Families and advocates push for a more liberal visiting policy at long-term care facilities
In August, during a drive-through parade at the Medilodge of St. Clair nursing home, Jane Ogden jumped from her idling car, popped open a beer, and rushed it to a wheelchair-bound man in a t-shirt and pajama bottoms. “Drink it quickly,” she said, “or they might take it away from you.”
She squeezed her dad’s arm and made to return to the car. Ogden ran into a nurse, who mildly reprimanded her. But she felt, after months of lockdown, that her dad needed the excitement.
Like all residents in long-term care facilities, Ogden’s dad has been living in near isolation since mid-March, when, to prevent and limit COVID-19 outbreaks, Governor Gretchen Whitmer cancelled all in-person visits deemed non-essential. That included check-ins from family members.
The rules loosened slightly in June when the Michigan Department of Health and Human Services began permitting visits if a resident’s health was declining, or they needed help with activities like eating and washing. In September, taking the advice of a state nursing home task force, MDHHS said facilities could (though wouldn’t be required to) hold outdoor visits.
Ogden has now seen her dad outside the last two weeks, but she longs to visit him indoors as well, and with fewer rules. Alison Hirschel, managing attorney at the Michigan Elder Justice Initiative, says her group urges the state “every day to please reconsider these very strict restrictions.”
“If a person goes to a hospital, they can have visitors, the visitors can touch them, and the visits don’t need to be supervised,” Hirschel said. “And people are only in the hospital for a few days, usually.
“But how is it that people in nursing homes, who are there, sometimes, the rest of their lives, haven’t been allowed visitors, haven’t been allowed to touch anyone, haven’t been allowed unsupervised visits?”
Outdoor visits make only a small difference
Ogden picked Medilodge of St. Clair for her dad because it’s right across the street from her house, in East China Township.
She calls the decision to place him there “heart-wrenching,” but by July 2019, the difficulty of managing his dementia and recovery from an emergency pacemaker surgery had left her with no other choice.
Before the March lockdown, Ogden was visiting her dad once a week. She now had to explain to him, by phone, “over and over and over again,” why those visits had to end, and why, after he tested positive for COVID in April, he had to isolate in his room (he’s since recovered).
“His sole desire is to spend time with his family,” said Ogden. “When you reach a certain point in your life, the risks of being exposed is really nominal compared to seeing your family.”
On Thursday, October 1, Ogden sat with her dad outside Medilodge of St. Clair, for their first outdoor visit since the policy change. He was on a patio encircled by a wrought-iron fence, in a wheelchair. Ogden pulled a chair up to the other side. She says he was happy, but also that, for both of them, those outdoor visits aren’t enough.
For others, they’re hardly possible.
“Outdoor visits, those are fine and dandy, except it’s October in Michigan,” said Brandi Collins, whose dad has been a resident at the Heartland Health Care Center facility in Sterling Heights since 2018. “I don’t see that as an option for my dad, because he would hate being outside.”
Even if she could convince her dad to brave the elements, an outdoor visit wouldn’t fly. A Heartland resident recently tested positive, which puts at least a two-week hold on outdoor visits.
Overall, Collins has been pleased with Heartland, and she understands why, for the safety of all the residents, it’s so important to keep unnecessary visitors off facility property. But she wishes the staff would put in more of an effort to facilitate regular communication, even if that just meant a phone call.
“They should be more proactive,” she said. “If I could just get a phone call twice a week from my dad, I’d be such a happy camper.”
Will the state allow indoor visits?
On September 17, two days after MDHHS’s outdoor rule went into effect, the Centers for Medicare and Medicaid Services released its own update to visitation guidelines at nursing homes.
The document says federally licensed nursing homes “should accommodate and support indoor visitation” for any type of visitor — that is, not just those visiting a loved one who’s dying — provided a few things: that the visitors are screened, wear masks, and physically distance, and that the facility hasn’t had a new COVID case in 14 days.
It also says that a facility failing to allow indoor visits “without adequate reason related to clinical necessity or resident safety … would be subject to citation and enforcement actions.”
MDHHS spokesperson Bob Wheaton said in an email that the department has asked CMS for clarification on the guidance, and that it continues to “review data to inform the safest path forward regarding visitation.”
The state’s nursing home task force also “strongly encouarge[s]” indoor visits, but acknowledges that those visits would be far from a return to normal. To that end, they recommend “state-developed training for visitors” to properly and fully educate them about things like hand hygiene and COVID-specific precautions.
Dr. Lona Mody, a professor of internal medicine, geriatrics, and palliative care at the University of Michigan, says this sort of educational program will be key if the state allows facilities to open up further.
“Hearing from a TV celebrity or news media is one thing,” she said. “But then hearing it again from (an infection control) coach who can walk you through both the practical side that’s behind it, and how to do it consistently and safely, would be a nice opportunity at this time.
But even then, it would be a while before normal relations and visits could resume, the type that Jane Ogden says she and her father need most.
“They just want to be patted and hugged, have their hand held — just loved,” she said. “Just know that people love them. And I’m sure that some staff are probably gracious like that, but it’s not the same as your family.”