Virginia, Maryland, and DC Now Allow Visitors in Nursing Homes and Assisted Living Facilities

Q. Last month, we had a scare when the nursing home where my mother, Marcia (85), who has dementia, resides called and said that she stopped eating and seems depressed and withdrawn. Although she doesn’t quite know who we are, my mother used to light up when we visited and brought the grandchildren. The nurse tried Facetiming with us, but it didn’t have the same effect as an in-person visit would.

By some miracle, my mother seems to be in better health now. I know that it is risky to visit senior loved ones at this time, but we’d really like to see her and spend time with her. What is the status of being able to visit loved ones in nursing homes or assisted living facilities in the DC area?

A. As nursing homes in many states start to emerge from a four-month lockdown, residents and their loved ones are desperate for in-person visits.

Thirty states and the District of Columbia have given the go-ahead to nursing home visits, according to LeadingAge, an association of long-term care providers. Eighteen states and the District of Columbia similarly plann to allow visits at assisted living centers.

Last month, the Centers for Medicare & Medicaid Services (CMS) clarified federal guidance on reopening nursing homes to visitors. Please see my article, Should Nursing Homes Reopen to Visitors?” from mid-May for more details on this guidance and how decisions about this were made at a federal level.

The Risks of Opening Nursing Homes and Assisted Living Facilities

Unless you’ve been living under a rock for the past four months, you know that nursing homes have been hit very hard by coronavirus throughout the pandemic. In fact, more than 143,000 nursing home workers and residents in 11,600 facilities have been stricken by the virus, according to the latest New York Times analysis and data from the Kaiser Family Foundation, and 56,000 nursing home residents and staff have died from the illness. In fact, 2 in 5 U.S. deaths from COVID-19 have occurred in nursing homes and other long-term care facilities. The following conditions at nursing homes have (and may continue to) exacerbate the spread of the disease:

shortages of coronavirus tests;
shortages of or lack of access to personal protective equipment (PPE) such as masks and gowns;
frequent physical contact between residents and staff;
understaffing;
employees who work in multiple facilities, increasing chances for exposure;
residents sharing rooms;
transfers of residents from hospitals and other settings.

In about 20 states, long-term care facilities still remain in lockdown, with building entry restricted to essential staff, health care workers and vendors, and outside visitors allowed only in “compassionate care situations,” such as when a resident is near death. You can visit loved ones in person in Virginia, Maryland, and DC, however, but you should of course be extra careful! Also, keep in mind that even in states that have authorized visits, individual nursing homes may remain locked down due to local or facility-specific circumstances.

“Visitation Saves Lives” Group Wants Family Visitation to be Mandatory, Despite the Risks

Although federal guidance says visitors should be permitted inside long-term care facilities at the end of life, this is not happening as often as it should, said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group, and founder of California-based “Visitation Saves Lives.”

Smetanka wants family visitation policies to be mandatory, not optional. According to Smetanka, “(a)s it stands, facility administrators retain considerable discretion over when and whether to offer visits because states are issuing recommendations only. Protecting our loved ones from COVID has led to intense isolation and could kill them just as easily as the virus.”

According to the Visitation Saves Lives website, “(t)he ban (on nursing home visits) harms residents. It has not been successful in keeping COVID-19 out of facilities as more than half of nursing homes and a large number of assisted living facilities have experienced outbreaks. Meanwhile, residents are suffering and even dying from neglect, loneliness, and profound depression. Family member visitors provided vital direct care to many residents, making sure they were fed, hydrated, active, and engaged.  Visitors also supervised care, identified health problems, and reported problems. All of these services that keep residents safe and healthy were lost with the visitation ban.”

To ease the minds of loved ones, according to Smetanka,”(f)amilies (who wish to visit loved ones) need to have good communication with the facilities about what’s going on in that facility. Are they following proper protocols? What are the expectations of the family or the staff? There needs to be really good communication and the setting of expectations so that everyone’s on the same page.”

If You Do Decide to Visit, Follow Safety Protocols and Be Extra Cautious

The 30 states that have authorized nursing homes to allow visits have recommended outdoor visits, under strict rules for distancing, monitoring, and hygiene. A dozen of those states and the District of Columbia currently allow only outdoor visits. Here are some other ways nursing homes and assisted living facilities are taking safety precautions:

Where visits are allowed, they generally must be by appointment, during specified hours;
In some states, only one or two people are allowed to visit a particular resident at a time;
Even those states allowing indoor visits are encouraging people to meet loved ones outdoors. Research has shown that the virus spreads less readily in the open air;
Facilities are checking visitors’ temperatures, questioning them about symptoms and potential exposure, and observing them for any symptoms or signs of infection;
Federal guidelines say visitors should be required to “wear a cloth face covering or face mask for the duration of their visit,” and states that allow visitation are generally doing so;
The CMS guidelines call on nursing homes that allow visitors to ensure social distancing, but they do not specify what that should entail. States that have authorized visits are generally mandating that facilities enforce the 6-foot rule;
The CMS guidelines urge nursing homes to continue barring any visitation until they have gone at least 28 days without a new COVID-19 case originating on-site, and this is being followed by many facilities.

Don’t Go If You Feel Ill

AARP has voiced its opinion that the best way to “see” your loved ones during this period is to continue through video-chat and conferencing platforms like Zoom, FaceTime and Skype. AARP is supporting the federal ACCESS (Advancing Connectivity during the Coronavirus to Ensure Support for Seniors) Act, which would provide grants for nursing homes to buy tech tools and services to facilitate virtual visitation during the pandemic.

The CDC urges potential visitors not to go if they feel ill,” even if those symptoms are mild,” or if you’ve had close contact with someone with COVID-19 in the previous two weeks.

Jennifer Schrack, an associate professor at the Johns Hopkins Bloomberg School of Public Health who specializes in the epidemiology of aging, also emphasizes thinking about possible recent exposure: “Have you yourself been isolated? Have you minimized your risk? Or are you essential personnel who’s going into the office? Are you going into a hospital every day because you work there?” Schrack also suggests keeping visits on the short side. “The longer you’re in a small or enclosed space with somebody, the greater the risk of transmission,” she says.

Use Your Best Judgement

In a nutshell, if you do decide to visit a loved one in a nursing home, be extra careful and use your best judgement. If you do not feel comfortable, work with the nursing home or assisted living facility to connect you to your loved one using technology such as Facetime, Skype, or Zoom. This way your loved one won’t feel as lonely and isolated and will know you are there and that you care.

Plan for Loved Ones Who Need Nursing Home Care in the Near Future

If you have a loved one who needs nursing home care or even if your loved one is already in a nursing home, if you haven’t done so already, the time to plan is now! Please contact us as soon as possible to make an appointment for a no-cost initial consultation:

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

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