NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A6966
SPONSOR: Bronson TITLE OF BILL:
An act to amend the public health law and the social services law, in
relation to personal caregiving visitors for residents of nursing homes;
and to amend a chapter of the laws of 2021 amending the public health
law and the social services law relating to personal and compassionate
caregiving visitors for residents of nursing homes, as proposed in
legislative bills numbers S.614-B and A.1052-B, in relation to the
effectiveness thereof
PURPOSE:
To authorize the Department of Health to develop regulations to allow
personal caregiving visitation, for the provision of routine care and
support, and for compassionate caregiving visitation, for the provision
of short-term emergency care and support at end of life or other dire
circumstances, by family members and legal guardians of residents of
nursing homes and adult care facilities.
SUMMARY OF PROVISIONS:
*Expands when compassionate caregiving can be provided for in end of
life and crisis situations.
*Clarifies that caregiving services provided do not ' replace the
services that nursing homes and adult care facilities are required to
provide
*Clarifies that only caregivers complying with appropriate safety and
screening procedures are allowed to be admitted to nursing homes and
adult care facilities.
*Allows each resident to have at least two designated caregivers.
*Establishes a documentation requirement for nursing homes and adult
care facilities related to designated caregivers to ensure compliance
with the law.
JUSTIFICATION:
In an effort to curb outbreaks of the coronavirus among nursing home
residents, New York State issued-a ban on outside visitation by nones-
sential visitors in March 2020. While the ban addressed a real need to
limit spread of the virus, it has become apparent that isolation from
loved ones presents significant risks of its own to the physical and
mental wellbeing of nursing home residents. In many cases, family
members prior to the ban regularly provided care for their loved one,
assisting with feeding, bathing, dressing, communication and other
essential activities of daily living. These family members-some of them
on a daily basis for years-functioned as de facto "staff," augmenting
the care and support provided by regular staff. We know that nursing
home aides are too often stretched thin under the best of circumstances;
during the pandemic, their numbers and capacity have been even lower,
exacerbating the challenge of adequately meeting residents' needs.
Personal care visitation would allow for such care to resume, with the
designated caregiver following the same protocols as staff.
In addition, this bill would expand on the definition, as conceived by
CMS, of "compassionate care visitation," so that facilities allow for
visitation not just at end-of-life situations but also in response to a
marked decline in a resident's physical, mental or emotional wellbeing.
This decline might be indicated by such conditions as depression,
increased confusion or cognitive decline, weight loss or various other
changes that signify a negative turn in physical or psychosocial health.
Such changes are increasingly -showing up as side effects of policies
that isolate residents from their loved ones for extended periods of
time and, in the most serious cases, pose their own risk of morbidity.
It is a sad fact that enforced isolation from loved ones has created a
whole new set of risks to nursing home residents-in many cases acceler-
ating mental and physical decline. Allowing exemptions for personal care
visitors and enhanced compassionate care visitation would be a reason-
able, pragmatic step toward re-establishing those critical informal
channels of care that are so crucial to the wellbeing of nursing home
residents.
LEGISLATIVE HISTORY:
2021: A.1052-B - Chapter 89 of 2021.
FISCAL IMPLICATIONS: None to the state
EFFECTIVE DATE:
Immediate.
STATE OF NEW YORK
________________________________________________________________________
6966
2021-2022 Regular Sessions
IN ASSEMBLY
April 15, 2021
___________
Introduced by M. of A. BRONSON -- read once and referred to the Commit-
tee on Health
AN ACT to amend the public health law and the social services law, in
relation to personal caregiving visitors for residents of nursing
homes; and to amend a chapter of the laws of 2021 amending the public
health law and the social services law relating to personal and
compassionate caregiving visitors for residents of nursing homes, as
proposed in legislative bills numbers S.614-B and A.1052-B, in
relation to the effectiveness thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 2801-h of the public health law, as added by a
2 chapter of the laws of 2021 amending the public health law and the
3 social services law relating to personal and compassionate caregiving
4 visitors for residents of nursing homes, as proposed in legislative
5 bills numbers S.614-B and A.1052-B, is amended to read as follows:
6 § 2801-h. Personal caregiving [and compassionate caregiving] visitors
7 [to] for nursing home residents during [declared local or state] public
8 health emergencies. 1. As used in this section, the following terms
9 have the following meanings:
10 (a) "personal caregiving visitor" means a family member, close friend,
11 or legal guardian of a resident designated by [such] the resident or
12 [such] the resident's lawful representative to [provide] assist with
13 personal caregiving or compassionate caregiving for [such] the resi-
14 dent[, including a compassionate caregiving visitor];
15 (b) "personal caregiving" means care and support of a resident by a
16 personal caregiving visitor that is provided to benefit such resident's
17 mental, physical, or social well-being;
18 (c) ["compassionate caregiving visitor" means a personal caregiving
19 visitor providing compassionate caregiving to a resident;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04858-11-1
A. 6966 2
1 (d)] "compassionate caregiving" means personal caregiving that is
2 provided in anticipation of the end of a resident's life or in the
3 instance of significant mental, physical, or social decline or crisis of
4 a resident;
5 [(e)] (d) "resident" means a resident of a nursing home; in relation
6 to a personal caregiving visitor, "resident" means the resident to whom
7 the personal caregiving visitor has been designated to [provide] assist
8 with personal caregiving or compassionate caregiving; and
9 [(f)] (e) "visit" includes [providing] assisting with personal care-
10 giving [to] or compassionate caregiving for a resident.
11 2. [Personal] During a public health emergency declared under section
12 twenty-four or section twenty-eight of the executive law personal care-
13 giving visitors may visit residents of nursing homes, [subject to] in
14 compliance with federal law and regulations and state regulations made
15 under this section. Nursing homes shall admit any personal caregiving
16 visitor who is in compliance with applicable requirements under this
17 section.
18 3. The commissioner shall make regulations under this section which
19 shall:
20 (a) require nursing homes to allow personal caregiving visitors to
21 visit residents subject to this section;
22 (b) set forth procedures for the designation of personal caregiving
23 visitors by residents or resident's lawful representatives, which: (i)
24 shall include documentation of each designated personal caregiving visi-
25 tor in the facility records; (ii) shall include procedures to ensure
26 that the preferences of the resident regarding the designation of a
27 personal caregiving visitor are respected; and (iii) may include, in
28 appropriate circumstances, requiring a [physical] health or mental
29 health professional licensed or certified under the education law to
30 state that the personal caregiving will substantially benefit the resi-
31 dent's mental, physical, or social well-being[; an]. A nursing home
32 shall not require that the health professional [is] be affiliated with
33 such nursing home;
34 (c) set forth procedures for changing a personal caregiving visitor
35 designation;
36 (d) provide that a resident shall [not] be entitled to designate [more
37 than] at least two personal caregiving visitors;
38 (e) provide that personal caregiving visitors shall be exempt from
39 prohibitions on visiting residents at nursing homes, subject to the
40 limitations and requirements [set forth by] of this [subdivision]
41 section;
42 (f) set forth the circumstances under which visiting by personal care-
43 giving visitors may be temporarily limited or suspended at a nursing
44 home to protect the health, safety and welfare of residents, including,
45 but not limited to, local infection rates, temporary inadequate staff
46 capacity, or an acute emergency situation;
47 (g) require, at a minimum, that all personal caregiving visitors
48 follow safety protocols [required for nursing home staff, including]
49 which may include, but need not be limited to:
50 (i) testing for communicable diseases;
51 (ii) checking body temperature upon entry into the nursing home;
52 (iii) health screenings upon entry into the nursing home;
53 (iv) appropriate use of personal [protection] protective equipment;
54 (v) social distancing (except as necessary for personal caregiving by
55 the personal caregiving visitor for the resident); and
56 (vi) any other requirement the department deems appropriate;
A. 6966 3
1 (h) set forth standards for frequency and duration of visits by
2 personal caregiving visitors at nursing homes;
3 (i) set forth standards for limiting the total number of personal
4 caregiving visitors for a resident and/or limiting the total number of
5 personal caregiving visitors allowed to visit a nursing home at any one
6 time based on the circumstances of the residents and the nursing home;
7 [and]
8 (j) require personal caregiving and compassionate caregiving to be
9 documented in the resident's individualized comprehensive plan of care;
10 and
11 (k) make appropriate provisions for compassionate caregiving [and
12 compassionate caregiving visitors].
13 4. The department shall post the requirements consistent with regu-
14 lations, on its website, including any requirements as to time periods
15 and region.
16 5. This section does not require the medical assistance program to
17 cover personal caregiving or compassionate caregiving and such caregiv-
18 ing shall not be reimbursed under the medical assistance program.
19 6. This section does not relieve any nursing home, or nursing home
20 operator or administrator, of any obligation or responsibility imposed
21 by any other applicable law or regulation.
22 7. Nothing in this section shall be construed to limit access by any
23 visitor to a facility that would otherwise be permitted under federal or
24 state law or regulation.
25 § 2. Section 461-u of the social services law, as added by a chapter
26 of the laws of 2021 amending the public health law and the social
27 services law relating to personal and compassionate caregiving visitors
28 for residents of nursing homes, as proposed in legislative bills numbers
29 S.614-B and A.1052-B, is amended to read as follows:
30 § 461-u. Personal caregiving [and compassionate caregiving] visitors
31 for residents of adult care facilities during [declared local or state]
32 public health emergencies. 1. As used in this section, the following
33 terms have the following meanings:
34 (a) "personal caregiving visitor" means a family member, close friend,
35 or legal guardian of a resident designated by [such] the resident or
36 [such] the resident's lawful representative to [provide] assist with
37 personal caregiving or compassionate caregiving for [such] the resi-
38 dent[, including a compassionate caregiving visitor];
39 (b) "personal caregiving" means care and support of a resident by a
40 personal caregiving visitor that is provided to benefit such resident's
41 mental, physical, or social well-being.
42 (c) ["compassionate caregiving visitor" means a personal caregiving
43 visitor providing compassionate caregiving to a resident;
44 (d)] "compassionate caregiving" means personal caregiving that is
45 provided in anticipation of the end of a resident's life or in the
46 instance of significant mental, physical, or social decline or crisis of
47 a resident;
48 [(e)] (d) "resident" means a resident of an adult care facility; in
49 relation to a personal caregiving visitor, "resident" means the resident
50 to whom a personal caregiving visitor has been designated to [provide]
51 assist with personal caregiving or compassionate caregiving; and
52 [(f)] (e) "visit" includes [providing] assisting with personal care-
53 giving [to] or compassionate caregiving for a resident.
54 2. [Personal] During a public health emergency declared under section
55 twenty-four or section twenty-eight of the executive law personal care-
56 giving visitors may visit residents of adult care facilities, [subject
A. 6966 4
1 to] in compliance with federal law and regulations and state regulations
2 made under this section. Adult care facilities shall admit any personal
3 caregiving visitor who is in compliance with applicable requirements
4 under this section.
5 3. The commissioner of the department responsible for the licensure or
6 certification for each type of adult care facility shall make regu-
7 lations for such type under this section which shall:
8 (a) require adult care facilities to allow personal caregiving visi-
9 tors to visit residents subject to this section;
10 (b) set forth procedures for the designation of personal caregiving
11 visitors by residents or resident's lawful representatives, which: (i)
12 shall include documentation of each designated personal caregiving visi-
13 tor in the facility records; (ii) shall include procedures to ensure
14 that the preferences of the resident regarding the designation of a
15 personal caregiving visitor are respected; and (iii) may include, in
16 appropriate circumstances, requiring a [physical] health or mental
17 health professional licensed or certified under the education law to
18 state that the personal caregiving will substantially benefit the resi-
19 dent's mental, physical, or social well-being[; an]. An adult care
20 facility shall not require that a health or mental health professional
21 [is] be affiliated with such adult care facility;
22 (c) set forth procedures for changing a personal caregiving visitor
23 designation;
24 (d) provide that a resident shall [not] be entitled to designate [more
25 than] at least two personal caregiving visitors;
26 (e) provide that personal caregiving visitors shall be exempt from
27 prohibitions on visiting residents at adult care facilities, subject to
28 the limitations and requirements [in] of this [subdivision] section;
29 (f) set forth the circumstances under which visiting by personal care-
30 giving visitors may be temporarily limited or suspended at an adult care
31 facility to protect the health, safety and welfare of residents, includ-
32 ing, but not limited to, local infection rates, temporary inadequate
33 staff capacity, or an acute emergency situation;
34 (g) require, at a minimum, that all personal caregiving visitors
35 follow safety protocols [required for adult care facility staff, includ-
36 ing] which may include, but need not be limited to:
37 (i) testing for communicable diseases;
38 (ii) checking body temperature upon entry into the adult care
39 facility;
40 (iii) health screenings upon entry into the adult care facility;
41 (iv) appropriate use of personal [protection] protective equipment;
42 (v) social distancing (except as necessary for personal caregiving by
43 the personal caregiving visitor for a resident); and
44 (vi) any other requirement the [office of temporary and disability
45 assistance] respective commissioner deems appropriate;
46 (h) set forth standards for frequency and duration of visits by
47 personal caregiving visitors at adult care facilities;
48 (i) set forth standards for limiting the total number of personal
49 caregiving visitors for a resident and/or limiting the total number of
50 personal caregiving visitors allowed to visit an adult care facility at
51 any one time based on the circumstances of the residents and the adult
52 care facility; [and]
53 (j) require personal caregiving and compassionate caregiving to be
54 documented in the resident's case management notes; and
55 (k) make appropriate provisions for compassionate caregiving [and
56 compassionate caregiving visitors].
A. 6966 5
1 4. The respective commissioners shall post the requirements consistent
2 with regulations, on their website, including any requirements as to
3 time periods and region.
4 5. This section does not require the medical assistance program to
5 cover personal caregiving or compassionate caregiving and such caregiv-
6 ing shall not be reimbursed under the medical assistance program.
7 6. This section does not relieve any facility licensed under this
8 article, or any facility operator, of any obligation or responsibility
9 imposed by any other applicable law or regulation.
10 7. Nothing in this section shall be construed to limit access by any
11 visitor to a facility that would otherwise be permitted under federal or
12 state law or regulation.
13 § 3. Section 3 of a chapter of the laws of 2021 amending the public
14 health law and the social services law relating to personal and compas-
15 sionate caregiving visitors for residents of nursing homes, as proposed
16 in legislative bills numbers S.614-B and A.1052-B, is amended to read as
17 follows:
18 § 3. This act shall take effect [on the forty-fifth day after it shall
19 have become a law. Effective immediately, the addition, amendment and/or
20 repeal of any rule or regulation necessary for the implementation of
21 this act on its effective date are authorized to be made and completed
22 on or before such date] immediately and regulations shall be made, which
23 may include emergency regulations, within forty-five days after such
24 date; provided however, nothing herein shall impact the effectiveness of
25 current department of health guidance pertaining to nursing home and
26 adult care facility visitation.
27 § 4. This act shall take effect immediately; provided however, that
28 sections one and two of this act shall take effect on the same date and
29 in the same manner as a chapter of the laws of 2021 amending the public
30 health law and the social services law relating to personal and compas-
31 sionate caregiving visitors for residents of nursing homes, as proposed
32 in legislative bills numbers S.614-B and A.1052-B, takes effect.
