Should Nursing Homes Reopen to Visitors?

Q. My mother, Betty, is in a nursing home in Richmond. Although she has advanced dementia, I could tell that she always enjoyed our family’s visits. Her face always brightened when she saw me, my wife, and her grandchildren. She would smile when we looked through old photo albums, listened to her favorite songs, or brought her favorite chocolates. Due to the coronavirus pandemic, we haven’t seen her in two months (except for a few times on FaceTime with the help of a kind nurse). We understand why nursing homes are still closed to visitors, with seniors being the most vulnerable population and some nursing homes being hit hard. However, I heard a guidance was released about nursing homes possibly reopening in stages. Do you know the latest on this in our area? Thanks for your help!

A. Since March 13, the Centers for Medicare and Medicaid Services (CMS) has restricted visitors and non-essential healthcare personnel from visiting nursing homes and assisted living facilities, with the only exceptions being for compassionate care situations, such as end-of-life. These measures blocked nearly all visitors in an effort to protect residents from coronavirus.

Nursing homes and assisted living facilities made the adjustments needed to protect the needs of seniors in long-term care facilities and the staff who care for them. Their goal was to limit the damage and to reduce the spread of the virus to the most vulnerable population — seniors. Even with all of the protections in place, nursing homes and other long-term-care facilities have been among the hardest-hit by the virus, with more than 140,000 cases and 27,000 deaths in the United States linked to COVID-19, according to the Wall Street Journal.

New Rules Would Reverse Previous Guidance

New rules, which are still under consideration, would reverse the previous CMS guidance that barred non-medical visits, recommending a three-phase opening for long-term care. Under the draft guidelines:

• Nursing homes would remain largely closed-down in the first phase.
• Facilities could enter the second phase and begin allowing limited visits once they report no cases for 14 days. Nursing homes with a quarter or more of residents who have been infected would face a higher bar before beginning to relax restrictions. They would need to go at least 28 days without new cases. If half or more of residents had been infected, the facility also would need to be examined by a state inspector before starting to ease restrictions.
• In the second phase, the nursing home would start by allowing limited access to visitors, likely only small numbers and restricted hours. The facility also could offer communal dining and group activities for residents, but with social-distancing restrictions.
• Nursing homes could enter the third phase of reopening under the guidelines if they meet requirements including going another two weeks without new infections. That phase allows for broader visitor access and a return to normal communal dining and group activities.

Precautions to Keep in Mind

What happens if a facility goes two weeks without any cases and then a visitor brings in COVID-19? This is one of the many issues representatives of the International Council on Active Aging’s COVID-19 Senior Living Task Force are considering. The task force, made up of more than 140 senior housing and care operators and members of four associations has been providing guidance to the government and to long-term care facilities about what needs to be done for safely reopening nursing homes and assisted living facilities, given COVID-19 considerations.

According to Colin Milner, chair of the task force, “(t)he tough discussions need to come up. For instance, staffing. How are you going to handle staffing? Part-time? Full time? How are you going to keep your staff safe? How are you going to ensure that they or anyone else coming into the community isn’t actually bringing in some form of disease with them, whether it is COVID-19 or something else in the future. What actions do you have to take?” Other things to consider include whether an ample supply of masks, gowns, and gloves are available for all residents, staff, and visitors. Also, nursing homes and assisted living facilities still don’t have enough coronavirus tests. Keeping all these things in mind, opening care facilities too soon will likely put staff and residents at risk from visitors, while at the same time placing visitors at risk.

“The task force’s charge is not to dictate,” Milner said, “but to create guidance that operators can use to make decisions based on the sector of the industry and country and state or province in which they operate.”

The task force formed at the same time as CMS released the draft three-phase opening. There is no time frame available for when the three-phase opening will become finalized and begin to take effect. The task force plans on releasing their own recommendations in June or July, which could coincide and possibly contribute to the government recommendations. Hopefully, all parties will be patient and work together to design a safe, careful, well-considered, and properly timed way for families to visit their loved ones.

Isolation is Hurting Seniors: What to Do

Residents who are isolated in long-term care facilities are likely suffering from loneliness and may feel depressed, some having not seen their loved ones for two months. These residents of long-term care facilities also don’t have family members who can advocate in person for them —an especially important role during the time of the coronavirus, when things can go wrong.

Isolation and loneliness are a real risk for seniors, as they are associated with significantly higher rates of heart disease and stroke and a 50% increased risk of dementia, according to the National Academies of Sciences, Engineering and Medicine. Isolated or lonely seniors also report a greater incidence of depression and anxiety.

Making sure that you stay in touch with senior loved ones can help to ease any feelings of loneliness they may experience while in isolation. Technology can’t replace the feeling of communicating in person, but it’s important to use the resources you have to stay connected while loved ones are in isolation including regular phone conversations, FaceTime or Zoom, or interactive games such as Words with Friends. Please see my recent article on this subject for more ideas. A recent article in the New York Times, “Just What Older People Didn’t Need: More Isolation,” also has some helpful tips.

Plan for Yourself and Your Loved Ones at this Time

As most of us realize, isolation measures are to protect as many people as possible from the worst effects of coronavirus and this will be temporary. If we make the effort to stay connected, we can make a big difference to people who are feeling alone at this time.

During this time, it is as important as ever to plan in advance. If you have not done Long-Term Care Planning, Estate Planning, or Incapacity Planning (or had your planning documents reviewed in the past several years), or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please call us to make an appointment for an initial consultation. For those who feel safer in their homes, we offer phone appointments or video conference appointments in lieu of in-person meetings (but we are still open for in-person meetings, of course using social distancing, safe sanitation, and face masks):

Elder Care Attorney Fairfax: 703-691-1888
Elder Care Attorney Fredericksburg: 540-479-1435
Elder Care Attorney Rockville: 301-519-8041
Elder Care Attorney DC: 202-587-2797