As Nursing Homes Reopen to Visitors, Will They Stay Safe?

State Long-Term Care Ombudsman Patty Ducayet (Photo by Jana Birchum)

Residents of nursing homes have gained new pathways to reunite with family and friends after months of painful separation. The federal Center for Medicare & Medicaid Services (CMS), which regulates nursing homes, issued new guidance in September that loosened restrictions put in place this March in response to COVID-19. Residents may now have in-person visits with loved ones when certain conditions are met. Also in September, Texas Health and Human Services Commission established a process for designated "essential caregivers" to visit and provide hands-on care to loved ones, and set guidelines for other types of visits.

One newly designated caregiver is Cissy Sanders, who the Chronicle reported on in July and whose mother lives at Riverside Nursing and Rehabilitation Center in Austin. In October, Sanders was able to be with her mom for the first time in many months, which she called "wonderful." "It's just so much better than having to communicate through a window," she said.

The CMS banned in-person visits early in the pandemic because the coronavirus is so deadly to the elderly. People 70 years old or older have accounted for 60% of all COVID-19 deaths in Travis County to date, according to Austin Public Health. But in their isolation, residents have also suffered depression and cognitive decline. "We recognize that physical separation from family and other loved ones has taken a physical and emotional toll on residents," CMS said in a statement in Septem­ber when the agency issued its new guidance. Nationally, indoor visits are now allowed at facilities without recent COVID-19 cases and in counties where the spread of the virus is controlled (those with a positivity rate below 10%). Periodic testing of staff and visitors is one way CMS aims to prevent outbreaks in facilities as they open up.

Travis County's positivity rate had been below 5% since late September, a rate at which CMS requires monthly testing of staff. But the rate reached 5.2% in the past week, which will trigger weekly testing of staff going forward. CMS also requires facilities to have a testing strategy for essential caregivers that includes an initial negative test, but allows discretion for the frequency of follow-up testing.

Sanders is happy she can now see her mom but worries about the virus being reintroduced at Riverside, where 14 people died from COVID-19 earlier this year. "I don't feel like the nursing home's testing, in particular, keeps up with the pace of visitation," she said. Riverside follows CMS standards for testing of staff and essential caregivers, according to Brooke Ladner, spokesperson for Regency Integrated Health Services, which operates Riverside. But Sanders worries that may not be enough. "There's so much room for error and so much room for the virus to get back into the building," she said. Some nursing homes do go beyond CMS requirements; for instance, local provider Caraday Healthcare tests all staff and essential caregivers at least every two weeks, according to company spokesperson CC Andrews.

Local leaders have not focused on increased risks to nursing homes in their warnings that Austin is on the brink of a communitywide surge. On Tuesday, Interim Health Authority Dr. Mark Escott's message to the Commissioners Court was stark. While Travis County is doing far better than places like El Paso, which he called a "catastrophe," we could find ourselves in a similar "nightmare scenario" if we don't act now, he said. "We've got to work hard to avoid that," he said.

Dozens of new COVID-19 cases have occurred at nursing homes and other long-term care facilities in recent weeks, among both residents and staff. Encouragingly, however, Escott told Council at last week's work session that there were no known COVID-19 cases associated with new visitation policies at nursing homes. "There are strict protocols in place for those visitations, and we're pleased that we have not seen any cases associated with that," he said. APH Director Stephanie Hayden noted that the department is providing additional protective equipment to these facilities, including cloth masks staff can reuse at home.

But many do worry that visitation, especially over winter holidays, could spell greater risks to nursing home residents. State Long-Term Care Ombudsman Patty Ducayet discussed the topic recently in a Facebook Live event. State rules allow residents to leave facilities and visit loved ones over the holidays, but they must quarantine for 14 days upon returning if they are gone overnight or are exposed to someone who is suspected of having or has COVID-19, Ducayet said.

Importantly, facilities are obligated to explain all procedures to residents before they leave, so they can make informed choices. Generally, residents would be safer to avoid gatherings completely, but if they go, very small outdoor events are safer and all guests should wear masks. Gatherings should not include those who are ill or may be ill with COVID-19. "Nothing is more important than protecting the health of residents," Ducayet added.