A week after the Centers for Medicare and Medicaid Services issued new rules for nursing home visitations, state health officials are preparing to loosen restrictions that have kept family members out of those facilities – in most cases – since the start of the pandemic.
Under the new CMS regulations, indoor visits are permitted so long as community spread is limited and the proper precautions are taken. The agency defines “low” to “medium” community spread as a COVID-19 positivity rate of 10% or lower, and it has laid out a series of recommendations for curbing transmission that include face coverings, social distancing and aggressive cleaning of designated visitation areas.
State officials did not say when they would relax the more stringent protocols now in place, but they have reached out to the nursing home leaders and others to begin discussions.
“Our team has reviewed the guidance, and is assessing what actions need to be taken to align the existing guidance that CT has in place with what CMS issued,” Deidre Gifford, Connecticut’s public health commissioner, said in a statement to The Mirror. “We have also been in touch with the ombudsman’s office and with the industry on how to implement this in a way that minimizes confusion and maximizes safety in the facilities while complying with CMS’ guidance.”
“We understand and appreciate the importance of visitation and will move swiftly to work with the industry to put this guidance into place,” she said.
Gov. Ned Lamont banned nursing homes visits in March as the coronavirus started spreading through Connecticut. Only loved ones of dying residents were able to enter.
In late August, the administration changed the policy to allow indoor visitations for residents whose condition had deteriorated due to social isolation. A doctor’s note was required for the visits to occur. Outdoor gatherings were also permitted over the summer.
The new federal mandate eliminates the need for a doctor’s note. Nursing homes must identify a space – a cluster of rooms, or a dedicated common area – for the visitations. Family members and friends must wear face coverings and practice hand hygiene. Social distancing of six feet is required, along with instructional signage and cleaning of the designated areas after each visit.
Connecticut nursing home officials said the visitations must be scheduled in advance. They are weighing other challenges: the prospect of separate bathrooms for guests, new entry and exit points, purchasing more protective gear and cleaning products, and reconfiguring spaces.
Industry leaders said they are supportive of the change but are awaiting guidance from the state.
“We had concerns, moving into the colder weather, about the ability to continue the outdoor visitations,” said Mag Morelli, president of LeadingAge Connecticut, one of two Connecticut nursing home associations . “We are looking forward to opening up more indoor visitation.”
Family members with loved ones in nursing homes have pressed the health department and elected officials to ease restrictions and allow more gatherings. Some residents have gone six months or more without seeing their relatives and friends. Cases of depression and anxiety have been reported.
Lawmakers recently pondered legislation to improve access for family members.
Advocates praised the federal decision to loosen restrictions.
“With the [low] infection rates that we’re seeing in nursing homes right now, we think we’re in a spot where visitation needs to be a priority,” said Anna Doroghazi, associate director of advocacy and outreach for the AARP in Connecticut. “Loneliness is the next crisis that we have to address.”
Doroghazi said she heard from a woman who recently met her mother – a nursing home resident – for a medical appointment. It was the first time she had seen her mother in six months.
“I’m hearing from family members and others that because they aren’t doing group dining, the social connections people had in the nursing homes are not there anymore,” she said. “I’m hearing that family members are noticing a cognitive and physical decline in their loved ones. People are so disconnected. They are lonely.”
Testing for visitors?
The federal rules require visitors to be screened before entering a nursing home.
Temperature checks, a questionnaire about signs and symptoms, and discussions about recent travel or exposure are among the recommendations by CMS.
The agency said testing visitors for COVID-19 is encouraged, but not required. That has left nursing home leaders in a quandary. Testing is costly and can take time. But by not testing visitors, asymptomatic virus carriers could enter the facility and trigger an outbreak.
The state already is paying for the regular testing of nursing home workers (it spent an estimated $30 million between May and August), and has signaled that it won’t pick up the tab for visitor testing.
“The state has indicated to us that they would not pay for visitor testing,” said Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities. “So it seems to fall on the nursing homes to make those determinations.”
Barrett said the facilities probably will have to do their own risk assessment and determine whether they want to pay for visitor testing. If community spread is low, he said, they may opt against it.
“The CMS rules almost guarantee uneven implementation,” he said. “Some nursing homes will exercise an abundance of caution and want to do the testing. They may be in a position to absorb the cost of doing that, but that can’t be guaranteed across the board.”
Many nursing homes have run into financial hardship. Already operating on narrow margins, occupancy at the facilities has plunged during the pandemic as fewer short-term patients seek care and more than 2,800 residents have died of coronavirus. In February, just before COVID-19 reached Connecticut, the average occupancy in the homes was 87%. By August, the average occupancy had dropped to 72%.
It was unclear if the state planned to issue a mandate for testing visitors. Gifford could not be reached for further comment.
The visitations are subject to other circumstances. To allow family members inside, a home must be COVID-19 free for 14 days, staff must monitor guests who may have difficulty complying with the rules, such as children, and facilities should limit the number of visitors per resident based on the size of the meeting space. Homes are also required to limit the movement of visitors, so they’re not wandering the halls.
If the positivity rate in a community exceeds 10%, visitations should only occur in compassionate care situations, such as an end-of-life scenario, the CMS regulations say.
“Today we think we can reasonably take this next step for visits,” Barrett said. “But whether this can be sustained, we’ll have to see.”