Frequently Asked Questions About Essential Caregivers

Both are important ways to support resident rights and make sure residents get individual care.

• Compassionate care visits are recommended to help residents facing hard situations, such as major upsets or end of life. These visits should not be routine. They should be allowed on a limited basis, as an exception to restricted visitation. If a visit meets the definition of compassionate care, the facility must make the visit possible. See Centers for Medicare & Medicaid Services Frequently Asked Questions on Nursing Home Visitation (PDF).
• Essential caregiver visits are allowed to help residents with emotional and/or daily living needs. The schedule for these visits is defined together by the resident, essential caregiver, and the facility and may include regular visits. The visits must meet requirements outlined in the essential caregiver guidance.

Yes. You should document and communicate your rationale (e.g., factors affecting risk and safety) for not implementing an essential caregiver program at this time. This will help you better respond to questions from residents, family members, the press, surveyors, and the long-term care ombudsman. Include the means by which you are addressing the needs and rights of residents, such as virtual/technology-supported visits, window visits, outdoor visits, and compassionate care visits. If the basis for implementing an essential caregiver program depends on meeting certain measurements or thresholds, such as the status of COVID-19 cases in your county, include that information, too.

Yes. You may launch an essential caregiver program at a later date. An organization that intends to implement a program may take more time to develop its policies and procedures, if needed. In addition, an organization that completed its policies and procedures by July 25 may elect to implement the program at a later date, based on key factors such as the rate of COVID-19 transmission in the facility’s community. It is recommended that organizations communicate clearly with families about their process, intentions, and timeline.

Yes. Facilities may identify events or factors that trigger suspending the essential caregiver program for a period of time. Examples may include, but are not limited to, newly confirmed or suspected cases of COVID-19 in the facility, the incidence of COVID-19 in the community, or shortages of personal protective equipment. Include these considerations in your policies and procedures, and communicate them to residents and essential caregivers.

Nothing in MDH guidance prohibits this. However, the organization needs clear policy about infection prevention protocols that essential caregivers must follow when going from one resident to serving another. The organization should educate the essential caregiver about the protocols.

The facility can include an age restriction in its policy if it chooses. It is rare for someone under age 18 to serve as an essential caregiver.

A provider should address in policy how to determine whether a resident will have an essential caregiver. It is best to get input from residents and their families as part of the policy development. An assessment can be an appropriate and effective tool to determine if a resident will benefit from having an essential caregiver, and what care and services are needed. Document the determination in the resident’s record.

Your policy should state the requirements that the essential caregiver must follow, such as screening; using personal protective equipment; following the schedule; visiting only the resident for whom they are designated to give care; and keeping a safe distance from other residents and staff. If the essential caregiver fails to follow the requirements, you may deny access. State in your policy that requirement violations may be cause to end or limit visitation rights. Prior to restriction/revocation, the facility, essential caregiver, and resident should discuss how to mediate concerns.

If the resident has the capacity to designate the essential caregiver, ask the resident who they want as the essential caregiver. If the resident is unable to make the decision, or is uncertain about or uncomfortable choosing, the facility should work with the resident’s guardian or other legal representative. If family members cannot agree, consider involving your regional ombudsman.

Yes. The facility must allow evening and weekend visits that accommodate the essential caregiver, who may be limited by work or child care duties. The facility should consider staffing considerations related to checking in and screening essential caregivers. Facilities should consult residents and essential caregivers when designing schedules.

No. Guidance clearly states that the facility entry screening process for essential caregivers must be active and the same as it is for facility staff.

The facility may set reasonable time limits on visits to make sure the program is carried out in a safe and effective manner. In doing this, they should consider a number of factors. Scheduling should take into account the time an essential caregiver needs to do the planned care and services. Facilities should work with a resident and the essential caregiver to identify a schedule where visits can last up to three consecutive hours, or until caregiver tasks are done. Facilities should also make sure scheduling considers the number of essential caregivers in the building at the same time, and the time that is needed to clean and disinfect a location that more than one essential caregiver uses. All of these considerations should be part of facility policy safety protocols.

MDH guidance says facilities should make sure scheduling of essential caregiver visits considers how many essential caregivers are in the building at the same time. The facility may set time limits to carry out the program safely. A facility may set reasonable limits on the number of visits per week if this is needed to accommodate scheduling visits for all essential caregivers. This should be part of facility policy safety protocols.

This may be clarified or limited by facility policy. If more than one essential caregiver is identified for a particular resident, an organization may limit a resident to a single essential caregiver visit on a given day, if this supports the goal of preventing COVID-19 in the setting. Facilities must consider safety factors, such as limiting the number of people who enter the facility, or the facility's ability to screen essential caregivers.

Yes, unless the caregiving provided requires privacy. Note: if such areas are identified, the facility must clean and disinfect the areas between essential caregiving visits.

MDH guidance requires facilities to actively check in and screen essential caregivers when they enter the building. The guidance does not require staff to monitor or supervise visits. However, a facility may need to check on essential caregivers to confirm that they are complying with expectations, such as using personal protective equipment, maintaining social distancing, limiting movement within the building, and so on.

The guidance does not say who is responsible for providing personal protective equipment. This depends on your facility's policies and on your access to supplies of personal protective equipment. Communicate your expectations clearly to essential caregivers before they arrive at the facility. A facility can ask essential caregivers to conserve personal protective equipment in the same way as staff, such as storing it properly for re-use and disinfecting it.

Essential caregivers are expected to use the same personal protective equipment as staff. Follow MDH guidance on Contingency Standards of Care for COVID-19: Personal Protective Equipment for Congregate Care Settings (PDF).

The essential caregiver must remain 6 feet away from staff and other residents at the facility. However, MDH guidance does not set a distance between a resident and their essential caregiver, because many caregiving tasks require a shorter distance.

If a resident living in a shared room asks for an essential caregiver visit, but the roommate does not consent, the facility should make a reasonable attempt to accommodate the visit. This may include designating a place for the visit other than the resident’s room; moving one of the residents to a new room, with their consent; or asking the roommate to step out of the room during the essential caregiver’s visit. Facilities should manage these situations on a case-by-case basis.

Essential caregivers should be permitted to enter the building even if Point Prevalence Testing has not occurred. However, MDH strongly encourages facilities to schedule testing if they have not done so already.

Yes. A facility can require that essential caregivers get tested. The facility’s policies and procedures should address testing arrangements, including who pays for any testing.

No, MDH will not issue a deficiency or licensing order if you do not implement an essential caregiver program. However, MDH may potentially cite a facility for violating residents’ rights if residents’ needs are not being met.

MDH may issue a citation if during a survey it finds that a facility’s infection control policies related to essential caregivers is insufficient. It may also issue a citation if a facility has an adequate policy, but it is not sufficiently carried out, such as failing to educate essential caregivers about infection control protocols.