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A GOOD AGE: Nursing home family visits to resume indoors

The Patriot Ledger - 9/21/2020

QUINCY -- It's the news many family members have been waiting for as the weather begins to turn colder: indoor nursing homes visits are beginning again.

The federal government has issued new guidelines taking a more compassionate approach to allowing family members, caregivers and clergy to resume indoor visits with residents of nursing homes. The visits depend on an absence of COVID-19 cases in the homes and low COVID-19 community rates.

AARP and other advocates have reported that some residents and their loved ones "are desperate for in-person visits" after the extended pandemic lock down. More than half of states, including Massachusetts have authorized limited indoor visitation and more liberal outdoor visits, but some families say they have watched their loved ones decline despite patio visits. The new federal guidelines came out on Thursday and Gov. Charlie Baker has said he expects to make an announcement this week.

The Centers for Medicare and Medicaid Services unveiled the new recommendations in a memo to directors of state agencies which perform routine nursing home inspections. In Massachusetts, area agencies on aging, which run the nursing home ombudsmen programs, have received new six-page guidelines from the state.

"They still have a lot of rules and require a lot of work," one local ombudsman said.

While the guidelines require many precautions, they allow family indoor visits for a much broader definition of compassionate care, not only when a resident is near the end-of-life.

The new guidelines allow for visits if:

• A resident who was living with their family before recently being admitted to a nursing home during the pandemic is struggling with the change in environment and the lack of physical family presence and support.

• A resident is grieving after a friend or family member recently passed away.

• A resident has had family members or caregivers who helped feed them until the lockdown. Some people with dementia need cues and encouragement with eating or drinking; they have lost weight or become dehydrated without that family presence.

• A resident who used to talk and interact with others is so isolated and upset that they seldom speak or cry more often.

Outdoor visits are still preferred but with winter coming, the changes address fears of some administrators that an end to visits would mean increased depression and even deaths among the residents.

The guidelines lay out a roadmap for resuming safe indoor visits and focus on the importance of meeting residents' psychosocial needs as long as there have been no new COVID-19 cases in the last 14 days. The rate of COVID-19 positive tests in the community is also a factor; below 10 percent is recommended. Visitors would be confined to a resident's room or special visiting area.

Nursing homes will face citations and enforcement actions for preventing visits without "a reasonable clinical or safety cause."

Staff, residents and visitors must wear a face mask throughout the visit. A visitor must remain at least 6 feet from the resident and attending staff members. Brief physical contact may be allowed. To reduce risk of transmission, individuals must use alcohol-based hand sanitizer with at least 60 percent alcohol before and after contact; hug with faces in opposite directions; only have short close physical contact and avoid close face-to-face contact even when face masks are used. Outdoor visits are encouraged when possible.

Families must be offered the opportunity to visit for at least 30 minutes.

AARP reports that Massachusetts in June became the first state to resume some nursing home visits.

The State House News Service reported on Friday that Gov. Baker said, "We've been talking to folks in the industry and folks in the public health world about how to create further opportunities for engagement, recognizing you can't stay outdoors given the changing nature of the weather."

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