Visits to nursing homes get the green light in Texas - with conditions

The Texas Health and Human Services Commission announced on Thursday that for the first time in five months, visitors will be allowed in Texas nursing homes and assisted living facilities. That’s good news. The bad news is that there is a lot of confusion about the announcement. It may take a while to answer the questions put forth by the facilities.

By Friday, it became clear that the policy reversal brought confusion to many who are directed affected. Visitors will be allowed on a limited basis only if the nursing home meets specific requirements. Assisted living facilities will also accept visitors and the requirements for those facilities will be a little more lenient than the ones for nursing homes. The rules put forward in the press release from the state agency had not been published for nursing home providers to see.

Visits will not start right away. It will take some time to determine which facilities qualify and for provisions to be made.

At assisted-living facilities, some indoor visits will be permitted, provided there are plexiglass barriers, there are no active cases of the novel coronavirus among residents and there are no confirmed cases among staff in the last two weeks. Physical contact between residents and visitors will not be permitted, state officials said.

The restrictions are tighter on nursing facilities, which must test staff members weekly and can offer only outdoor visits.

“This is a rapidly evolving situation and we are constantly assessing what actions are necessary to keep residents and staff safe in these facilities,” said Phil Wilson, the acting executive commissioner of Texas Health and Human Services Commission. “By following these procedures and rules, facilities can more effectively prevent the spread of COVID-19 and help us achieve our shared goal of reuniting residents with their families and friends.”

With the spike in COVID-19 cases in Texas during June and July, a surge was seen in long term care facilities. As of Thursday, 57% of nursing homes still report at least one active case. More than a third of Texas’ deaths are from patients in nursing homes and assisted-living facilities. Families and patient advocates have been asking for limited visitations, though, in order to visit their loved ones and friends who have been cut off from the outside world. The elderly and most vulnerable to the coronavirus are slipping through the cracks, according to some Texas lawmakers.

“Families are just desperate right now to be able to see their loved ones,” Alexa Schoeman, deputy state ombudsman in HHSC’s office of the long-term care ombudsman, said in an interview last week.

Kevin Warren, president and CEO of the Texas Health Care Association, called Thursday’s announcement “a great step forward.” In an interview last week, he said reconnecting families with their loved ones was “a priority” and that “it should be done as quickly as we can.”

Some Texas lawmakers had been agitating for a policy change for weeks. Last month, state Rep. Scott Sanford, R-McKinney, and state Sen. Charles Perry, R-Lubbock, along with dozens of other signatories, asked state health officials to loosen restrictions on visitations for patients with memory difficulties and mental disabilities.

“We will not stand to let these Texans fall through the cracks,” they wrote.

One problem with putting the change in policy into effect is that there is about a two week lag in data published by the state on coronavirus cases in individual facilities, and it only goes back to July 13. Using the current data, at least 550 of the state’s 1,223 licensed nursing facilities — or 45 percent — would be disqualified. With the rule that all staff must be tested weekly, the shortage of tests comes into play. The federal government is sending testing devices to nursing homes but not all facilities in the state have received them yet. Nursing homes need more clarity, according to those running them. Even with the details that need to be worked out, though, it is still good news.

Any visitation is better than no visitation, said Patty Ducayet, the state’s long-term care ombudsman, who has repeatedly heard from family members that virtual visits fall short in meeting the needs of older residents and others who require a higher level of care. But she said the general outline of the rules as of midday Friday raised concerns.

Among her questions: What happens if a facility meets the requirements but still refuses to allow visits or cannot provide weekly testing? Will personal protective equipment be given for visitors? Will visitation ever be allowed at facilities with active COVID-19 cases? (She believes it should.)

Still, she said, “This is something, and something is better than nothing.”

This is a first step, a step in the right direction for the elderly and their families. It should also be noted that facilities who meet the requirements but are not comfortable with visitors do not have to allow visitation. Nursing homes have to submit a form showing they meet the requirements. Visits have to be scheduled in advance, residents have to wear a face mask if possible, and social distancing must be maintained. No physical contact with the nursing home resident is allowed.

Assisted living facilities have a little more flexibility. There is no requirement for weekly testing of staff and there is an option for visits to take place indoors with a plexiglass barrier.

This gives hope to families worried about loved ones in these facilities. Everyone can use that during these stressful times.