Debate Over Touching Stalls Nursing Home Recommendations
In question is how to allow visitation by members of the general public at many of the state’s 4,000 long-term care facilities.
A task force set up by Gov. Ron DeSantis reached broad agreement Tuesday on a plan that would reopen nursing homes to “essential” and “compassionate” caregivers, as well as allow visitation by members of the general public at many of the state’s 4,000 long-term care facilities.
But a divide remains over a return to normalcy.
Family members and the public were shut out of nursing homes and assisted living facilities in March amid evidence that older and frailer residents are most vulnerable to die from COVID-19, the highly contagious respiratory disease caused by the coronavirus.
With coronavirus infections tapering off and the moratorium on visitation set to expire the first week in September, DeSantis wants to open facilities back up. But members of his hand-picked group, dubbed the Task Force on the Safe and Limited Re-Opening of Long Term Care Facilities, haven’t agreed on whether to allow members of the general public, who would be required to wear face masks, to touch residents during visits.
The discord over that issue will force the panel to hold at least one more meeting Wednesday before finalizing recommendations and presenting them to DeSantis.
Task force member Mary Daniel, who went to work in a long-term care facility as a dishwasher just to spend time near her husband, vociferously opposed a proposed recommendation that would require general visitors to maintain social distance from residents they are visiting. Draft recommendations currently wouldn’t require general visitors to social distance from the residents they are seeing. The recommendations would require social distancing from all other residents.
Mary Mayhew, secretary of the Agency for Health Care Administration and chairwoman of the task force, discussed broadening the recommendation to require six feet of separation for all visitation.
“No, no, no, no, and no. We need to touch them. They need to be touched. We need to hold their hands. We need to touch them. Please don’t take that away,” Daniel said when Mayhew asked her about the proposed change. “That’s a deal breaker for me. We have to be able to touch them.”
State Surgeon General Scott Rivkees, a member of the task force, said social distancing continues to be necessary. He explained that being close to a person for 15 minutes is considered an “exposure,” even if everyone is wearing face masks.
“If individuals are getting close together, there is going to be spread. The closer they are together. Hugging is more. It really increases an individual's risk of getting COVID if somebody has COVID-19. The social distance and the masks, they go hand and hand together. I am very sympathetic to the needs for hugging and touching. But if you look at the guidelines for just about every other state that I have reviewed, the distancing and the masks are critical elements,” Rivkees said. “Breaking down this barrier really could increase the risk of the individual who is being visited. There’s no way around that.”
Touching wasn’t the only issue that the committee wrestled with.
Rivkees requested the elimination of a draft recommendation to allow long-term care facilities to require testing for visitors, a request that was opposed by the two long-term care industry representatives on the task force: Florida Health Care Association Executive Director Emmett Reed and Florida Senior Living Association President and CEO Gail Matillo. They said the recommendations should give long-term care providers flexibility to test if they choose.
Rivkees argued against allowing facilities to decide on testing, noting that test results are only a point in time. And rapid point-of-care tests are only effective when used on symptomatic people who --- he argued --- wouldn’t pass required front-door screening, which would include taking temperatures.
“A facility may want to require testing,” Rivkees said, “but it doesn’t mean that requirement is grounded in science."
Overall, the task force agreed to allow general visitation by people age 18 and older at nursing facilities that have gone 14 days without the onset of new COVID-19 cases among residents or staff.
Initially, the group’s recommendations only included residents in the 14-day count, but Rivkees said it was important to also include staff members.
Based on data from the past 14 days, about 80 percent of the state’s assisted living facilities, nursing homes and intermediate care facilities for people with developmental disabilities would be cleared to open visitation to the general public under the 14-day standard.
The task force also agreed to allow facilities that meet the 14-day standard to begin offering beauty salon and barber services.
DeSantis appointed the task force and charged it with making recommendations on how to safely reopen facilities to visitors. As of Tuesday, there were 9,777 residents of nursing homes, assisted living facilities and intermediate care facilities for the developmentally disabled who were infected with COVID-19 at their residences. More than half of them have been transferred out of the facilities, either to hospitals or one of 23 dedicated COVID-19 facilities.
Meanwhile, under the recommendations, people who are closest to residents --- so-called “essential caregivers” --- would be allowed visitation regardless of whether facilities have gone 14 days without a new onset of COVID-19. Essential caregivers are people who provide health care services or assistance with activities such as bathing, dressing and eating.
Another category, compassionate visitors, would be allowed access to help residents through situations such as the death of a loved one.
All visitors, whether they are members of the general public, essential caregivers or compassionate visitors would be required to wear personal protective equipment and face masks. Every resident would be allowed to designate at least one essential care provider.
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