Our Florida elder law attorneys advise many families who have a loved one residing in a long-term care nursing facility. While the coronavirus pandemic has been disruptive and burdensome for everyone, it has created additional, brutal realities for these families. When the COVID 19 pandemic took off in March, Florida’s nursing homes closed to visitors for safety reasons. Communal dining in many cases was discontinued. Residents were effectively confined to their rooms and cut off from family visits. Now, residents are suffering from isolation and loneliness. Their families are desperately worried. And of course, nursing home staff is carrying an unbelievably difficult load.
When can you again visit your loved one in a nursing home? What will the process look like?
Florida Nursing Homes: Current Visitation Policies
Five months later, the visitor ban remains in place. Nursing homes in Florida (as well as group homes and assisted living facilities) are still not permitting visitors to enter. Only medical staff and employees get access, as well as some vendors and maintenance people. Exceptions may be made for loved ones if a resident is near death or suffering some other trauma.
Staff members take I-Pads from room to room for virtual visits, arrange phone calls or take residents to windows to see family drive by and wave. But obviously, none of these experiences substitutes for a hug or in-person smile. Kristen Knapp, spokeswoman for the Florida Health Care Association, a nursing home industry group, says: “Being able to wrap your arms around your mom, dad or spouse … a Skype visit doesn’t take the place of that.” The visitor ban may be necessary for protecting life, but there’s no doubt the protracted isolation is taking a toll, impacting residents’ mental health, and potentially leading to faster cognitive decline in some.
New Task Force To Devise Visitation Guidelines
In response to this ongoing crisis, Florida Governor Ron DeSantis on August 6 announced the formation of Florida’s Task Force on the Safe and Limited Re-Opening of Long-Term Care Facilities. Its mission: devise guidelines that will safely permit family members to resume visiting loved ones in nursing homes. “In an effort to protect our most vulnerable, we made the difficult decision in March to prohibit visitation to these facilities,” said DeSantis. “While these measures were necessary, it has taken an emotional toll on our families. I look forward to the ideas that arise from this task force on how we can continue our mission to protect the vulnerable while allowing for the much-needed human connection of spending time with family and friends.”
The task force had its first meeting the week of August 13 and met again August 18. Members are:
Mary Daniel: Mrs. Daniel attracted media attention when she took a job as a dishwasher at the Jacksonville facility her husband, an Alzheimer’s patient, resides in. Recognizing the importance of human contact she has said, “People are dying right now from failure to thrive.”
Emmett Reed, Florida Health Care Association Executive Director
Scott Rivkees, Florida State Surgeon General
Mary Mayhew, Agency for Health Care Administration Secretary (task force chairperson)
Michelle Branham, Alzheimer’s Association Vice Pres. Of Public Policy
Richard Prudom, FL Dept of Elder Affairs Secretary
Gail Matillo, FL Senior Living Association, Pres and CEO
Grim Numbers The Task Force Must Consider
As it seeks solutions, the panel has some grim numbers to consider. Here is a sampling:
- After declining in June, COVID-19 cases at nursing homes are again on the rise, according to a report from the American Health Care Association and National Center for Assisted Living. The report attributes the increase to an increase in cases in the surrounding communities; shortages of personal protective equipment; and delays in test results for residents and staff. Florida is among the states (along with Texas, Arizona and California) with the highest increase in cases.
- According to the Centers for Medicaid and Medicare Services, new infections in residents at long-term care facilities in Florida rose by 142% between July 1 and July 21. Cases among staff rose 121%.
- Leading Age states that as of July 20, 2020, there have been 2,343 deaths attributable to COVID 19 for long-term care residents and staff in Florida. Infection rates for residents of nursing homes and assisted living facilities is over 3%.
- Since the pandemic began, there have been over half a million Floridians diagnosed with COVID-19.
- The Florida Department of Health reports 3,730 deaths of residents and staff at long-term care facilities through August 11. Of these, 390 (10%) are in Palm Beach County; 88 (2%) in St. Lucie County; 59 (2%) in Martin County; 258 (7%) in Broward County; 28 (1 %) in Indian River County; and 4 in Okeechobee County. You can see all the latest statistics on Florida coronavirus at the Florida Department of Health website.
- An August 13 article in the NY Times notes that although only 8% of all diagnosed COVID cases are traceable to nursing homes, 41% of all deaths are. As of August 13, the virus has infected more than 402,000 people at some 17,000 facilities nationwide. Infected people linked to nursing homes also die at a higher rate than the general population. The median case fatality rate — the number of deaths divided by the number of cases — at facilities with reliable data is 16 percent, significantly higher than the 3 percent case fatality rate nationwide.
- According to the Johns Hopkins University COVID tracking project, in late July Florida had 19.2% positivity rate in the general population.
What To Expect If You Visit Your Loved One In A Nursing Home?
The task force has generated some preliminary ideas. Depending on what guidelines are adopted, this is what you might experience when you are again permitted to visit your loved one in a nursing home. Keep in mind that the situation is very fluid.
One proposal would require you to be tested before entering the facility, although the general contours of how this would be administered, and when, are not yet fleshed out. Currently, the state requires staff to be tested every two weeks, although delays and backlogs have been reported. The Florida Health Care Association backs this idea but believes it should apply only to long-term care facilities where no coronavirus cases are present. Task force member Mary Daniel, the member who went to work in a facility to be near her husband, also believes testing is a must, and has suggested that family would be willing to pay for tests themselves if it allowed them access to their loved ones.
The U.S. Department of Health and Human Services announced July 14 that it would distribute rapid diagnostic test instruments and tests to 2,000 facilities, initially focusing on nursing homes in COVID-19 hotspots and facilities deemed to have an elevated risk of COVID-19 outbreaks. Florida’s 24 hotspot counties include Palm Beach County, St. Lucie County, Martin County and Broward County (along with Baker, Clay, Duval, Flagler, Hardee, Hernando, Hillsborough, Lake, Miami-Dade, Monroe, Nassau, Orange, Osceola, Pasco, Pinellas, Polk, Seminole, St. Johns, Sumter and Volusia). That puts 471 of Florida’s 693 nursing homes on the list. However, a preliminary survey by the Florida Health Care Association indicates many kits have yet to arrive.
About 30 states now permit visitors under strict conditions. The Centers for Medicare and Medicaid Services recommends this if a nursing home has had no cases for two weeks, provided that visitors are tested prior to entry. The CMS encourages lifting the visitation ban only when the surrounding community has an acceptably low infection rate. Whether this will apply to our area is yet to be determined. (If you have a loved one in a nursing home in a state other than Florida, check out the August 10 AARP guide to the visitation rules nationwide)
Personal Protective Equipment (PPE):
Other Suggestions From the Panel Include:
Opening up visitation would start with designated “essential caregivers.” If you visited a resident at least twice a week before lockdown began, you would be considered an essential caregiver.
Per current federal guidelines, you would be admitted to visit only if the facility was COVID free for at least 28 days, fully staffed with adequate PPE on hand, and had the capacity to test visitors.
Ideally, you would meet with your loved one in an outdoor area such as a patio. An alternative might be an indoor area, separate from the other common areas, that is regularly sanitized. Exceptions might be made for residents who for various reasons cannot leave their rooms.
While some states have allowed visitation outside in areas separated by plastic panels, state Surgeon General Scott Rivkees said that might not be an option in Florida.
Additional meetings of the task force have produced some draft guidelines, including letting the following individuals into facilities provided they test negative for COVID:
- Essential caregivers: Someone who provides a resident with health services or assistance with bathing, dressing or eating.
- Compassionate caregivers: This is an individual who would be able to visit to help a resident through a difficult time, such as the death of a loved one.
- Requiring all visitors to wear protective equipment.
However, it remains any open question as to whether the state will actually mandate such changes and whether they will be implemented.
Check with your loved one’s facility to keep up to date on any changes to visitation procedures, and again, keep in mind that this situation is a very fluid one that can change from week to week.