Visitors are so important to the well-being and safety of nursing home residents that federal regulators in November lifted all visitation restrictions imposed at the start of the pandemic. Even as the crisis marched forward.
Regulators, however, adjusted that rule last month, giving nursing homes that ability restrict visitors “with very limited and rare exceptions.”
The rule change worries industry watchdogs, who point to data showing that the pandemic worsened already dire staffing levels in nursing homes and caused a "tandem wave of fatalities ... quietly claiming tens of thousands more who are succumbing not to the virus but to neglect by overwhelmed staffs and slow declines from isolation," the Associated Press reported in Nov. 2020.
So far, nursing homes in Berkshire County do not appear to be changing the open, 24-hour visitation policy required by law. Instead, they are taking COVID-19 precautions that help ensure safe visits. Policies can be seen on nursing home websites and most visitation rules hinge on vaccination status. Berkshire Healthcare, which owns six of the county’s 13 skilled nursing homes, is taking this approach.
Lisa Gaudet, the nonprofit's vice president of business development and marketing, said by email that in some locations, the vaccination status of a resident's roommate may lead to visitation being moved to a common area.
“Other than that we screen all visitors upon arrival and offer Binax tests to those who would like one prior to their visit, but they are not obligated to take a test if they are not inclined,” she said.
At Berkshire Rehabilitation and Skilled Care Center in Sandisfield, which is under a state-authorized admissions freeze due to COVID-19 cases, unvaccinated residents must quarantine for up to 14 days after a visit, according to a post on Athena Care's website. "These residents may only have window visits and compassionate care visits during this time. We continue to encourage everyone to get vaccinated immediately."
The company says that any facility with an “outbreak,” defined as one or more positive COVID-19 cases among staff or residents, must pause visitation "while mandatory testing takes place." An Athena spokesman did not respond to requests for comment.
Amid a surge caseloads in the county, relatives of those in facilities with poor staffing levels have contacted The Eagle, worried that there might not be enough employees to screen visitors. Yet, in poorly staffed buildings — a longstanding problem in the county, an Eagle investigation found — visitors are critical as advocates and caretakers.
State and federal regulators embrace this view and are allowing visits, even when there is an outbreak investigation, according to the DPH. The DPH also says that visits can’t be conditioned on whether someone takes a test or not. One state health official wrote in a recent memo that a resident has the right to have any visitor at any time they want, as long as it doesn’t impose on the rights of other residents.
Industry watchdogs still worry. They say the new CMS guidance allowing visitation exceptions will pose a threat to residents. It is often a resident's relatives who advocate for their proper care and who file complaints of alleged neglect or abuse. Such complaints, which lead to most violations and fines, diminished by about half during 2020, according to a report by the Inspector General.
Watchdog groups say that banning visitors in 2020 didn't stop the virus from raging through buildings. Staffers brought it in. “It came in anyway — what made the difference was vaccinations of residents, ” said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy in Washington.
The group is pushing for legislation to ensure visitation rights regardless of public health emergencies. The nonprofit last month took the position against the CMS’ shift to bar visitors even in rare circumstances, and said it was likely due to industry pushback of its full lifting of restrictions.
Several industry officials wrote CMS to warn that in light of an expected surge in omicron variant infections, “[nursing home] staffing shortages may lead to the inability to ensure that safe visiting policies are being followed.”
Edelman says poor staffing is why visitors should not be barred under any circumstances. “If you don’t have enough staff, then who is feeding the residents? Who’s taking care of them?” she asked. “Families are just so essential. They're not just people coming in to play bingo.”
EAGLE INVESTIGATIONS: Poor staffing ratios have festered for more than a decade in the majority of Berkshire County nursing facilities, and continue today. Our investigation puts faces to those numbers.