ST. LOUIS — Federal regulators have lifted a ban on visits to most nursing homes, allowing residents at hundreds of Missouri facilities to see their loved ones up close and, in some cases, indoors for the first time in months.
The new rule, announced Thursday by the Centers for Medicare and Medicaid Services, lifts a ban on visits to nursing homes put in place in March to control the spread of COVID-19, allowing visits at nearly all of the 15,000 federally licensed nursing homes across the country, including 522 in Missouri.
While Missouri and other states have already allowed outdoor visits at some state-licensed homes, the CMS requires that outdoor visitation resume at hundreds more nursing homes.
And it requires indoor visits be allowed at homes that meet two key conditions: no new COVID-19 case in the past two weeks, and the surrounding county must have a positivity rate — an infection rate among those tested for COVID-19 — that is no higher than 10%.
The decision was welcomed by advocates for nursing home residents, who have long raised concerns that visits and social activities are crucial for nursing home residents’ physical and mental health, especially those unable to operate phones or other communication devices.
“We’re thrilled that families can be reunited,” said Marjorie Moore, with VOYCE, a Creve Coeur-based nonprofit that advocates for nursing home residents.
CMS in March also closed down communal dining and group activities for nursing home residents, effectively limiting them to their bedrooms.
Nursing homes can now resume social activities for residents and communal dining — with required social distancing measures, and requirements that all residents and staff wear masks.
“They’ve been doing without those little things that make them happy for so long,” Moore said.
But the visits and social activities have to be done safely, advocates stressed.
Because the virus is highly contagious and particularly dangerous to older adults with preexisting conditions, it poses a severe threat to nursing homes providing elderly patients close care.
As of Sept. 17, COVID-19 had killed 54,437 residents of federally licensed nursing homes across the country and infected 223,626 residents, CMS reports.
In Missouri, 848 residents of federally licensed nursing homes have died of COVID-19, up from 650 deaths as of Aug. 16. A total 4,791 residents have been infected, and the virus has also sickened nursing home employees, killing 13.
While the virus’ spread has slowed in some areas, including St. Louis County, which last week reported a slowdown in COVID-19 infections at care homes, the St. Louis region has continued to see climbing infection rates among the wider community.
That poses a concern because, while the virus is less dangerous to healthy younger adults, it can be spread by people who are asymptomatic, Moore said.
“Whenever we have people going in and out of nursing homes you have that chance of bringing it in,” Moore said.
“Bringing COVID into a facility is just one of the deadliest things that can happen now. Making sure they’re wearing a mask, that they’re staying home if they’re sick, is especially important for people with relatives in nursing homes.”
Residential care facilities are expected to continue taking preventative measures including screening employees, residents and visitors for COVID-19 symptoms, providing them with face masks and gloves, requiring frequent hand-washing and cleaning common areas. The CMS rules places strict requirements on visits. Indoors visits, in particular must meet conditions including:
• Only one visitor per resident will be allowed inside at a time.
• Visitors must wear masks.
• Visitors, residents and staff must adhere to social-distancing guidelines.
• Visitors must be quickly directed to a designated meeting area, and can’t roam the halls or visit common-room areas.
But residents are allowed visits at qualifying nursing homes, and federal regulators can sanction nursing homes that prohibit a visitation without a valid medical reason.
The CMS rule only applies to nursing homes that receive funding through Medicare or Medicaid, and doesn’t apply to assisted-living homes or other types of residential care facilities.
The Missouri Department of Health and Senior Services is expected to announce similar rules allowing indoor visits to assisted-living communities and other types of residential care facilities that are regulated by state or local authorities, said Bill Bates, CEO of LeadingAge Missouri.
After the ban was enacted in March, family members of nursing homes residents were only allowed to visit them for “compassionate care,” or end-of-live visits.
But many families in the St. Louis complained of difficulty getting information about loved ones living inside facilities where the virus spread, in some cases calling facilities only to learn their loved ones were infected with COVID-19 days earlier. The CMS rule also expands the reasons a family member would be allowed a “compassionate care” visit at a nursing home reporting new COVID-19 cases.
The visits will also allow families to install video cameras in residents’ rooms under a new Missouri law. Though the law went into effect Sept. 3, many families weren’t able to get inside the homes to start the process, Moore said. Her agency is bracing for calls from concerned families.
“We’re concerned about what people are going to find when they are able to get in,” Moore said. “We are probably going to be seeing a lot of people seeing their family members for the first time.”
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