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

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.

Sample Policies

The following excerpts from healthcare organizations' visitation policies meet the HEI Equal Visitation criterion. 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.

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.