Before the pandemic, Norma Barrientos visited her mother two or three times a week, staying for hours at Skyline Nursing Center, where Mary Sifuentes has lived for more than two years. But they haven’t been allowed to see each other in person at the Dallas nursing home since March, when the state banned visits at such facilities to prevent the spread of COVID-19.
Barrientos said her mother feels abandoned.
“It’s taking a toll on me. Depression is really hitting hard,” she said. “I can only imagine what she’s going through because she stays in bed all day.”
Now, with the state providing new visiting policies, she hopes to reunite with her mother soon.
Since the Health and Human Services Commission announced plans Aug. 6 to allow limited visitation at nursing homes and other long-term care facilities, guidelines for nursing homes have gone into effect.
Other types of facilities will have both indoor and outdoor visitation. More specific rules will be posted for assisted-living and intermediate-care facilities, Kelli Weldon, a spokeswoman for the commission, said in an email.
“Protecting the health and safety of people in facilities we regulate is our top priority,” she said.
The facilities will need the commission’s approval before allowing visitors. The Health and Human Services Commission is reviewing applications to allow visits, but it doesn’t have a number yet for how many have been approved, Weldon said.
Visits will be allowed only at facilities without active COVID-19 cases among residents and with no positive cases among staff members within the last two weeks. Employees must be tested weekly, and visitors will schedule appointments, according to the state. Visitors also will be screened.
It’s not mandatory for a facility to allow visitors, and local rules may override the state’s permission to do so. However, Lauren Trimble, chief of staff for Dallas County Judge Clay Jenkins, said Thursday that the state’s rule supersedes the county’s executive order from the spring, and officials are notifying local facilities of the Health and Human Services Commission’s change.
‘A critical step’
Advocates say that though the new rules are still being implemented, allowing visits is an important development.
“It’s one that I know people have been waiting quite a while for,” said Kevin Warren, president and CEO of the Texas Health Care Association. “While everybody recognizes that there has to be a balance between visitation and maintaining health and safety of the residence, this personal interaction again, in-person contact with families is a critical step.”
Diana Martinez, president and CEO of the Texas Assisted Living Association, said her organization sent more than 800 letters from staff members, residents and their relatives to the state in July to urge resuming visits.
She said residents have struggled with the mental effects of living months in isolation without their loved ones.
“You start seeing people decline. ... That’s where we had gotten,” Martinez said. “One of the big things that we were pushing for is we have to have a plan, even if it may not be attainable right now. We need to plan so people have something to hope for.”
At Skyline Nursing Center, where Barrientos’ mother stays, a representative said Thursday that the facility will follow the state’s rules but declined to say whether Skyline had applied to resume visits.
Barrientos said she has been waiting since last week for a call back from the facility with more information. She isn’t sure how easy the visitation rules will be for her because her mother has dementia, but she hopes the guidelines are a step toward her being allowed to visit her mother.
The facility says it has no active cases of COVID-19, and Barrientos said she’ll take whatever precautions necessary to help prevent the spread of the disease.
“If I have to wear a biohazard suit, I’ll wear that too,” she said. “Whatever it takes — rubber boots, rubber gloves and everything else. That’s how badly I’m missing my momma.”
Godwin Dixon, the co-owner of the new Teresa’s House Assisted Living and Memory Care in McKinney, said it already has applied to allow visitation.
He said the facility’s assisted-living and memory-care units are prepared for COVID-19 because they were designed with safety measures to prevent the spread of diseases such as the flu.
“This is an absolutely critical piece … if the virus were only going to stick around for two to three months, you can lock down pretty severely and everybody can stick it out,” Dixon said. “But for a virus that’s probably going to be the new normal, we need to now say, ‘How do we manage this in the long term?’ ”
Residents and their families have agreed to conduct visits outside, he said.
”This visitation, I think, really is the best of both worlds because we can have the senior getting the care that they so badly need, yet still being able to see and be there with their family,” Dixon said.
In addition to concerns for residents’ and staff members’ health, nursing homes and similar facilities may have legal concerns about ensuring rules for visits are enforced scrupulously.
Nationwide, lawsuits have been filed against nursing homes and other long-term care facilities where residents and workers have succumbed to the virus. In Texas, families in Dallas, Austin and San Antonio already have filed such suits.
For people who can move freely, there may be uncertainty about where they contracted the virus. But for people who must stay isolated in nursing homes and similar facilities, there’s not much doubt where they were exposed.
Still, questions remain about what extent nursing homes and other long-term care facilities can be held liable in the event that a resident or staff member contracts the virus. As the pandemic wears on, facilities across the country are pushing for more immunity against COVID-19 litigation.
As of mid-June, 25 states had granted limited liability protections to long-term care facilities, either through executive orders or state laws, the Texas Alliance For Patient Access told KXAN-TV in Austin.
Although the orders vary from state to state, many don’t protect facilities from criminal liability or gross negligence and neglect lawsuits, for example, in cases in which a facility fails to provide proper precautions or care to prevent COVID-19 outbreaks.
Health-care providers in Texas wrote a letter to Gov. Greg Abbott in April asking for similar protections, arguing that the unprecedented nature of the outbreak put circumstances such as a lack of personal protective equipment out of facilities’ control. But so far the state has not moved to enact similar measures.
Some law firms in Texas have agreed to take on COVID-19 nursing home cases, advertising that facilities may be held responsible in court for compensation including medical expenses and emotional distress if it didn’t take reasonable measures to protect residents.
Is it safe?
Dr. Sarah Ross, assistant professor of geriatrics for the University of North Texas Health Science Center, said she’d feel comfortable encouraging families to visit their loved ones, based on the guidelines the state has set.
Ross, who serves as the co-medical director at the James L. West Center for Dementia Care in Fort Worth, said she has seen the prolonged restrictions on visits harm residents, leading to depression, loneliness and weight loss. She said she has seen two cases in which residents’ spouses have considered moving into the nursing home just to have contact with their partners.
“Nothing’s going to be risk-free,” Ross said. “There is going to be some risk of exposure on either end. But I think that that contact is important … both on the patient and on the family side, they’ve missed out on that for several months now.”
She said the state’s guidelines reduce the risk of exposure as much as possible, based on what is known about the virus.
Visitors and residents will be required to wear masks when they’re together, and facilities must notify the state if an outbreak occurs.
But families can take other precautions before and during their visits, Ross said.
Some health experts have suggested keeping visits short and considering the daily activities leading up to the visits to evaluate individuals’ risk of passing on the virus.
People who have had frequent contact with people outside their homes could quarantine themselves for 14 days before visiting a nursing home, Ross said.
“In addition to the mask and hand-washing, just checking that daily temperature so that if something creeps up, and you don’t have any symptoms but your temperature is rising, you can be alerted to something early,” she said.