Five Takeaways On Nursing Home Visitations

Aug 30, 2020

A ban on visitation at Florida’s 4,000 long-term care facilities expires in early September, and Gov. Ron DeSantis is poised to reopen doors to residents’ family members and friends who have been unable to visit because of the coronavirus pandemic. 

DeSantis will consider recommendations finalized Wednesday by the Task Force on the Safe and Limited Re-Opening of Long Term Care Facilities.

The governor appointed the panel, made up of Agency for Health Care Administration Secretary Mary Mayhew, state Surgeon General Scott Rivkees, Department of Elder Affairs Secretary Richard Prudom, Florida Health Care Association Executive Director Emmett Reed, Florida Senior Living Association President and CEO Gail Matillo and Jacksonville resident Mary Daniel, who has gained national notoriety for working as a dishwasher at a memory-care facility so she can see her husband.

Here are five takeaways about the panel’s deliberations and recommendations:

MASKS ON ALL THE TIME: While DeSantis has refused to require Floridians to wear face masks during the pandemic, there’s no disagreement about whether masks should be mandated in long-term care facilities. Under the recommendations, “essential” caregivers, who assist with daily living activities such as eating, bathing and grooming, would have access to residents’ rooms and would be required to wear the same personal protective equipment donned by health-care workers. Members of the general public would have more-limited visitation rights and wouldn’t be allowed into facilities without wearing masks and agreeing to adhere to social distancing requirements.

HUMAN TOUCH: Most of the task force’s visitation recommendations track guidelines that the federal government already had issued, causing advocacy groups such as AARP Florida and Families For Better Care to ask, “Why now?” But the task force recommended that emotional support, which includes touching and hugging, should be added to a list of daily-living activities that “essential” caregivers might provide. That would put Florida in a unique position, said Rivkees, who argued against its inclusion. In a rare glimpse of public disagreement, Mayhew countered: “Dr. Rivkees, we’ve got a lot of people in our nursing homes and assisted living facilities who are suffering from significant depression.”

TESTING: The panel altered a recommendation that would have allowed nursing homes to require visitors to be tested for COVID-19 before entering buildings. The change was championed by Rivkees, who said rapid point-of-care tests are suggested for use on symptomatic people only. He said those people wouldn’t make it past screening practices, including temperature checks, at the front doors of facilities. The recommendation was altered to make clear that facilities’ use of testing “must be based on current CDC and FDA guidance,” referring to the federal Centers for Disease Control and Prevention and the Food and Drug Administration.

THE RETURN OF RIVKEES: The task force meetings signaled a re-emergence of sorts for Rivkees. He had largely disappeared from DeSantis’ news conferences after publicly saying in April that people might have to continue to socially distance for a year. DeSantis later shot down questions about whether he continued to support his top public health official. Rivkees made his voice heard during the task force’s discussions. In addition to altering the testing recommendation, Rivkees convinced the panel to include COVID-19 infections for staff members in a 14-day lookback period that will be used to determine if facilities can be open for general visitation. When staff infections were taken into consideration, 60 percent of facilities would have qualified to offer visitation, compared to 83 percent that would have qualified based only on whether residents had suffered infections, Mayhew said.

VOICES NOT HEARD: DeSantis didn’t appoint Florida’s long-term care ombudsman, Michael Phillips, to the panel. The ombudsman is charged with advocating on behalf of nursing home residents. Brian Lee, executive director of Families For Better Care and a former state ombudsman, noted Phillips’ omission from the panel and sent the governor a letter asking that Phillips be appointed so “residents will have their voice included in the process.” Phillips’ absence from the process was notable, especially when the panel’s discussions centered on whether voluntary ombudsmen across the state who work with Phillips have been allowed entrance into facilities during the visitation ban, which started in March.