By Barbara Feder Ostrov, CALmatters, October 26 2020
Families desperate to visit loved ones in California nursing homes finally may see some relief after state health officials recently released updated guidelines allowing indoor visits in 46 counties, with some caveats.
The long-awaited guidance came after months of pressure from families who say their relatives have suffered without the companionship and, sometimes, the extra caregiving that their frequent visits provide. They have been making do with rare window and outdoor visits and have depended on the homes’ willingness to allow such arrangements.
“As much as you want safety from COVID, you don’t want deterioration and death from isolation,” said Melody Taylor Stark of Monrovia, whose 84-year-old husband Bill lives with post-polio syndrome and lung cancer in an Arcadia skilled nursing facility.
The guidelines released Friday apply to long-term care facilities, including nursing homes, but not necessarily assisted living or independent living homes. The California Department of Social Services, which regulates assisted and independent living facilities, generally has deferred to public health visiting guidelines during the pandemic, with some exceptions.
Indoor visits will now be allowed at nursing homes in the 46 counties currently in California’s red, orange and yellow tiers, which have lower levels of virus transmission than the remaining 12 “purple” counties. Visitors must be screened for fever and COVID-19 symptoms, wear masks and wash hands upon entering the facility. Among other requirements, homes must have had no COVID-19 cases in residents and staff for the past 14 days. But county health officers retain the power to ban indoor visits if they think local conditions are too dangerous.
The visitation changes were regarded with caution by some advocates.
“The new guidelines appear to reimpose very restrictive measures in counties with highest prevalence rates under the state’s ‘zone’ system,” said Mike Dark, attorney for California Advocates for Nursing Home Reform, a consumer advocacy group. “The problem is that we are likely looking at many more months of high transmission, and these restrictions themselves will likely result in much suffering and deaths.”
Dark said the state’s pubic health department “needs to find a better way to balance contagion mitigation and the needs of residents for life-saving visitation.”
It will be some time before Melody Taylor Stark will be able to see her husband again in person, as his home is Los Angeles County, which remains in the purple tier. But she said she is trying to remain optimistic. The new guidelines could help – if nursing homes actually abide by them, Stark said.
“The words are out there, but what do they mean and who’s enforcing it?” she asked. Stark praised her husband’s nursing home for protecting the residents’ health, but said they needed to do more for their mental health.
Before the pandemic, she said, she would see her husband twice a day most days, stopping in before her work with a mental health agency and then again for dinner. “You become part of the community there,” she said. “’Home’ is with my husband and ‘house’ is where I sleep and shower before I leave. I haven’t been ‘home’ for a long time.”
As the nursing home’s lockdown dragged on, Stark said she saw her husband’s “overall health and wellness” decline. His facility, Huntington Drive Health and Rehabilitation Center, only started allowing window visits in August, months after the home’s mid-March lockdown. In October, the facility began permitting outdoor patio visits – 15 minutes per visit, and only once a month per visitor. The home’s administrator, Tony Agoncillo, declined comment on Monday.
“My husband’s a very optimistic person,” said Stark, 65, of Monrovia, but “I’d hear him say, ‘this is no way to live.’ He would tell her that he makes himself go to sleep in the afternoons “since it passes the time”
The new guidelines come at a time when California has been holding the line on new COVID-19 infections compared with an alarming surge of cases across the country. Despite the many precautions skilled nursing homes have taken, residents are still being infected: 48 new infections were reported between Oct. 23 and 24, the last data available, and about 703 residents are currently infected, isolated in separate COVID units or hospitalized, according to the California Department of Public Health.
Since the start of the pandemic, more than 27,000 California nursing home residents and nearly 21,000 workers have been infected with COVID-19; 4,821 of them have died.
The California Association of Health Facilities welcomes the new guidance, said Deborah Pacyna, a spokeswoman for the nursing home industry group, in an email. “Family visits are incredibly important for the health and well-being of residents.”
But she added, “The push for indoor visits is a perfect example of why facilities need liability protection,” echoing national industry calls for legal immunity during the pandemic, something California lawmakers seem unlikely to grant.
Facilities will be dependent on strict visitor compliance with safety requirements and distancing or residents and staff will be at risk of infection.
Other states including New Jersey, Indiana and Florida also recently eased visiting restrictions for nursing homes. Federal health and Medicare officials in September offered guidance, which many California families praised for easing restrictions and presented to their local homes to demand change. That made for an awkward situation for California health officials, as the federal guidance is “not clear, not decisive and tends to leave a lot of wiggle room at a time when we need clarity,” said Dr. Mike Wasserman, immediate past president of the California Association of Long Term Care Medicine.
Wasserman described California’s new guidelines as “a really good step in the right direction.”
“We all wish the federal guidance would follow the science; that hasn’t necessarily been the case,” Wasserman said. “The state is really trying hard to integrate science into its guidance. Protecting residents at the expense of harming them through isolation is the balance we have to strike.”