Dec 13 2024 | Visitation

Imagine yourself in your own home, reading or watching TV. Someone you’ve known for years – or maybe, instead, a new acquaintance you met just last week – knocks on your front door. Who makes the decision whether or not you invite that person into your home? Or perhaps that person asks you to go with them to the local diner for a cup of coffee; who decides if you can go or not?

For all of us, these two questions come with easy answers. You make the decision to welcome someone into your home; you decide whether you want to go out for coffee or not. In fact, who you choose to visit with, and where (and when and why) are completely within your control.

Now ask yourself: what if a family member of yours, or even your landlord, does not like the person knocking on your front door? And they tell you that you shouldn’t (or can’t) visit with that person?

The answer, again, is a simple one. It’s not your family member’s or your landlord’s decision with whom you choose to visit, inside as well as outside your home.

We, as adults, take into consideration others’ thoughts and ideas about the visit. We consider how the visitor might affect others in our home, or how the visit might impact plans we might have with others. But ultimately, the decision still remains with you.

Now imagine you’ve moved into an assisted living or skilled nursing facility. Do your decisions about who you visit, and where, change? Essentially, no. The laws are clear, residents of long-term care facilities retain their basic civil and legal rights, as well as the opportunity to exercise reasonable control over life decisions and to engage in religious, political, civic, recreational, and other social activities. Our state and federal governments have taken additional steps in the protection of residents’ rights regarding visitation. Laws specifically state that each resident has the right and the facility must not interfere with access to any resident by the following:

• Any representative of the state
• The resident’s individual physician
• The state long-term care ombuds
• The agency responsible for the protection and advocacy system for individuals with developmental disabilities and/or mental illness

Also, subject to reasonable restrictions to protect the rights of others and to the resident’s right to deny or withdraw consent at any time, the resident has the right to visit at any time without interference the following:

• The resident’s representative
• Any immediate family or other relatives of the resident
• Others who are visiting with the consent of the resident

Note that there is no mention of the resident’s capacity in these laws. While legal surrogate decision makers may be authorized to make decisions on healthcare-related issues and/or financial concerns on behalf of the resident, visitation does not fall into either category.

Each facility and staff member plays a significant role in the protection and advocacy for residents’ rights related to visitation. This means ensuring that each resident remains the locus of control and decision-making related to their visitors and visitation both inside and outside the facility. This sometimes requires the facility to take active role in advocating and educating others when they express a desire to restrict a resident’s visitors or access to others either inside or outside of their home/facility.

While there may be challenges at times related to visitors, keeping the resident at the center of the decision-making process is key. The facility is the resident’s home, and the resident retains the right to visit with whomever they choose. At times, visitation might cause worry for staff or family. This must be looked at on a case-by-case basis and in collaboration with the resident; likewise, all resident rights must be taken into consideration.

The restrictions placed on visitation and social gatherings during the public health emergency caused tremendous negative impacts on all people, especially the most vulnerable residents living in long-term care settings. Substitute House Bill 1218, adopted into law in 2021, specifically addresses measures to prevent restrictions from recurring by the use of Essential Support Persons (ESP); to learn more about the role and expectations of the ESP, visit here.

For more information on this, and other resident rights, visit Washington Health Care Association’s webpage focused on information and resources regarding Resident Rights. Resources are also available from the Washington State Long Term Care Ombudsman Program.

WHCA members are encouraged to reach out to our regulatory team if you have questions:

Vicki McNealley, Assisted Living Director

Elena Madrid, Executive Vice President of Education and Regulatory Affairs