For nearly 20 months, the 1.3 million Americans living in nursing homes and their families had to contend with strict visitation policies that caused distress for separated loved ones and had serious health consequences for many suddenly isolated seniors.
Visitors were barred completely. Some facilities banned visitors from residents' rooms, others allowed only one visitor at a time, and others allowed only one visitor outdoors.
The Centers for Medicare and Medicaid Services closed facilities to visitors in March of 2020 due to rules known as "guidance." Since then, it has issued several revisions.
All that has changed. The federal agency advised the country's nursing homes to allow visitors for all residents at all times. The agency said that 86 percent of US nursing home residents and 74 percent of employees were fully vaccineed.
Limits on the number of visitors, time, location, and Frequency have been removed by the update. Unless a roommate is unvaccinated or immunocompromised, access to residents' rooms is allowed.
The federal policy still encouraged vaccinations and emphasized the importance of controlling infections.
The executive director of the National Consumer Voice for Quality Long-Term Care said that it made an important statement. She said that facilities were given a lot of discretion. It puts rights back in the hands of the residents.
Visitors can be asked about their vaccination status, but facilities can't require it. During a Covid outbreak, the nursing homes must allow visitors inside with masks. Visitors who don't reveal their vaccine status must wear masks.
The rules only apply to nursing homes that are federal regulated. Many states will apply this to assisted living settings. California loosened some assisted living rules.
David Grabowski, a health care researcher at Harvard Medical School, said that cutting off residents from their families was unethical and that it was bad care. These are not social outings.
Family visitors often helped feed, wash and dress their loved ones in nursing homes that were short-staffed before the Pandemic. They gave reassurance and stimulation, but also the ability to monitor the facility's safety and quality. A study that Dr. Grabowski was a co-author on showed that nursing home residents with dementia received better care at the end of life if a family member visited regularly.
When contact was cut off for a long time, families reported declines in health. A study of nursing home residents in Connecticut found that there was an increase in depression and weight loss during the lockdown.
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The Hebrew Home was where Gloria DeSoto met with her family.
After fighting for nearly a year with administrators at her mother's nursing home in Pinckney, Mich., she was allowed to make compassionate care visits. She said that the restrictions were ridiculous. The facility allowed her three one-hour visits a week in a public area only by appointment. She couldn't change her mind if she couldn't make one of the times.
When the facility loosened restrictions, Ms. Huckin was able to see her mother in her room. Her mother had developed a bedsore and early pneumonia, as well as losing weight and becoming depressed.
Since her visits were restricted to an hour or less outdoors, her sister grew depressed and lost weight. She said that she wouldn't have had this downward spiral if we'd been allowed inside. She wouldn't be on Hospice care.
Some doctors and families worry that the pendulum has swung too far and that reopening will leave an already vulnerable population vulnerable to another surge. There are rising covid infections in nursing homes.
A Connecticut nursing home reported the deaths of eight residents with serious underlying health issues after the new federal guidance was announced.
The president of the Society for Post-Acute and Long-Term Care Medicine said that it was not a good idea to have people in and out during an outbreak.
He was a medical director or attending physician at three nursing homes and saw the early toll of the Pandemic. He wished the guidance had given administrators more flexibility. He noted that Medicare might have waited until after the holidays to distribute booster shots.
Despite the removal of federal restrictions, some administrators think state and local health regulations may be better.
The Los Angeles Jewish Home's chief medical officer said that a facility has to follow the most restrictive rule. He is cautiously optimistic that the state and county will loosen their policies in a few weeks. For now, the facility requires advance scheduling, limit visit length, and permit each resident only one visitor at a time indoors.
The staff has been on the phone since the policy was announced. Family members who have heard about it are saying, 'Yippee!' We had to say, 'We are so sorry, but not so fast.'
A representative for the Centers for Medicare and Medicaid Services said that state or local health departments might need to re-examine their restrictions due to severe safety reasons. The representative said that local governments shouldn't try to add rules and regulations that limit a nursing home resident's right to receive visitors.
The new federal policy is likely to loosen more extreme local and state policies.
The managing attorney at the Michigan Elder Justice Initiative has been helping a woman with her relative who is in a nursing home because of a brain injury.
The advisee, who lives out of state, was very distressed. She had to drive seven hours for a visit and only had 15 minutes to visit.
Michigan issued new guidance after the federal policy was announced that allowed visits at all times with no limits on the length of the visit or the number of visitors. This is a complete game change.
