Florida nursing homes to reopen to visitors -- with some restrictions

Florida Gov. Ron DeSantis said Tuesday he will allow visitors into nursing homes and assisted living facilities, nearly six months after the state blocked visitation during the first wave of coronavirus infections.

DeSantis said during an appearance in Jacksonville that he would sign an executive order lifting the ban on visitors, while also allowing “essential” caregivers to touch long-term care residents.

Two elder-care advocacy groups criticized the move to reopen facilities, asking why it is coming now and questioning a decision not to mandate that visitors be tested before entering facilities.

The executive order will take effect immediately, said Agency for Health Care Administration Secretary Mary Mayhew, who headed a DeSantis-appointed task force that came up with recommendations for reopening facilities. 

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But Mayhew said long-term care providers will need to have written policies in place before the doors swing open to allow “essential,” “compassionate” and “general” visitation to resume.

Mayhew, whose agency licenses most of the state’s long-term care facilities, said providers will be “moving with a sense of urgency” to get the policies in place.

In announcing the executive order, DeSantis acknowledged that the move will increase the number of COVID-19 cases in long-term care facilities but said the need for visitation --- which has been banned for the most part since March 15 --- could no longer be ignored.

“Many of the folks understand that they have loved ones who are in the last stage of their life. They are not demanding a medical miracle, they are not having unrealistic expectations. They would just like to say goodbye or hug somebody,” DeSantis said through a choked voice, before adding, “I think it’s difficult to think that some of our actions may have prevented …”

DeSantis’ Task Force on the Safe and Limited Re-Opening of Long-Term Care Facilities finished working on its recommendations last week.

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The governor announced the reopening in Jacksonville, where task-force member Mary Daniel lives. Daniel, founder of the group Caregivers for Compromise, gained national attention after she took a job as a dishwasher at a memory-care facility where her husband resides. Daniel argued that the visitation ban was more harmful than effective, saying that residents were depressed and some were dying from the isolation because they didn’t flourish.

Daniel’s advocacy helped influence the recommendations, including expanding the type of services that people categorized as essential caregivers could provide. The expansion involved adding emotional support to a list of services that essential caregivers provide.

Department of Health Secretary Scott Rivkees, also a member of the task force, said Florida is the only state to consider emotional support an activity of daily living, such as eating, bathing and dressing. Essential caregivers who help residents with activities of daily living will be allowed access to residents’ rooms and won’t have to adhere to social distancing requirements, allowing them to touch residents.

“It’s going to be as if the days didn't happen. Because that first hug, that first conversation, and rubbing their back, and holding their hand will take away the pain that we all have been suffering these past 175 days,” Daniel said. She also predicted that Florida’s decision to allow emotional support provided by essential caregivers will become a blueprint for other states to follow.

The guidelines will allow each resident to have two designated essential caregivers, though only one could visit at a time. People with intellectual and developmental disabilities are allowed to have visits from two essential caregivers at a time.

The executive order, which also applies to intermediate care facilities for people with developmental disabilities and group homes, is based on the recommendations crafted by the task force. The recommendations called for allowing general visitation at long-term care facilities so long as the facilities have gone 14 days without any new cases of COVID-19 among residents and staff.

Unlike essential caregivers, general visitors will be required to socially distance from the residents. The task force also recommended that general visitors be limited to people age 18 and older, but DeSantis said he was going to revisit that policy. 

Emmett Reed, executive director of the Florida Health Care Association and a task-force member, said his nursing-home industry group is waiting to see the details of the executive order and the rules and regulations that will accompany it. But Reed is hopeful that the fine print will give long-term care facilities flexibility to implement the new policies. 

While Reed said his sense is that opening visitation to essential and “compassionate” caregivers is the top priority. But he said some facilities may choose to include general visitation in their initial reopenings. Compassionate visitors would be allowed access to help residents through situations such as the death of a loved one.

“Every care center is different, and if you ask my members (about reopening plans), three different members will give three different answers. Flexibility is really important to us,” Reed said.

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As of Saturday, 9,020 long-term care residents were infected with COVID-19. 

AARP State Director Jeff Johnson issued a statement acknowledging that families will be pleased with the changes, but he asked why they are coming now.

“While it is true that the number of active cases in elder-care facilities has declined somewhat from its high point in recent weeks, the virus is still circulating in our communities. We would note that cases were far lower in May and June than now, yet the ban on visitation was not changed. If this is sound policy now, why was it not sound policy then?” he said. 

The recommendations would allow nursing facilities to ask visitors to take COVID-19 tests but only if the tests comply with federal Centers for Disease Control and Prevention and Food and Drug Administration guidelines. Those guidelines were altered last week to recommend testing for symptomatic people only.

Former state long-term care ombudsman Brian Lee sent a letter Monday to DeSantis asking that the state not allow nursing home visitation unless facilities have the ability to conduct COVID-19 tests on asymptomatic or symptomatic people.

Lee, executive director of the advocacy group Families For Better Care, said allowing visitation without requiring molecular testing is dangerous and potentially deadly.

“Make no mistake, Families for Better Care desperately wants families reunited as soon as possible. Families must be able to comfort and pray with each other,” Lee wrote in his letter. “But families need to be assured that they will survive your visitation plan once it's activated. There is no margin for error for getting this wrong. No one else needs to die unnecessarily because a premature visitation policy failed to have the right kind of testing in place. Please include a molecular rapid testing requirement in your visitation plan.”