En español | Nursing homes in most states are starting to emerge from the lockdowns imposed at the beginning of the coronavirus pandemic in March. As of mid-October, all but three states were allowing some form of general visitation, and the federal government has issued guidelines for long-term care homes to "safely facilitate in-person visitation."
Where visits have resumed, they are very different from those before the pandemic. Nursing homes need to take many steps to minimize the chance of further transmission of COVID-19, which as of late October had appeared in about 20,700 long-term care facilities, causing more than 84,000 deaths, according to data from the Kaiser Family Foundation.
The federal Centers for Medicare and Medicaid Services (CMS) has laid out guidelines for state and local officials to use in determining when and how visitors can return, but there will be differences, from state to state and nursing home to nursing home, in when visits resume and on what terms.
"Families need to have good communication with the facilities about what's going on in that facility,” says Lori Smetanka, executive director of the Consumer Voice, a nonprofit that advocates for the public on long-term care issues. “Are they following proper protocols? What are the expectations of the family or the staff? There needs to be really good communication and the setting of expectations so that everyone's on the same page."
Here are some details about the next steps toward reuniting with loved ones in long-term care.
Can I resume visiting my loved one?
To date, 47 states and the District of Columbia have authorized nursing homes to allow visits, generally with time limits and strict rules for distancing, monitoring and hygiene. Some require that visits take place outdoors where the risk of coronavirus transmission is lower. (Check the status of nursing home visits in your state.)
Florida, Indiana, Minnesota, New Jersey and South Dakota have adopted "essential caregiver" policies. In those states, long-term care facilities may allow greater access (for example, longer and more frequent visits) to a designated family member or other person who provides essential support to a resident, such as help with daily living activities like eating, bathing and grooming.
The latest CMS guidelines urge nursing homes to acccommodate indoor visitation if they have gone at least 14 days with a new COVID-19 case. Among other measures to help prevent new outbreaks, the agency says facilities must:
- screen visitors for COVID-19 symptoms;
- require face-covering and physical distancing;
- provide adequate personal protective equipment (PPE) for staff;
- and routinely test staff for COVID-19.
AARP has advocated for increased funding to nursing homes to address staff and PPE shortages and to ramp up testing.
Where visits are allowed, they generally must be by appointment, during specified hours. In some states, only one or two people are allowed to visit a particular resident at a time. Even those states allowing indoor visits are encouraging people to meet loved ones outdoors.
What kinds of health checks will nursing homes run on visitors?
The federal guidelines call for everyone entering a facility to undergo “100 percent screening,” including:
- checking visitors’ temperatures,
- questioning them about symptoms and potential exposure, and
- observing them for any symptoms or signs of infection.
The current CMS guidelines do not require nursing homes to test visitors for COVID-19 but encourages them to do so if they are located in counties with medium or high rates of coronavirus spread.
Long-term care facilities “will need to continue to evaluate ways to make it safe for visitors to enter our buildings without posing a risk to residents, whether that is through testing with rapid results, wearing personal protective equipment, limiting who visitors can interact with when they come in or other ways to keep residents safe,” the American Health Care Association and National Center for Assisted Living, an industry group, said in a statement to AARP.
Will I have to wear a mask?
Almost certainly. Face-covering is one of the "core principles" for preventing new nursing home outbreaks listed in the federal guidelines and is a staple of state-level rules for resuming visitation.
The guidelines also call on nursing homes to ensure that visitors practice hand hygiene, but they do not address whether facilities should provide masks or sanitizer. LeadingAge, an organization that represents nonprofit providers of elder care, notes that many nursing homes are “desperately in need” of PPE to cover their own needs.
"If it were me, I would assume that I would have to bring a mask or hand sanitizer with me,” Smetanka says. “I think that's something that facilities are going to want to control themselves, to make sure the masks and the sanitizers are appropriate for use,” she adds, but “people should be prepared to bring their own."
Will I have to stay 6 feet from my loved one?
The CMS guidelines call on nursing homes that allow visitors to ensure social distancing, and states that have authorized visits are generally mandating that facilities enforce the 6-foot rule.
To maintain distancing, and in accordance with federal and state guidance, nursing homes are generally:
- limiting visitors' movements within a facility, requiring them to go directly to their loved one’s room or a designated visiting area;
- requiring visits to be scheduled in advance;
- permitting visits only during select hours; and
- regulating the number of people who can visit a resident, and the overall number of visitors on-site, at any given time.
What else can I do to minimize risks to residents?
Don't go if you feel ill, “even if those symptoms are mild,” or if you've had close contact with someone with COVID-19 in the previous two weeks, advises Kara Jacobs Slifka, a medical officer in the CDC's Division of Healthcare Quality Promotion.
Jennifer Schrack, an associate professor at the Johns Hopkins Bloomberg School of Public Health who specializes in the epidemiology of aging, also emphasizes thinking about possible recent exposure: “Have you yourself been isolated? Have you minimized your risk? Or are you essential personnel who's going into the office, who's going into a grocery store because you work there? Are you going into a hospital every day because you work there?"
Schrack also suggests keeping visits on the short side. “The longer you're in a small or enclosed space with somebody, the greater the risk of transmission,” she says.
Another option is to make some visits virtual. Videoconferencing and chat platforms like Zoom, Skype and FaceTime have become lifelines for residents and families during the pandemic, and continuing to use them at times even after lockdowns lift can minimize opportunities for illness to spread.
AARP is advocating for a federal requirement that nursing homes support virtual visits between residents and families.
"With families today spread out all over the country, virtual visitation can be an important long-term way for family members to stay in touch with their loved ones,” says Bill Sweeney, AARP's senior vice president for government affairs. “Everyone should have the ability to do that."
Editor’s Note: This story has been updated to reflect new information.