Nursing homes eye easing of visitation restrictions

WINDOW ROCK

Even though nursing homes across the United States have been severely impacted by COVID-19, with outbreaks causing high rates of infection, on Nov. 12 the Centers for Medicare and Medicaid Services further eased restrictions and to allow visitation “for all residents at all times.”

Under the CMS regulations, facilities must allow indoor visitation for residents without limitation on the number of visitors, the frequency and length of visits, or require advance scheduling.

This comes amidst the Delta surge, which is overwhelming hospitals on the Navajo Nation and surrounding states and nursing home directors in the region like Wayne Claw of the Navajoland Nursing Home in Chinle suggest the move is premature.

“We didn’t agree with it and a lot of our doctors didn’t agree with it,” Claw told the Navajo Nation Council’s Health, Education and Human Services Committee on Nov. 24.

“A lot of the nursing homes that surround the Navajo Nation in Winslow, Flagstaff and Gallup didn’t like the idea of just opening back up,” he said. “COVID is surging again and we’re very protective of our elders.”

While nursing home COVID-19 death rates have declined dramatically since their peak in December 2020, there have been a total of 140,563 nursing home residents lost to the disease since the beginning of the pandemic.

Nursing home lockdowns, forced isolation and physical separation from family and loved ones also took an emotional toll on residents, state CMS.

CMS indicated widespread vaccinations make it safer to resume more regular visits.

About 86% of nursing home residents and 74% of staff in the U.S. are fully vaccinated and all nursing employees are required to complete their two-dose vaccinations by Jan. 4, 2021.

However, per CMS, visitors must be allowed regardless of resident and visitor vaccination status, although outdoor visits are still recommended when either are not fully vaccinated.

And, if the resident and all their visitors are fully vaccinated, and the resident is not immunocompromised, they may also choose not to wear face coverings or masks and to have physical contact.

The only exception to the open visitation policy is those who are positive for COVID-19, have symptoms of COVID-19, or currently meet the criteria for quarantine, who may not enter nursing home facilities

‘We’re fearful’

Claw said all of the COVID-19 safety practices Navajoland had been using has been very effective and his facility wants to stick with more stringent visitation policies they developed to protect residents.

“We follow all the CDC and CMS policies and we put our own together and they accepted it,” he said. “Now, CMS sends us a note saying you guys need to open it back up. It scared us.”

Claw appealed to HEHSC Committee members for support.

“We’ve been doing very well on the Navajo Nation,” Claw told the HEHSC. “Let’s keep it that way. Let’s continue protecting precious elders. We need to tell CMS we’re going to stay with what we’ve been practicing.”

In the border town of Winslow, Ariz., Winslow Campus of Care Administrator Dan Belisle expressed similar concerns.

“We’re fearful,” said Belisle. “We’re very fearful.”

Between December and January, WCC lost 40 of its 102 residents to a virulent outbreak of COVID-19.

“We might have had the worst in the state (Arizona) about a year ago,” he said. “The last thing anybody in this building wants to have happen is to get anywhere near that again.”
However, COVID-19 positivity rates in Navajo County have increased over the last 10 weeks from below 10% to 20.3%, he said.

“Our population here is 100 percent Native and our workforce is 100 percent Native and this is one of the hottest spots in the country, said Belisle.

“We’re as concerned as anybody else in this world and we’re going to make a request to CMS and that’s about all I can say at this point,” he said. “I’m just not at liberty to talk about that until we get some sort of answer.”

Protecting residents

At the beginning of the pandemic, CMS restricted all nursing homes from having visitors, except for essential health care and compassionate care providers, including end-of-life visitations from hospice and clergy.

Claw said at that time in March 2020 when they had to close down Navajoland and stop visitation, they immediately got prepared and put policies together on how to keep the elders in contact with their families.

“We purchased more IPADs and phones and used them to communicate with the visitors,” he said. “They were able to do window visits and communicate that way. It worked pretty good.”

When CMS started slowly permitting visits again in the spring of 2021, Claw’s Navajoland Nursing Homes started allowing one visitor per family who was tested and vaccinated. Each visitor wore gowns, masks, face shields and rubber gloves and met with residents in a separate area of the building.

“That’s to protect our residents,” he said. “We care and love our grandmas and grandpas and we don’t want them to get sick.”

Claw said all of his employees are tested every day “in and out” of the facility and they have a quarantine building next to the main nursing home.

“We still had to take elders out to hospitals for appointments,” he said. “We put policy together to make sure that when we bring them back, they stay there 10 to 14 days. Throughout the whole pandemic in 2020, we did that and it was very safe.”

Actual policies may vary

AARP said many states have interpreted the CMS guidelines as recommendations rather than requirements, with some states crafting their own rules, which often vary from facility to facility.

Belisle said since the outbreak last winter, WCC has only been doing window visits and electronic communications such as through Skype.

Staff are tested twice a week and they’ve had no further issues with COVID-19, he said.

Additionally, now 99.5% of WCC’s 90 residents have been fully vaccinated.

“We’ve got everybody in the house vaccinated with the exception of two CNA who are being removed from the schedule,” he said.

Belisle said it’s tough to lose two employees who chose not to comply with the vaccine mandate amidst “monumental” staff challenges in the nursing industry.

“We’re continuing to practice what we’ve been doing,” said Claw. “My staff has been doing a very good job throughout the whole pandemic keeping residents safe.”

Claw said the federal CMS doesn’t realize that tribes like the Navajo Nation have a tribal government that cares about the elders too.

“I told them, no, we’re going to protect our elders,” he said. “That’s the reason I asked the Health and Education Committee to support us so that we don’t just open back up like they’re doing in other places.”

HEHSC Chairman Daniel Tso committed to sending a letter to CMS to express concern on behalf of Navajo elders in nursing home facilities across New Mexico, Arizona and Utah.

“I would say, stay with your best practices and will see what we can do from our legislative side,” Tso told Claw. “We’re all concerned.”

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