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 1. Healthcare Equality Index Resource Guide
 2. Equal Visitation


EQUAL VISITATION

Equal Visitation

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OVERVIEW


WHY AN EQUAL VISITATION POLICY?

Research and experience have shown that a patient’s access to visitors is a
crucial part of the healing process. Yet LGBTQ people have been denied the same
access to their loved ones as other patients and visitors. To help remedy this
discriminatory practice, President Obama issued a memorandum in April 2010
ordering the Department of Health and Human Services to guarantee the visitation
rights of LGBTQ people, inspired by the tragic experience of Janice Langbehn,
Lisa Pond and their children, who were kept apart by discriminatory hospital
officials as Lisa lay dying.

When inpatient healthcare organizations explicitly guarantee equal visitation to
LGBTQ patients, they offer vital assurance to patients and clear guidance to
employees.


THE JOINT COMMISSION AND CMS STANDARDS

In 2011, in response to the President’s memorandum, the Centers for Medicare and
Medicaid Services (CMS) revised their CMS Conditions of Participation to require
covered facilities to “not restrict, limit or deny visitation privileges” based
on sexual orientation or gender identity. The Joint Commission simultaneously
aligned its visitation standards (see RI.01.01.01 EP 2 Note) with the CMS
requirements. Revisiting Your Hospital’s Visitation Policy, a joint publication
from HRC and the American Health Lawyers Association, details the CMS’ and The
Joint Commission’s requirements and provides a wealth of other background
information, as does The Joint Commission LGBT Field Guide. In addition, some
state laws guarantee equal LGBTQ visitation.

CMS explicitly requires that hospitals must adopt written policies and
procedures concerning patients’ visitation rights, including any clinically
reasonable and necessary restrictions or limitations on visitation.
Additionally, hospitals must provide notice to patients or support persons of
their visitation rights, including the right to receive visitors designated by
the patient. Hospitals may not deny visitation privileges based on race, color,
national origin, religion, sex, gender identity, sexual orientation, or
disability.

The Joint Commission also requires hospitals to have written policies that
address procedures regarding visitation rights, aligned with the same CMS
standards of allowing the presence of a support individual of the patient’s
choice, and prohibiting discrimination based on age, race, ethnicity, religion,
culture, language, physical or mental disability, socioeconomic status, sex,
sexual orientation, and gender identity or expression.


TO RECEIVE CREDIT IN THE HEI:

 * An organization must document that it has an LGBTQ-inclusive equal visitation
   policy
 * The policy is communicated to patients in at least two of the following ways:
   * Posted on facility website
   * Posted or displayed in waiting rooms and other public areas of the facility
   * In materials routinely given to patients at admitting/registration
   * In materials routinely given to patients at other time(s)
   * In materials routinely available for take-away in waiting areas
   * Posted in waiting area(s)
 * An organization must inform its employees of its equal visitation policy in
   at least one of the following ways:
   * Posted on facility intranet site
   * Posted in employee work area(s)
   * In materials routinely given to employees at orientation
   * Reviewed in in-person employee training
   * Reviewed in online employee training




HEI SCORED QUESTIONS


DOES YOUR VISITATION POLICY GRANT EQUAL VISITATION TO LGBTQ PATIENTS AND THEIR
VISITORS?

To receive credit in the HEI, a facility must:

Upload a copy of the facility's equal visitation policy.

More information:

Many facilities go above and beyond explicitly noting that patients may
designate the visitor(s) of their choice and prohibiting discrimination in
visitation based on sexual orientation or gender identity. To further alleviate
worries held by LGBTQ patients and families, hospitals often make an explicit
reference to equal visitation for same-sex couples and same-sex parents. In
addition, it is a best practice for facilities to include an explicitly
LGBTQ-inclusive definition of “family,” or link to or make direct reference to
such a definition in the visitation policy.

Approaches to offering this critical guarantee include:

 * Prohibiting discrimination in visitation based on sexual orientation or
   gender identity, either explicitly within the visitation policy or by linking
   or making reference to an explicitly LGBTQ-inclusive patient
   non-discrimination policy
 * Including (or linking or making direct reference to) an explicitly
   LGBTQ-inclusive definition of “family”
 * Making an explicit reference to equal visitation for same-sex couples and
   same-sex parents
 * Noting explicitly that patients may designate the visitor(s) of their choice

See templates that include sample language for each of these approaches.

Examples:


AtlantiCare Regional Medical Center (Atlantic City, NJ)

This equal visitation policy clearly indicates that patients have the right to
designate a visitor of their choosing, along with alleviating LGBTQ-specific
worries by including “same-sex partner” in the list of those who might visit,
and finally through a non-discrimination statement that includes both “sexual
orientation” and “gender identity.”

It is the policy of AtlantiCare Regional Medical Center (ARMC) to promote
patient and family-centered care while providing a therapeutic environment for
patients and a safe environment for patients, family, visitors, and staff.

ARMC will provide notice to patients or their Support Persons (where
appropriate) of their visitation rights, including the right to receive, subject
to the patient’s consent, visitors designated by the patient, including but not
limited to a spouse, civil union partner, domestic partner (including a same sex
partner), another family member, or a friend. The notice must also advise of the
patient’s right to withdraw or deny consent at any time either orally or in
writing. The provision of notice will be documented in the medical record.

ARMC will not restrict, limit, or deny visitation privileges based on race, skin
color, age, national origin, ancestry, nationality, religion, sex, gender
identity or expression, sexual orientation, or disability. All visitors enjoy
full and equal visitation privileges consistent with patient privileges and the
limitations set forth in this policy.

Thomas Jefferson University Hospital (Philadelphia, PA)


This is shorter equal visitation policy that clearly indicates that patients
have the right to designate a visitor of their choosing, along with alleviating
LGBTQ-specific worries by specifically including “same-sex partner” in the list
of those who might visit, and finally through a non-discrimination statement
that includes both “sexual orientation” and “gender identity.”

In support of each patient’s rights, the hospital allows patients to receive
visitors that the patient designates including, but not limited to, a spouse,
domestic partner (including a same sex domestic partner), family members, or a
friend, for emotional support during the course of his/her stay. Patients are
able to withdraw or deny such consent at any time. TJUH prohibits discrimination
against visitors based on age, race, ethnicity, religion, culture, language,
physical or mental disability, socioeconomic status, sex, sexual orientation,
and gender identity or expression. Visitors designated by the patient (or
support person, where appropriate) do not have to be legally related to the
patient and shall enjoy visitation privileges that are no more restrictive than
those that immediate family members would enjoy.

Children’s Mercy Kansas City (Kansas City, MO)


This equal visitation policy specifically addresses the worries LGBTQ families
have when visiting their children. By including a broad definition of “family,”
this policy welcomes LGBTQ families in addition to other diverse families.

Purpose: To define the expectations for persons visiting hospitalized patients,
recognizing our commitment to non-discrimination and providing access without
regard to race, color, sex, national origin, disability, age, religion, marital
status, citizenship, gender identity, gender expression, sexual orientation,
and/or other legally protected classification at all Children’s Mercy inpatient
locations.

Specific Considerations:

 * Children’s Mercy promotes and supports a patient and family centered approach
   to care delivered in a context sensitive to the importance of relationships.
 * Children’s Mercy recognizes the importance of contact with family members and
   friends for the mental and physical well-being of patients.
 * For purposes of visitation “family” means any person(s) who plays a
   significant role in an individual’s life. This may include person(s) not
   legally related to the individual. Members of “family” include:
   * Spouses, domestic partners, partners in civil union and both different-sex
     and same-sex significant others.
   * Minor patient’s parents, regardless of the gender of either parent.
   * Parents may be legal parents, foster parents, same-sex parents,
     step-parents, those serving in loco parentis, and other persons operating
     in caretaker roles.
 * The PICU, ICN and Fetal Health Center unit specific visitation policies do
   not restrict visitors based on race, color, sex, national origin, disability,
   age, religion, marital status, citizenship, gender identity, gender
   expression, sexual orientation, and/or other legally protected
   classification.


IS YOUR EQUAL VISITATION POLICY COMMUNICATED TO PATIENTS IN AT LEAST TWO
DIFFERENT WAYS?

To receive credit in the HEI, a facility must:

Provide at least two examples – typically one is a website example and the other
will be a document like a brochure. It could also be a poster or photo of
sign/poster in waiting area. If the policy is included in the Patient Bill of
Rights, the same example(s) from PND question may be used.

More information:


Communicating your equal visitation policy to patients is just as, if not more
important than having the policy itself in place. Adding your equal visitation
policy to your facility website, patient bill of rights poster or brochure
alleviates the added anxiety LGBTQ people face when visiting their loved ones.

The HEI requires survey participants to document not only that they have equal
visitation policies, but also that they make these policies readily accessible
to patients in at least two of the following ways:

 * Posted on facility website
 * In materials given to patients at admitting/registration
 * In materials given to patients at other time(s)
 * In materials available for take-away in patient waiting areas
 * Posted in patient waiting area(s)

Examples:

Posted on facility website:

 * Tulane Medical Center has a comprehensive visitation policy outlined in their
   online patient bill of rights, which they also link to on their general
   visitation page.
 * University of Kentucky Albert B. Chandler Hospital lists the patient’s
   visitation rights on their general information/visitation page.

In materials given to patients at admitting/registration:

 * Holtz Children’s Hospital and JMH Women’s Services gives its visitation
   policy to patients at admission.
 * Howard University Hospital disseminates its Patient Bill of Rights to
   patients prior to hospital admission.

In materials available for take-away in patient waiting areas:

 * Christiana Care Health System’s Wilmington Hospital includes their Visitation
   Policy in patient waiting areas.
 * St. Louis Children’s Hospital's Patient Rights and Responsibilities brochure
   has their inclusive visitation policy and is made available for all in
   patient waiting areas.

Posted in patient waiting area(s):

 * Park Nicollet Methodist Hospital posts their Patient Rights and
   Responsibilities in their patient waiting areas to display their Patient and
   Equal Visitation policies.


IS YOUR EQUAL VISITATION POLICY COMMUNICATED TO YOUR EMPLOYEES IN AT LEAST ONE
WAY?

To receive credit in the HEI, a facility must:

Upload at least one example of how the policy is communicated to staff. This
example must be an internal example, not a public document. It cannot be the
same as the example of how the policy is communicated to patients.

More information:

The HEI requires facilities to share their LGBTQ-inclusive Visitation
Non-Discrimination Policy with its employees in at least one of the following
ways:

 * Posted on facility intranet site
 * Note that while having the policy posted on the intranet will allow a
   facility to meet this criterion, we strongly encourage facilities to promote
   these policies to their employees in a more proactive way such as through
   training.
 * Posted in employee work area(s)
 * In materials routinely given to employees at orientation
 * Reviewed in in-person employee training
 * Reviewed in online employee training

Examples:

Posted on facility intranet site:

 * Jackson Health System gives an example of its Visitation policy posted on its
   intranet.

Posted in employee work area(s):

 * Steps to Recovery uses a display case in an employee area to showcase its
   Patient Non-Discrimination and Equal Visitation policies to employees.

In materials routinely given to employees at orientation:

 * Many facilities indicated that they give new employees copies of the actual
   visitation policy at orientation.

Reviewed in in-person employee training:

 * Steps to Recovery reviews their facility’s equal visitation policy in a
   PowerPoint slide during employee trainings.

Reviewed in online employee training:

 * F.F. Thompson Hospital requires employees to review their key
   non-discrimination policies using this online training module.
 * A Southern California hospital uses this online training module to review
   patient’s rights policies with employees.




APPROACHES

The HEI requires inpatient healthcare organizations to implement and document a
visitation policy that explicitly guarantees equal visitation to LGBTQ patients
and their visitors. The following are three different approaches that a
healthcare facility can take to ensuring equal visitation.

 * Prohibiting discrimination in visitation based on sexual orientation or
   gender identity
 * Including (or make direct reference to) an explicitly LGBTQ-inclusive
   definition of “family”
 * Making an explicit reference to equal visitation for same-sex couples and
   same-sex parents


PROHIBITING DISCRIMINATION IN VISITATION BASED ON SEXUAL ORIENTATION OR GENDER
IDENTITY

Within Policy Statement

 * All hospitalized patients have the right to have visitors of their choice
   during their stay, unless visitation interferes with the wellbeing, rights or
   safety of others, or is not medically indicated in the patient’s care.
 * HOSPITAL will not deny visitation privileges based on race, religion,
   ethnicity, language, culture, size, gender, sexual orientation, gender
   identity or expression, socioeconomic status, physical or mental ability or
   disability. Patients will be informed of these rights upon admission to the
   hospital.
 * HOSPITAL has established the following guidelines for visiting, recognizing
   the role of family members and visitors in supporting and promoting the
   wellbeing of patients, and to assist staff in their efforts to provide care
   in an environment of dignity compassion and respect.
 * HOSPITAL does not restrict, limit, or otherwise deny visitation privileges on
   the basis of race, color, national origin, religion, sex, gender identity or
   expression, sexual orientation, or disability.
 * HOSPITAL promotes and supports a patient and family centered approach to care
   delivered in a context sensitive to the importance of relationships. The
   purpose of this policy is to define and set expectations regarding persons
   visiting hospitalized patients and to recognize our commitment to provide
   visitation in accordance with our non-discrimination policy, which provides
   access without regard to race, color, sex, national origin, disability, age,
   religion, marital status, citizenship, gender identity, gender expression,
   sexual orientation, and/or other legally protected classification. It also
   provides a mechanism to issue identification to authorized individuals
   visiting a patient.

WITHIN POLICY GUIDANCE

Patients may receive visits from visitors of their choice. Patients also have
the right to withdraw or deny consent to visitation at any time. Patients who
lack capacity may receive visits from family, friends and other individuals,
consistent with the non-discrimination provisions of this paragraph.

 * HOSPITAL is committed to ensuring that all visitors enjoy full and equal
   visitation privileges consistent with patient preferences.
 * HOSPITAL does not restrict, limit, or otherwise deny visitation privileges on
   the basis of race, color, national origin, religion, sex, gender identity,
   sexual orientation, or disability.



INCLUDING (OR MAKE DIRECT REFERENCE TO) AN EXPLICITLY LGBT-INCLUSIVE DEFINITION
OF “FAMILY”

Healthcare organizations can ensure equal treatment of LGBTQ patients and their
families by adopting an explicitly inclusive definition of “family.” The
following definition of “family,” which is being used by healthcare
organizations nationwide, incorporates expert advice from hospital
administrators, legal counsel, and health professionals:

 * [HOSPITAL] adopts the following definition of “family” for purposes of
   hospital-wide visitation policy: “Family” means any person(s) who plays a
   significant role in an individual’s life. This may include a person(s) not
   legally related to the individual. Members of “family” include spouses,
   domestic partners, and both different-sex and same-sex significant others.
   “Family” includes a minor patient’s parents, regardless of the gender of
   either parent. Solely for purposes of visitation policy, the concept of
   parenthood is to be liberally construed without limitation as encompassing
   legal parents, foster parents, same-sex parent, step-parents, those serving
   in loco parentis, and other persons operating in caretaker roles.

This definition of "family" establishes a usefully broad concept of family. The
specific enumeration of family members provides guidance to staff and prevents
biased interpretations of “family.” It should also be noted that the term
“domestic partners” in this definition encompasses not only domestic
partnerships but also all legally recognized same-sex relationships, including
civil unions and reciprocal beneficiary arrangements.

The definition of “family” focuses on a functional definition of parenthood,
established by an individual’s role as caretaker of a minor child. This is
designed to ensure visitor access for the individuals most responsible for the
care of a minor patient, even if this caretaker relationship lacks formal
recognition under state law.

This definition of “family” informs hospital personnel about the unique nature
of parenthood in the visitation context. While the definition requires that
caretaker individuals be granted visitation for minor patients, this caretaker
status does not necessarily confer the rights that accompany legal parental
status. For instance, applicable state law may dictate that only a biological or
custodial parent may determine the course of medical care for a minor child.



MAKING AN EXPLICIT REFERENCE TO EQUAL VISITATION FOR SAME-SEX COUPLES AND
SAME-SEX PARENTS

WITHIN POLICY GUIDANCE – REFERENCE TO PATIENTS’ RIGHTS STATEMENT

As stated in the patient rights and responsibilities, hospitalized patients have
the right to:

 * A support person of their choice to remain with them during their hospital
   stay.
 * Receive or deny visitors as designated by the patient or their
   representative, including, but not limited to a spouse/civil union partner,
   domestic partner, family member, friend or legal representative.
 * Withdraw or deny consent to all or specific visitors at any time during their
   stay.

WITHIN POLICY GUIDANCE – WHO MAY BE DESIGNATED AS VISITOR OR FAMILY/SUPPORT
PERSON

Visitors may include, but are not limited to, spouses, domestic partners, both
different-sex and same-sex significant others, both different-sex and same-sex
parents, other family members, friends, and persons from a patient’s community.

A designated family/support person may be present to support the patient during
their hospital stay. A support person may include but not be limited to a
spouse, adult child, parent, close relative, friend, domestic partner, and both
different and same sex significant others. A support person is welcome to stay
at any time depending on patient’s need for medical care/treatments, rest,
privacy, safety and patient preference.

This definition may include a person (s) not legally related to the patient.
This person(s) is often referred to as a surrogate decision maker or health care
proxy if authorized to make healthcare decisions for the patient should he or
she lose decision making capacity. More specifically, family means any person(s)
who plays a significant role in an individual’s life. This may include a person
(s) not legally related to the individual. Members of “family” includes spouses,
domestic partners, and both different sex and same sex significant others.
“Family” includes a minor patient’s parents, regardless of the gender of either
parent. Solely for the purposes of visitation policy, the concept of parenthood
is to be liberally constructed without limitation as encompassing legal parents,
foster parents, same sex parent, step parent, those serving in loco parentis and
other persons operating in caretaker roles. ed to make healthcare decisions for
the patient should he or she lose decision making capacity.

WITHIN POLICY GUIDANCE – DEFINITIONS

 * Support Person: Any person who is present to support the patient during their
   hospital stay, including but not limited to a spouse, adult child, parent,
   close relative, friend, domestic partner, and both different sex and same sex
   significant others. Does not require that the person be legally related to
   the patient.
 * Parent: May include person with legal custody, foster parent, same sex parent
   or step-parent, regardless of gender. May also include persons in a primary
   caretaker role.

WITHIN POLICY GUIDANCE – VISITING HOURS

 * Pediatrics: Parents can visit 24 hours a day. Solely for purposes of this
   visitation policy, the concept of “parent” is to be liberally construed as
   encompassing legal parents, foster parents, same-sex parents, step-parents,
   those serving in loco parentis, and other persons operating in caretaker
   roles.

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