Long-term Care Facilities Look to Allow, Protect Visits

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COURT HOUSE – While most of the nation seems focused on Covid vaccine availability, with a goal of “returning to normal,” long-term care (LTC) facilities are dealing with how to continue protecting residents now that many have been vaccinated. 
Recognizing the emotional and physical toll separation from loved ones has taken on many LTC residents during the pandemic, the Centers for Medicare and Medicaid (CMS) March 10 revised its Covid visitation guidance, emphasizing the importance of maintaining infection prevention practices, given the continued risk of transmission (https://go.cms.gov/3rF9rFN).
However, as one LTC spokesperson noted, “Keep in mind the situation is very fluid and can change quickly. Although the Covid positive numbers are low, as of today (March 30), in Cape May County, New Jersey is experiencing a spike.”
Jan Carrato, communications and public relations director, United Methodist Communities at The Shores, in Ocean City, added, “Everyone I know is anticipating the light at the end of the tunnel ahead.”
While the state Department of Health (DOH) encourages visitors to become vaccinated when they have the opportunity, they mandated that visitors should not be required to be tested or vaccinated, or show proof of such, as a condition of visitation to LTC facilities. 
Visitation depends upon vaccination status, Covid status, screening question results, Covid test results, the region’s CALI score (Covid Activity Level Index), the facility’s total vaccination rate, and more.
Compassionate visits are allowed, regardless of vaccination or Covid status, according to the DOH’s mandatory guidelines for visitors and facility staff (https://bit.ly/3maB0G1).
“As of today (March 30), The Shores is in the yellow zone/phase (with most to least restrictive being red, orange, yellow, and green),” explained Carrato.
Crest Haven Nursing and Rehabilitation Center is in a mixed status, as of March 30. 
According to Administrator Jennifer Hess, “The West Wing is under outbreak status, which is anytime there is at least one positive case of either an employee or resident due to a single positive employee test. If our testing yields no new resident or staff cases over the next 14 days, West Wing may have outdoor visitation.
“There is currently outdoor visitation for the East Wing residents,” she added. “Once the facility is beyond the current outbreak status, we will take the steps necessary to reopen indoor visitation.”
The quickly changing dynamics have Genesis HealthCare updating its facilities’ websites by 6 a.m. daily, with the current visitation status at its two locations operating within Cape May County. 
Currently, there is limited indoor visitation at the North Cape Center, in North Cape May, according to Lori Mayer, company spokesperson. 
The center specializes in short-stay rehabilitation, LTC and post-hospital stays.
At Victoria Manor, its other local location, also in North Cape May, indoor visitation was allowed, as of March 30, according to Mayer. 
Victoria Manor provides short-term, long-term and respite care.
Genesis HealthCare no longer operates the Court House Center, in Court House, and Victoria Commons, in North Cape May, as of April 1.
“We understand the huge toll that separation has taken on our residents and families,” Mayer said. “Many of our affiliated centers will now allow indoor visitation at all times and for all residents (regardless of vaccination status), with the exception of the three scenarios listed below. 
“CMS, the federal agency that regulates nursing centers, has updated its visitation guidance due to high resident vaccination rates and a drop in Covid cases around the country.”
The following are the three scenarios where indoor visits would not be permitted, per CMS:
* If the center’s county positivity rate is greater than 10% and less than 70% of residents in the facility are fully vaccinated, then unvaccinated residents may not receive visits;
* Residents with confirmed Covid, whether vaccinated or unvaccinated, until they meet criteria for discontinuation of transmission-based precautions; and
* Residents in quarantine (observation), whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
Center staff, visitors and residents must still adhere to the core principles of Covid infection control, including maintaining physical distancing, screening those who enter the facility for Covid symptoms, hand hygiene, wearing a surgical mask, and conducting visits outdoors whenever possible, Mayer said. 
“This continues to be the safest way to prevent the spread of Covid, particularly if either party has not been fully vaccinated,” she added.
Regarding families taking their loved ones out of the building for non-medical purposes, the DOH released guidelines for holiday visits last fall (https://bit.ly/3fvC4Tt). 
Carrato said The Shores is currently formulating a policy consistent with the risk assessment established by the DOH.
“This assessment tool determines whether residents need to quarantine after visiting with loved ones for non-medical purposes,” she noted.
Residents at The Shores are wearing masks, eating meals in the dining rooms while seated 6 feet apart, and engaging in activities 6 feet apart. Fully vaccinated residents can choose to have close contact (including touch) with a visitor only if the person is wearing a tight-fitting (surgical) mask.
“Families can schedule visits online through the family portal on The Shores website,” Carrato said. “If they are not digitally savvy, they can arrange visits by phone. 
“For safety and health, we encourage them to use the portal, so we can control the number of visitors at any one time and control where in the building they are visiting (assisted living apartments, skilled nursing rooms, etc.). We are limiting each resident to no more than two visitors at a time.”
The Shores will schedule outdoor visits when the weather gets warmer, according to Carrato.
Crest Haven prefers outdoor visits at all times, Hess said, “as it continues to work to provide residents with a safe atmosphere to have meetings with family. In order to do that, outdoor visits are preferred at all times and are permitted when the facility is not under transmission-based precautions or outbreak status.
“Other safety measures under the guidance from the DOH include residents and guests must wear well-fitted face masks, sanitize their hands and maintain appropriate social distance,” she said. “Face masks may not be removed, and no eating is permitted during visitations. 
“Residents who are fully vaccinated may have physical contact with their guests, such as a hug or holding hands, but masks may not be removed. Hands must be sanitized before and after contact.”
Hess said rapid testing for Covid is recommended before a guest may visit the facility. Indoor visitation may occur only when the facility is not in outbreak status, and the facility submitted the appropriate attestations to the DOH.
“Families could take their resident if vaccinated and proper protocols are observed,” she added.“There is a risk assessment that must be completed each time a resident goes on an outing to determine if quarantine is necessary afterward.”
According to the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL), nursing homes and other LTC facilities will not be able to go back to “normal for some time, but providers are doing everything they can to safely facilitate activities that are beneficial to residents.
“We are not out of the woods yet, and we must remain vigilant until we fully understand how effective the vaccines are among our population, especially in light of new variants,” the organizations said, in a March 29 media alert. “That’s why, in February, we asked the Centers for Disease Control and Prevention (CDC) to focus research on the vaccines’ impact in long-term care.
“Getting back to normal probably won’t occur at least until we achieve herd immunity among the general population,” they said. “Researchers have found that spread in the community is linked to nursing home outbreaks. The sooner we all get vaccinated, the sooner we can hopefully end this pandemic and bring back some sense of normalcy. It’s up to all of us, not just residents and staff.”
To contact Karen Knight, email kknight@cmcherald.com.