February 5, 2021, Kimberly Marselas, McKnight's Long-Term Care News - Vaccination campaigns and reduced COVID-19 transmission may soon bring visitors back to nursing homes, but officials in one state are using legislation to wedge the doors open now. Indiana lawmakers are considering a bill that would require all of the state’s 534 skilled nursing facilities to participate in an Essential Family Caregivers Program.
Overseen by the state health department, the program allows residents to appoint up to two caregivers who can enter facilities to help with meals, grooming, even companionship — and even when community spread or a positive test in that building might otherwise keep guests out.
The program already exists but is optional.
“The intent is to require uniform adoption,” said Zach Cattell, president of the Indiana Health Care Association, which supports the legislation. “It’s understandable because family members may have different experiences in different facilities.”
The bill also requires skilled nursing facilities to allow a visitor during expanded compassionate care situations in language echoing federal regulations issued last fall. Its standards would be implemented in future health emergencies too.
Though Cattell told McKnight’s Long-Term Care News he doesn’t expect the legislation to reach the governor until April, it likely will push more facilities to prepare by making the logistical and policy changes needed to accommodate the return of visitors.
Those that haven’t already implemented a caregivers program typically cite lack of time as the reason.
“They are all-consumed by COVID-19,” Cattell said. “At the end of the day, administrators, nurses, the folks who provide this hands-on care, they want to protect their residents… We also want highly involved family members. We want our communities to be open. These are people’s homes.”
The proposed legislation would still allow designated caregivers to enter when county positivity rates are above 10% or if the building has had a positive test within the last 14 days.
As nursing home residents in many states complete their vaccination series, it remains uncertain how long the Centers for Medicare & Medicaid Services will take before relaxing its visitation policy.
A model for others?
It’s unclear how many other states have considered similar legislation fixes while waiting. But Cattell has heard from other state leaders trying to aid families upset about being away from relatives for so long.
In Pennsylvania, a 400-member group rallied at the state capitol beseeching lawmakers to expand visitation rights. Some state legislators pursued a program like Indiana’s but access remains dictated by CMS and health department guidance, according to a state association.
Indiana has seen at least 23,000 cases in nursing homes and long-term care facilities, with more than 4,900 deaths, according to The Tribune. But cases have been declining statewide for eight weeks.
According to Cattell, CVS had provided first shots at the 319 state SNFs it is serving, and 31% of those had second shots as of Feb. 3.
The American Health Care Association said it was not tracking visitation policies state by state but is encouraged by the development of programs like the one in Indiana.
“This will help with prolonged social isolation for our residents, but it will also help supplement care and support for residents during the ongoing public health emergency,” the organization said in an email. “With the pandemic persisting, we must remain vigilant about protecting our nation’s most vulnerable, but balance that with the need to stay connected with loved ones.”
AHCA stressed the need to remain vigilant about infection control as restrictions ease. The Indiana bill would require all caregivers to “take any required testing,” agree to take “precautionary measures including hand hygiene and the wearing of a mask or other personal protective equipment,” and only enter designated areas.
In testimony earlier this week, IHCA’s Laura Brown noted the bill protects facilities from liability for COVID-19 spread among residents or visiting family members if acting within program guidelines and without “gross negligence.”