SONIA Y. ANGELL, MD, MPH
State Public Health Officer & Director
State of California—Health and Human Services Agency
California Department of Public Health
AFL 20-38.1, May 2, 2020
TO: All Facilities
Visitor Limitations Guidance (This AFL supersedes AFL 20-38)
All Facilities Letter (AFL) Summary
This AFL notifies all facilities of new visitor limitation guidelines for pediatric patients, patients in labor and delivery, and patients at end-of-life.
This AFL clarifies that health facilities may permit a support person to accompany a patient for whom a support person has been determined to be essential to the care of the patient (medically necessary), including patients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairments.
Due to the community spread of Coronavirus Disease 2019 (COVID-19), considerations must be made for the safety of health facility staff and patients, resulting in many health care facilities suspending visitation, except when medically necessary or essential to the care of the patient. The California Department of Public Health (CDPH) recognizes the importance that visitors play in the mental well-being of patients, including pediatric patients, patients in labor and delivery, and patients at end-of-life. CDPH also recognizes the importance of ensuring people with disabilities receive the support they need while hospitalized. CDPH considers visitors an essential part of patient care and recovery.
CDPH has developed recommended visitor guidelines for certain patients to ensure support for their mental health and well-being, while striving to limit the spread of the virus.
Visitors are essential for the mental health of pediatric patients. CDPH recommends that pediatric patients be allowed one support person.
In the case of prolonged hospitalization, CDPH recommends two designated support persons for pediatric patients, provided that only one visitor is present at a time.
Labor and Delivery Patients
The presence of a partner or support person is essential to the mental health of patients who are in labor and delivery. CDPH recommends that one support person be allowed to be present with the patient.
Patients at End-of-Life
Visitors are essential to the mental health of patients who are at end-of-life. For their continued mental health, and well-being, the department recommends that one visitor be allowed to be present with the patient.
Patients with Physical, Intellectual, and/or Developmental Disabilities and Patients Cognitive Impairments
The presence of a support person is essential to patients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairments. CDPH recommends that one support person be allowed to be present with the patient when medically necessary.
For hospitalized patients, especially with prolonged hospitalization, the patient or family/patient representative may designate two support people, but only one support person may be present at a time.
All support persons must stay in the room and be asymptomatic for COVID-19 and not be a suspected or recently confirmed case. Support persons may be screened prior to entering the clinical areas. Support persons must comply with any health facility instructions on personal protective equipment.
Additionally, CDPH strongly encourages facilities, including but not limited to skilled nursing facilities, to create ways for residents and patients to have frequent video and phone call visits. If shared devices are used for video calls facilities should ensure appropriate infection control measures are in place.
Original signed by Heidi W.Steinecker
Heidi W. Steinecker
Center for Health Care Quality, MS 0512 . P.O. Box 997377 . Sacramento, CA 95899-7377, (916) 324-6630 . (916) 324-4820 FAX
Department Website (cdph.ca.gov)
Page Last Updated : May 2, 2020
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