COVID still isolates some in Michigan nursing homes. It may get worse.
The state lifted COVID-related visitation restrictions in nursing homes in March. The feds have allowed it, too.
But in some facilities around Michigan, families say they still struggle to see loved ones inside long-term care facilities. Even those who saw restrictions relax during the summer months when COVID case counts were low, say they’re seeing a return of limitations.
“I’m vaccinated. My husband is vaccinated,” said Joanne Hickman, 72, who said Tuesday she has been inside her husband’s nursing home room only once since the state ordered a ban on visitation more than 17 months ago — something it has since relaxed.
“So you tell me, who are they protecting?” she said.
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Nursing homes already have spent more than a year trying to balance the need for infection control against the grinding isolation of the pandemic felt by residents, and there is some evidence that the loneliness of an industry-wide quarantine last year contributed to COVID’s deadly toll in nursing homes.
The Health Care Association of Michigan, which represents the long-term care industry, has said its facilities must work within the safety guidelines of the Michigan Department of Health and Human Services and the U.S. Centers for Medicare and Medicaid Services.
“Visitation requirements for nursing facilities have not changed,” according to an email Bridge Michigan received from HCAM last week in response to questions about varying visitation policies.
Individual facilities, the email said, have no say in such decisions.
But some Michigan nursing homes have made visits next to impossible, limiting visitation to a few hours on weekdays, for example, said Salli Pung, who oversees the Michigan State Long-Term Care Ombudsman program.
She said her office gets “multiple calls a week from families.”
“We're also hearing things like that the staff have to supervise the visits,” Pung said. “We're hearing that when they do get a visit, you have to schedule it and it's anywhere from as little as 15 minutes or up to maybe a 30-minute visit. For a resident who hasn't seen their loved one, that's just not enough time.”
To use the government guidance as a reason to shut down visitation is disingenuous, said Alison Hirschel, managing attorney at the Michigan Elder Justice Initiative, part of the Michigan Poverty Law Program.
“The clear intent of the (federal) guidance is to promote visitation to the greatest extent possible,” she said.
The state’s most recent order largely refers to an 8-page CMS guidance document that was updated in April. That guidance gives discretion on visitation to nursing homes “based on a facility’s structure and residents’ needs,” while the state guidance offers recommendations.
The CMS document notes that facilities should follow core infection control practices — such as social-distancing, cleaning and masks. Still, it notes “the toll that separation and isolation has taken” and that “there is no substitute for physical contact, such as the warm embrace between a resident and their loved one.”
“Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor” within CDC guidelines, the guidance reads.
According to the CMS guidance, facilities “should allow indoor visitation at all times and for all residents (regardless of vaccination status).” The facility should impose limits in three instances:
- It can limit visitation for unvaccinated residents if the county’s positivity rate is more than 10 percent and fewer than 70 percent of residents are fully vaccinated. County rates are updated each day on the Michigan Mi Safe Start Map.)
- It can limit visitation for vaccinated or unvaccinated residents with COVID-19 infection, or
- It can limit visitation for vaccinated or unvaccinated residents who are in quarantine.
Facilities must also immediately suspend visitations if a COVID case is detected “until at least one round of facility-wide testing is completed.” After that, visitation can resume in areas that aren’t infected.
The Grand Traverse Pavilions, where Joanne Hickman’s husband, Bobby Jo, resides, is doing all it can to protect everyone, Deborah Allen, the Pavilions’ chief development and community engagement officer, told Bridge Michigan earlier this month. She said the facility is facilitating outdoor visits and, starting this month, allowing some indoor visits such as the visit Hickman had last week.
“Nothing in the last 18 months has been ideal, and we’re doing everything we can within the guidelines” to make visitation work, Allen said.
But Joanne Hickman said scheduled, short visits that are supervised aren’t enough to help her husband after 18 months of restrictions.
Without visits, she said, “he does nothing but sit there. What kind of life is that?”
The Martha T. Berry facility in Macomb County was one of the first nursing homes to reopen visitation early this year after the state relaxed restrictions, and it has continued to offer indoor visitation, working through complicated and ever-changing state and federal guidance, said executive director Kevin Evans.
It took nine pages of instruction just to set up a log-on to the system into which nursing homes must file weekly COVID data to CMS, he said.
Meanwhile, he said, nursing homes are criticized when they try to make visitation safe, while staff feel “vilified” for choosing not to be vaccinated even as they perform noble work. The isolation of the pandemic has undoubtedly contributed to immeasurable misery and even death inside nursing homes, he said. It has taken its toll on those who work in the nursing home industry, too.
“My heart is just broken for the people that are just saying, ‘Well, what else can we do? What else can we give?” he said.
As delta-fueled COVID cases climb, the squeeze is likely to get worse.
Linda York understands that facilities want to prioritize keeping loved ones safe.
The Macomb Township woman is a member of the Michigan Caregivers for Compromise Facebook page, which — similar to the group Save Our Seniors Michigan — has logged a string of comments from users who say they have been cut off from relatives in Michigan’s nursing homes.
York said she was thrilled in March when she appeared for a glass door visit with her husband, Garry, at East Village Harbor of Chesterfield, where he receives care for his multiple sclerosis.
There, a staff member opened the door, to York’s surprise.
You can kiss your husband, York remembers the worker saying.
York said she started shaking immediately. She was so startled that the moment remains a bit of a fog, she said Tuesday.
She stepped inside. She wrapped her arms around Garry.
That was March.
She and Garry grew used to in-person visits over the spring and summer. They met in the facility’s common area, but it felt private and intimate. She was more than happy to accommodate the facility’s rules for screening and to wear a mask while entering or exiting the building.
The couple hugged and held each other’s hands. They removed their masks with each other. Saw each other smile.
But last week? It was a different kind of surprise than in March.
No touching. Social distancing again. Masks at all times, the new rules demanded.
And after 25 minutes, a staff person alerted them that their time was nearly up.
She said she and her husband are both vaccinated. “It doesn’t matter,” she said. “I still can’t hold him. I can’t hug him. I can’t kiss him.”
Residents at other homes have told the state’s ombudsman program that visits have been canceled last minute — even as visitors arrive.
“You would not believe how often that happens — that a family member is on the way to a visitation, and the nursing home calls, a staff member is sick, or there’s another reason, and it gets canceled,” said Louise Verbeke, a local ombudsman in southeast Michigan.
But the vaccines?
The Biden administration last week announced that it may withhold crucial federal funding from nursing homes that don’t require vaccines of the workers.
The goal is to keep COVID out of nursing homes, but some worry that the new mandate will force some vaccine-hesitant workers out of the industry that already struggles to find enough staff.
That, in turn, may make visitation even more difficult.
For some time, Pung told Bridge last week, “residents even have a difficult time getting a phone call. There were times when we would call the facilities and the phones would just ring. No one answered because there weren't enough staff to answer the phones,” she said.
Before the pandemic, volunteers and family members were a constant fixture in many nursing homes, serving almost as an extension of the staff. They assisted with meals, tidied rooms, played games and kept residents engaged, and in some cases helped with personal care.
While they were there, they also provided extra eyes to make sure facilities were maintaining cleanliness and safety, Pung and others said.
That has changed dramatically since the pandemic. In one recent conversation, Pung said, an ombudsman from her program said the floor was so dirty her shoe stuck to it.
“She said she had to grab a chair to unstick herself,” Pung recalled. And “we've heard of families that have gone in and said that it looks like the tops of dressers have not been dusted in probably well over a year.”
The level of misery from the lack of oversight and engagement, Pung said, is immeasurable.
The pandemic and its rules, Pung said, have “trained” some residents to “stay in their rooms and not talk with people.”
When ombudsmen from her program visit now, she said, “we don't see residents sitting out and trying to engage with other people.” she said.
“Think of eating every meal in your room for a year and a half and not seeing other people, and most of the people that are coming in, they have a mask on at least some might have gowns and gloves as well,” she said. “It can't feel like real life.”
Said Hirschel, at the Michigan Poverty Law Program: “The very people who are the first to recognize that a loved one isn't getting good quality care are the people who are being restricted from visiting.”
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