three or more cases are identified in staff members and/or residents within a 14-day period, visitation must be suspended. Visitation may resume 14 days after the identification of the last case.

The DHEC guidelines also outline the specifics of a visit:

• A visitor may only visit for 15 minutes unless he or she provides documentation of a recent (negative) COVID-19 test. 
• Only two visitors are allowed per resident at one time, and children under 12 should not be permitted (except under special family circumstances on a case-by-case basis). 
• Visitors must wear a mask over their nose and mouth at all times, and must strictly maintain social distancing for the duration of the visit. 
• All visitors must check in and check out at a designated outdoor screening site, and the facility must document each visit and record contact information for all visitors. 
• Every visitor must be screened for signs of COVID-19 (including checking their temperature) before they are allowed to visit. 
• Visitors may not enter the facility’s buildings at any time.

The guidelines also take into account other health and safety factors not related to COVID-19. For example, care should be taken to protect patients from the sun and heat during outdoor visits. 

It is important to note that facilities are not required to offer limited outdoor visitation. They also may suspend visitation for a number of reasons, including increased local transmission of COVID-19, visitor non-compliance with safety guidelines, and inclement weather. 

Although DHEC’s allowing of outdoor visitation is welcome news to residents and their family members, it likely will take time for facilities to meet DHEC’s stringent criteria, acquire any additional PPE and resources needed to satisfy that criteria, and to develop or update their own internal COVID-19 plan, oversight, and documentation protocols.