All North Carolina nursing homes, combination homes, adult care homes and family care homes (LTC Facilities) must now include with their admission material the emergency visitation policy (EVP) that will be in effect when their normal visitation policy is suspended or changed during a declared disaster or emergency. LTC Facilities must also explain how the EVP process will work during the admission process.

Pursuant to Session Law 2021-145, known as “Clifford’s Law,” LTC Facilities are required to develop specific visitation policies to have in place in the event regular visitation policies must be suspended or limited. The North Carolina Department of Health and Human Services (NCDHHS) was tasked with providing specific protocols for facilities to implement pursuant to Clifford’s Law. These protocols were published on June 27, 2022 and went into effect immediately.

What you need to know:

Visitation Protocols Must Be Provided Now

Even though the North Carolina State of Emergency has expired, the EVP to be used in the event of another state-declared emergency or disaster must be explained and provided in writing to all residents prior to admission.

Requirements of the Clifford’s Law Visitation Policy and Procedure

NCDHHS has prepared a list of protocols to be implemented related to the Clifford’s Law Visitation Policy. They include the following:

• The LTC Facility must articulate how it will determine whether there is a disaster declaration or emergency that will affect its normal visitation protocol. Examples of steps to take include consulting with:
  • Local emergency management and/or health department
  • North Carolina Department of Public Safety emergency management division
  • NCDHHS Division of Public Health
  • NCDHHS, Division of Health Service Regulation
• The LTC Facility must identify how it will implement its EVP, what staff will implement the EVP and train staff on how to implement the EVP.
• The EVP as written shall:
  • Permit Each resident to designate one pre-approved visitor and one pre-approved alternate visitor.

• Provide for at least two visits a month from preapproved visitors during any period of time when the “normal” visitation policy is suspended or changed due to a declared disaster or emergency.
  • Specify that principles of infection prevention must be followed by preapproved visitors and note that preapproved visitors who fail to follow infection prevention protocols can be excluded from the facility.
  • Designate an indoor and/or outdoor visitation area.
  • Include contact information for the Long-Term Care Ombudsman.
  • Articulate the protocol for re-institution of normal visitation policy no later than the end of the disaster declaration or emergency.

Executive Orders, Secretarial Orders, or Centers for Medicare and Medicaid Services Directives will control

To the extent the EVP is contrary to governmental orders issued during a declared disaster or emergency, the Governmental Order/CMS directive will control.

Who Will Monitor and Enforce?

At this time, the Regional Long-Term Care Ombudsmen have been tasked with monitoring and reporting on the activation of Clifford’s Law Visitation Protocols when normal visitation at a facility cannot be followed. It is unclear what actions will be taken and who will have authority to take action in the event the EVP protocols are not met.

Considerations for Policy and Procedure

Here are some key questions the leaders of long-term care facilities should keep in mind as they implement policies and procedures to comply with Clifford’s Law:

• How will you determine if the EVP is consistent with other Governmental Orders/CMS Directives that may require limitation on visitation?
• How will you document visits and when an alternative visitor should be notified that original chosen preapproved visitor is not available?
  • How will you define unavailability of a preapproved visitor?
• What is your policy for updating list of preapproved visitors?
  • Yearly as part of care planning process? Only when notified of need for a change?
• How will you notify visitors if they are no longer permitted to visit based on failure to follow applicable infection control policies?  How will this be documented?
• How often will you in-service staff?
• How will you inform existing residents admitted prior to June 27, 2022 about their options? 
  • Will you wait until you need to suspend normal visitation, or get names of their preapproved visitors now/next acre planning meeting?

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