California Department of Public Health Issues New Visitation Guidance

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On August 25, the California Department of Public Health (DPH) issued All Facilities Letter 20-22.4 outlining some significant changes to the State’s ever-evolving guidance relating to visiting nursing homes and other health facilities during the COVID pandemic.

The AFL makes clear that visitation restrictions cannot be absolute.  Facilities may not bar any of the following:

  • Visits by Ombudsmen: Facilities must permit ombudsmen in the facility. Any ombudsman representative entering the facility is subject to screening for fever and COVID-19 symptoms and must wear appropriate PPE.
  • Visitors for legal matters: Visitors must be permitted for legal matters that cannot be postponed including, but not limited to, estate planning, advance health care directives, Power of Attorney, and transfer of property title. Any visitor entering the facility is subject to screening for fever and COVID-19 symptoms and must wear appropriate PPE. 

The new AFL also makes clear that facilities must permit residents to designate one visitor per resident for inside facility visitation, so long as certain conditions are met:

  • There is a decline in the number of new cases, hospitalizations or deaths in the community.
  • There are no new COVID-19 cases in the facility for 14 days, among either residents or staff.
  • There are no staffing shortages and the facility is not using a COVID-19 staffing waiver. 
  • The facility has a testing plan in place in compliance with AFL-20-53.
  • The facility must maintain good regulatory compliance with a COVID mitigation plan.

CANHR suggests that if a facility justifies restrictions on the basis of any of the last three points residents and their families immediately bring the problem to the attention of the DPH, as inadequate staffing and lack of compliance with testing and mitigation plans is a cause for immediate concern.

The AFL states that even those facilities that cannot meet these conditions shall provide outdoor and other visitation options, including but not limited to:

  • Scheduled visits on the facility premises where there is 6-feet or more physical distancing, and both residents and visitors where facial coverings with staff monitoring infection control guidelines. (i.e. large communal spaces, outdoor visits, drive-by visits or visit through a person’s window); and
  • Offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.).

If a facility is not in compliance with these guidelines, residents and their families should send the facility administrator a letter asking that the facility follow the law and permit, at a minimum, outdoor visitation.  A sample letter can be found here:

 Facilities sometimes invoke local county health department rules in restricting visitors. In such cases residents and their families should ask for and review local health department visitation guidelines, and ensure that local health departments are aware of DPH guidance. If visitation is still not permitted, residents and families should file a complaint with the state DPH invoking the new rules. A guide to the filing of complaints can be found here: