As nursing home resident advocates continue calling attention to the negative mental, emotional and physical impacts of social isolation, the state is working to update its guidance to comply with a new federal directive on nursing home visitation.
On Sept. 17, the Centers for Medicare & Medicaid Services issued guidance providing “reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.”
The guidance states that nursing homes should “accommodate and support” indoor visitation, beyond just for compassionate care situations, if the facility has not seen an onset of new COVID-19 cases in the last 14 days, and if the positivity rate for the county is under 10%.
The county positivity rate doesn’t need to be considered for outdoor visitation. If the positivity rate is above 10%, indoor visitation should only occur for compassionate care situations.
In an FAQ on nursing home visitation, CMS says it can’t define each instance that may be a compassionate care situation, but it might include end-of-life situations or a resident losing a loved one.
The guidance currently in place in Connecticut is an Aug. 27 executive order from Gov. Ned Lamont, which only requires access to indoor visits when a resident’s death is “imminent” or the resident has undergone “a significant change of condition in his or her physical, mental or psychosocial status,” as determined in consultation with a physician or nurse.
In Lamont’s coronavirus briefing Thursday, Chief Operating Officer Josh Geballe said the Connecticut Department of Public Health is working to update its guidance to comply with the CMS directive.
Asked about the timeline, Geballe said the updated guidance could come out as soon as the next day, but as of Sunday, neither Lamont’s office nor DPH had announced anything.
Mairead Painter, the state’s long-term care ombudsman, said in a video update Wednesday she expects nursing homes to have visitation starting by Friday. She said if that’s not happening and people are running into challenges, she wants to know about it.
Anna Doroghazi of AARP Connecticut said she hopes the state will be clear on what will happen if facilities don’t meet CMS standards and what recourse families have.
Doroghazi said AARP’s first focus has been on safety, “but now what we’re hearing from the family members of nursing home residents is that the ongoing social isolation and loneliness that their loved one is experiencing is now its own crisis.”
She said in window visits and virtual visits, some family members have seen significant declines in their loved ones. And for those with dementia or other cognitive decline, perhaps it “hasn’t computed that there’s a global pandemic,” and they don’t understand why their loved ones aren’t there.
In addition, family members have played important care functions, such as bringing food, doing laundry, and cutting hair or nails, making their absence harder on the hard-working staff.
AARP would like to see increased staffing, an end to civil immunity for nursing homes, and for residents to be allowed to have cameras in their rooms — and Doroghazi wants the legislature, not the governor through executive order, to make this happen.
“It’s shocking to me that nursing home residents being separated from their loved ones, and nursing home residents dying at rates that far exceed national averages, is not a priority issue for the legislature,” said Doroghazi, who had noted that about 70% of COVID-19 deaths in Connecticut were in long-term facilities, compared to about 40% nationwide. “We want them to weigh in.”
Lamont issued a call Friday for the legislature to return starting Tuesday for a limited special session, but nursing homes or visitation were not mentioned among the 10 items in the governor’s call.
Months of advocacy for expanded visitation
Ledyard resident Carol Nelson has had her 82-year-old husband in a local nursing home for four years, following a stroke nine years ago that left him paralyzed on his left side and made it too difficult for him to be at home.
Nelson said he started to have hallucinations before COVID-19, but that his hallucinations and confusion have gotten worse since March.
She remembers her husband coughing last month, and on Aug. 21, he was admitted to Lawrence + Memorial Hospital for pneumonia and sepsis. The couple has been married for 60 years this month, and Nelson wonders if she would’ve picked up on the coughing sooner had she been able to visit more and for longer periods.
In the hospital, she was allowed to visit him every day, while she wore a mask but he didn’t. They could hold hands. She helped feed him.
Nelson said her husband was dismissed from the hospital on Aug. 28 and was to spend 14 days on the nursing home’s isolation floor. She was granted a 30-minute visit there five days later and was informed ahead of time this would extend her husband’s time on the isolation floor by five days.
Nelson said when she visited the nursing home, which hasn’t had a single COVID-19 case, she and her husband each had to wear a mask, face shield and paper gown.
She understands the restrictions and is upset not at the nursing home but at the overall COVID-19 situation, and at Lamont for his restrictive executive orders.
Similar to Doroghazi from AARP, Stonington resident Liz Stern spoke of “augmented care” from families, the lack of which during the pandemic is impacting not only residents but also staff. Her mother is in a local nursing home.
“She’s had significant cognitive decline, and I can tell you that the nursing home that she’s in has responded positively, they’ve augmented her support, and they’ve augmented her communication with me,” Stern said.
But she’s concerned the CMS guidance is not specific enough about the regularity and length of visits, and said we “leave so much up to facilities for individual interpretation.” In conversations with women throughout Connecticut, Stern has heard significant variety in how much facilities communicate with families.
She is involved with the family council of her mother’s nursing home, and she has spent months raising awareness of the negative impacts of social isolation among nursing home residents.
She was one of multiple family members and representatives of advocacy organizations to sign a letter to Acting DPH Commissioner Deidre Gifford on Aug. 11, asking that indoor visits be allowed for support persons as long as the facility hasn’t had any new cases in the past 14 days.
The Connecticut Senate Republican Caucus has also been advocating for expanded nursing home visitation. The day after Lamont’s executive order in August, all 14 members wrote to the governor asking him to allow safe indoor visits for all residents, not just those who have recently declined or are near death.
They pointed out that family visits could help prevent deterioration in the first place and noted that many nursing home residents feel like prisoners.
“The elderly in our nursing homes do not have time on their side, and they deserve to be able to see their loved ones,” the senators wrote. “The negative impact of isolation on mental and physical health can be just as dangerous as the pandemic itself and must not be overlooked.”