Ready to Reopen? Virginia’s Nursing Homes Consider Visitation Policies

People may soon hug loved ones in long-term care facilities.

GRETNA – After a half-year of tight restrictions, long-term care facilities in Virginia may soon let people visit their loved ones.

Despite trends suggesting a resurgence of the coronavirus pandemic around the upcoming holiday season, the Centers for Medicare and Medicaid Services (CMS) released visitation guidance to facilities in September.

That doesn’t mean nursing homes have their doors wide open, nor does it imply that CMS advised that. It means officials set a plan in place for loved to embrace once again – eventually.

Pandemic precautions put into place

In March, Gov. Ralph Northam announced a statewide lockdown for long-term care facilities. He then created the Virginia Long-Term Care Task Force in April.

Quickly, numbers displayed disproportionate COVID-19 cases in congregate settings, like nursing homes, due to living in confined quarters.

COVID-19 had the highest prevalence in those over age 65, coupled with the worst health impacts. Because of that, nursing homes went under quarantine. The Centers for Disease Control and Prevention (CDC) published on Sept. 11 that eight out of 10 COVID-related deaths were people 65 and older. Throughout Virginia, only residents requiring compassionate care or families with loved ones in end-of-life situations could enter the facility. Even then, with strict guidelines.

In May, CMS released nursing home reopening recommendations. That provided guidance on visitation for nursing homes through a phased reopening process. The plan encouraged nursing homes to move in a step-by-step manner toward more normal operations.

In the phased approach, nursing homes restricted non-essential healthcare personnel during Phase 1. They allowed entry in limited numbers during Phase 2. In Phase 3, they allowed entry with proper infection control and personal protective equipment practices expected in all phases. 

Last month, CMS released a new memorandum, further outlining reopening guidelines for Virginia nursing homes. The memorandum covered funding. It also provided reasonable ways a nursing home could safely facilitate in-person visitation, addressing residents’ psychosocial needs. The memorandum noted that visitation practices should be based on the COVID-19 test positivity rate in the county where a facility operated and neighboring counties.

The task force noted that as testing and PPE supply chains improved, both the CDC and CMS released updated guidance. The updates provided recommendations for safely lifting restrictions.

Putting tests in place

In late summer, nursing home employees throughout the Commonwealth became some of the most frequently COVID-tested people in the state. That’s thanks to a. August CMS interim final rule on testing, which mandated testing in certain COVID-positive areas.

Nursing home staff currently test on the following county positivity rate criteria:

• County Positivity Rate of Under 5%:  Once Monthly
• County Positivity Rate Between 5 and 10%:  Once Weekly
• County Positivity Rate Over 10%:  Twice Weekly

The interim rule also required symptomatic staff and resident testing. If an outbreak occurs, all staff and residents that previously tested negative must test again. They must also retest every three to seven days, until there are no new cases.

The testing regiment overtook the three-phase reopening plan. The phased reopening recommendations are no longer applicable for nursing homes.

Resident impact

Imagine living only a few miles from a loved one, but not being able to physically visit with one another. That’s the reality for many people with loved ones in long-term care facilities since March.

Many people dealt with isolation during the height of the pandemic. Some particular populations at nursing homes experienced compounding issues.

“We are aware that the visitation restrictions place nursing home residents suffering from various illnesses, such as Alzheimer’s, with increased challenges,” the task force officials said in a statement to Dogwood. “The guidance published by CMS and the CDC has encouraged compassionate care practices for residents with challenging circumstances, although the availability of PPE and testing have made facilitating in-person visits a challenge for some nursing homes.”

However, nursing homes across the state adapted to the changes as they came. Several long-term care facilities held socially distanced drive-thru parades and helped facilitate face-to-face meetings without physical touch.

“Since the beginning of the pandemic, we have heard incredible stories of facilities safely bringing families together by setting up comfortable outdoor meeting areas that encourage social distancing, leveraging video conferencing to bring individuals face to face and by utilizing partitions to bring loved ones closer together in a safe manner,” the task force statement said.

With the new guidelines in place, nursing homes are on their way to welcoming visitors back into the facility.

“If nothing else, we believe this pandemic has shined a light on just how critical social interactions and physical touch are for all Virginians, especially those residing in congregate care settings,” the task force statement said. “We know that the practices set forth throughout the pandemic have been incredibly difficult for individuals to adjust to, and hope that adhering to these recommendations to keep loved ones safe will make these interactions all the more rewarding.”

When will they reopen?

Mike Harris, Gretna Health and Rehabilitation Center administrator, and his team followed CDC and Virginia Department of Health COVID-19 guidelines as the pandemic raged through the state. Now, the long-term care facility in Gretna looks forward to lifting lockdown restrictions.

However, Harris noted that certain things need to happen before the doors open to visitors again.

“We are strictly following the CMS reopening guidance, while we also continue to adhere to direction provided by CDC and the Pittsylvania County Health Department. Our ability to reopen depends on the Pittsylvania County COVID-19 prevalence rate and the number of patients or staff members who are currently positive from our center. When the rate is below 10% and our center has no positive cases and no need for outbreak testing, we are able to facilitate visitation,” Harris said. “We currently have one staff member who is positive for COVID-19, but this person is expected to clear positivity status very soon. Once we receive confirmation, we can resume visitation. We understand this is a very difficult time for our patients and their families and look forward to being able to welcome visitors back very soon.”

When facilities eventually allow visitation, the task force recommends that they still follow pandemic safety procedures.

“It is critical that visitors utilize proper infection control practices, such as social distancing, hand hygiene and wearing [a] cloth face covering or face mask. In addition, if anyone is feeling sick at all, they should wait to visit a nursing home,” the task force said. “If possible, individuals should be tested for COVID prior to visiting a facility.”

Amie Knowles reports for The Dogwood. She can be reached at [email protected]