When COVID-19 cases shot up in New London this month, Bill White, whose family owns the Beechwood Post-Acute & Transitional Care Center there, began to worry about visitors bringing the disease into the facility.
Federal and state guidelines were changed recently to allow indoor visitations at nursing homes, but the rules don’t require guests to be tested for coronavirus. White worried that would leave his facility vulnerable to an outbreak.
“My radar was really starting to go off,” he said. “I am fearful every day, and fear is a great motivator.”
White’s nursing home adopted its own policy requiring family members and friends to show a negative coronavirus test result before visiting a loved one inside the building. The test must be done within 72 hours prior to the visit.
Beechwood has managed to make it through the pandemic with no deaths so far, but White knows how quickly good fortune can reverse.
“I wanted to make sure we’re doing everything we can,” he said. “We’re trying to show our community that we are really being cautious.”
As the weather cools and COVID-19 cases rise, state leaders have also become nervous about the indoor visits. Deidre Gifford, Connecticut’s acting public health commissioner, sent a memo earlier this month to nursing homes in New London County and other parts of eastern Connecticut – now considered hot spots due to an increase in cases – recommending they come up with their own mandates for visitor testing.
Such a policy could include either a community-based testing strategy, in which visitors get a test through their primary care provider or at a local clinic, or an on-site option, where facilities offer rapid tests to family members and friends at the door.
The state has issued no edict requiring visitor testing, saying the decisions will be left up to the nursing home operators.
Industry leaders support the testing and have also encouraged facilities to adopt their own policies.
Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, which represents 145 of the state’s 213 homes, said increased community spread in some areas and recent outbreaks in a handful of buildings have fueled concerns about indoor visitation.
The state Department of Public Health earlier this month issued alerts for New London, Norwich, Windham and Preston, all in eastern Connecticut, following an increase in cases in those communities. Between Sept. 20 and Oct. 3, New London recorded at least 115 new COVID-19 cases, raising the daily case rate to 30.5 per 100,000 population, according to DPH.
Long-term care facilities in those areas and elsewhere have reported recent outbreaks. The state ordered the removal of all residents from the Three Rivers nursing home in Norwich last month after 27 people became infected with coronavirus and at least four died. Other major outbreaks have been reported in Colchester and Avon.
“With community spread on the rise, there are increasingly inherent and elevated risks regarding indoor visitation,” Barrett said. “As much as we support it … with the recent outbreaks and the very clear evidence of increased community spread across Connecticut, we think a visitor testing policy is essential to prevent further spread.”
Paul Liistro, owner of the Manchester Manor and Vernon Manor nursing homes, said while his facilities are not currently in hot spots, he’s moving ahead with a visitor testing policy. Like Beechwood, visitors are required to get tested through their primary care doctor or local clinic and must produce a negative result. But Liistro’s timing is a little more relaxed; loved ones must be tested within a week prior to their visit, rather than 72 hours.
As of Oct. 13, the most recent data available, Manchester manor has logged 55 COVID-19 cases among residents since the pandemic began, and Vernon Manor has reported one.
“We think it’s the right idea,” Liistro said. “People are letting their guard down a bit. They may be mingling with others who appear to be normal, not wearing a mask, and they’re getting infected and bringing it into the buildings.
“We’re not going to allow anybody to come into the buildings without a negative certificate, no matter who they are.”
Concerns surface about access
The testing, while crucial to detecting carriers of the virus who don’t show symptoms, has raised concerns among proponents of the indoor visits.
Mairead Painter, Connecticut’s long-term care ombudswoman, said although she is in favor of the testing, it shouldn’t be a barrier to visitation.
“In one case, we had a family member reach out to their physician to get the testing done, and the doctor said it wasn’t necessary and wouldn’t order it,” she said. “So in that case, it shouldn’t be a barrier to that person having a visit.”
The timing of the tests and how quickly results are returned can also pose problems, Painter said.
“Some of the plans we saw said people had to be tested within 72 hours of a visit. But if you have a visit scheduled and it’s canceled due to the weather or maybe there was a false positive result – there are lots of reasons why a visit could be rescheduled – then your test is outdated,” she said. “Until testing is very accessible, where someone could get it and then have a visit within a few minutes, it makes it very challenging.”
Painter is encouraging nursing homes to use rapid tests at the door rather than requiring guests to go to a physician’s office or a clinic. She also urged anyone who is having trouble with the visits to contact her office.
“We know that residents need social and emotional support at this time,” she said. “They’ve gone seven months now without regular interaction with family and friends, and it’s having unintended consequences.”
Officials with the AARP in Connecticut echoed Painter’s concerns.
“We hear regularly from family members who want to visit their loved ones in nursing homes, but the visits are cancelled at the last minute without explanation, or the technology being used to facilitate the visit doesn’t work,” said Anna Doroghazi, associate director of advocacy and outreach for the organization. “Visitor testing in medium or high-positivity areas seems reasonable, but it cannot become another insurmountable obstacle to human connection.”
Operators of nursing homes that require testing say they’re trying to be as accommodating as possible. On warm days, they arrange outdoor visits, since testing is not mandated for those gatherings. If a visit has to be postponed, they try to put loved ones on the schedule again quickly.
But they’re seeking buy-in from the community to continue the visitor testing.
“There’s no downside to implementing something like this,” said White, the owner of Beechwood in New London. “Worst case, maybe I make somebody upset. But if people get sick, I can say that I did everything I could.”