Immediate Access to Residents & Visitation Rights

Since the next regulations in the residents’ rights section of Appendix PP are similar in nature, we’ve combined the information for your review. These include F562, F563 and F564 related to allowing access to the resident and the resident’s visitation rights.

F562 requires that the nursing home allow immediate access to residents in your care to the following:

• Any representatives of the Secretary or the State (i.e. state and federal surveyors)
• Any representatives of the Office of the State long term care ombudsman
• The resident’s individual physician
• Any representatives of the protection and advocacy systems, as designated by the state and as established under the Developmental Disabilities Assistance and Bill of Rights Act of 2000
• Any representative of the agency responsible for the protection and advocacy system for individuals with mental disorders
• The resident’s representative

With any of the above individuals, the nursing home must not prohibit or discourage any residents from allowing these individuals to visit with the resident. However, the resident can express that they do not want them to visit. This is why surveyors are expected to ask the residents for permission to visit them and/or watch the staff perform care and services (such as personal hygiene). This would not limit the representatives from the federal or state government from reviewing the person’s record though.

In F563, the residents have the right to receive visitors of their choosing, at the time of their choosing, subject to their right to deny visitation when applicable, and in a manner that does not impose on the rights of other residents. This includes immediate and/or reasonable access to the resident by:

• An immediate family member or other relatives, subject to the resident’s right to deny or withdraw consent.
• Other visitors with the consent of the resident and subject to reasonable clinical and safety restrictions.
• Any individual that provides health, social, legal, or other services to the resident.

Additionally, the nursing home must establish policies and procedures regarding visitation rights including examples of reasonable clinical and safety restrictions. Appendix PP outlines the following:

• Restrictions to prevent infection or disease transmission. However, CMS notes that risk factors and health status should be considered such as end-of-life care.
• Visitors with signs or symptoms of transmissible infections should defer their visitation.
• Keeping the doors locked or secured with alarms for the safety of the resident and staff.
• Restricting or denying visits to individuals who are suspected of possibly abusing the resident pending any investigation outcomes.
• Individuals who have been found to have committed crimes such as theft.
• Individuals who may be disruptive or inebriated.
• Individuals who may be bringing illegal substances that places the resident and/or other residents at risk of injury or illness.

If nursing homes place specific limitations or restrictions on visitors, the resident’s record must reflect the identified concern and the limitation or restriction that is placed on visitation. The resident and the visitor must be notified of the limitation or restriction and it should be periodically reevaluated. The nursing home should consider offering limitations vs. restrictions whenever possible – such as offering supervised visitation before denying complete access. Any limitation or restriction should be included in the residents’ care plan. In addition, the nursing home should educate the visitors if the resident (or other residents) has a disease or illness that may place their safety at risk (such as an infectious disease outbreak).

Regarding visitation that may violate other residents’ rights, considerations should be made to alternate options that do not violate the rights of others. For example, if a visitor requests to visit late in the evening and the individual resident is okay with this their roommate may be asleep during this time and the late visit may violate their rights. Alternative options such as allowing the late visit to occur in a family room or common area may be discussed as it would allow the resident to still have the visit while not violating their roommates’ rights.

F564 requires the nursing home to notify the resident of their visitation rights, any policy or procedure in place regarding visitation, and any limitation or restriction placed on visitation. This includes the residents’ right to deny visitation at any time. Additionally, the nursing home must not deny visitation privileges based on discriminatory reasons such as race, color, national origin, religion, sex, or disability and that visitation is consistent with the resident preferences.