Citing Internal Report, New York Opens Door For Nursing Home Visits — But Preaches Caution

July 13, 2020, Alex Spanko, Skilled Nursing News - Health officials in New York late last week signed off on the resumption of visits to nursing homes that meet a host of safety criteria, while also emphasizing the danger of asymptomatic spread within facilities.

Facilities free of COVID-19 cases for 28 days will be allowed to open their doors to non-emergency visitors, the New York State Department of Health announced late Friday.

That figure is in line with guidance from the federal Centers for Medicare & Medicaid Services (CMS), though CMS has left the ultimate decision on safe reopening to individual states.

In New York, that decision also includes a 10% cap on nursing home residents that can receive visitors on any given day, a move that officials believe will help facilities maintain appropriate distancing; each resident will also only be allowed two visitors at a time.

As in other states, visits will be restricted to outdoor areas as long as the weather permits, with indoor meetings allowed only in “certain limited circumstances” in well-ventilated rooms.

Operators must also screen all visitors and maintain a contact-tracing database with the information from each screening, including addresses, phone numbers, and confirmation that the visitor did not have symptoms.

The NYSDOH warned that failure to comply with any of the stipulations could result in the end of visitations; the state also reserves the right to suspend visits at any point.

“If the facility falls out of compliance with requirements listed in this advisory, the NH should immediately halt visitation and inform the Department,” the agency noted.  “In addition, the Department can halt visitation at the nursing home at any time due to community or facility spread of infection, or when the Department identifies that the NH has failed to comply with requirements of this advisory.”

The question of whether to resume nursing home visitations — and how — remains a difficult challenge for residents, families, public health officials, and operators.  Resident advocates have exerted increasing pressure on the government to end the visitation bans that have been in place since mid-March, citing the mental and physical toll that loneliness and isolation take on seniors.

Families also routinely provide caregiving support and can shed a light on allegations of abuse and neglect.

But with an official federal death toll of more than 35,000 in the nation’s nursing homes, geriatricians and operators have expressed concerns about the logistics of facilitating visits — especially as facilities grapple with slow testing turnarounds and skyrocketing expenses for personal protective equipment (PPE), which will be required in even greater volumes to allow safe visits.

Howard Zucker, the state’s health commissioner, acknowledged the dangers in a statement announcing the new rules.

“With the knowledge we now have about how COVID-19 came into nursing homes — mainly through asymptomatic staff and visitors through no fault of their own — it is critical that as we resume visitations to these facilities we do it in a smart and cautious way to ensure the health and safety of residents and staff,” Zucker said.

“We will continue to closely monitor the situation in each facility, and make adjustments based on the facts and data moving forward.  I know how painful it has been for residents of these facilities to endure such a long period of time without seeing family and loved ones, and my hope is that this adjustment to the visitation policy will provide some comfort to everyone.”

Zucker’s statement references a report, released by the NYSDOH last week, that placed the blame for COVID-19 outbreaks on residents and staff who unwittingly brought the virus into individual nursing homes — and not, in the agency’s determination, a controversial policy requiring facilities to accept resident with COVID-19.

That report has stirred controversy among public health experts and nursing home leaders who disagree with the state’s internal conclusions, especially given the politically charged nature of the discourse over whether Gov. Andrew Cuomo’s actions around nursing homes contributed to the death count.