The world powers with the most infected with covid-19 0:56
(CNN) --
As Covid-19 cases rise again in nursing homes, some states have begun requiring visitors to show proof they're uninfected before entering the facility, fueling frustration and dismay among relatives.
Officials in California, New York and Rhode Island say the new COVID-19 testing requirements are necessary to protect residents - a highly vulnerable population - from exposure to the highly contagious omicron variant.
But many family members say they can't get tests amid huge demand and tight supplies, preventing them from seeing their loved ones.
And staying out of the facilities is unbearable, like a nightmare that repeats itself endlessly.
Severe staffing shortages are complicating the effort to ensure safety while keeping facilities open;
this shortage also jeopardizes care in long-term care facilities, a concern of many family members.
What are the world powers with the highest percentage of the population infected by the covid-19 pandemic?
"Another confinement" before new policies in nursing homes
The mother of Andrea DuBrow, 75 years old and with a serious Alzheimer's disease, has lived for almost four years in a nursing home in Danville, California.
When DuBrow couldn't see her during the early months of the pandemic, she said, her mother forgot who she was.
"This latest restriction is essentially another lockdown," DuBrow said at a meeting last week about California's new rule.
"The time that my mother has left in which she can recognize, in some small part of her that is locked up, that it is me, her daughter, cleaning her, feeding her, holding her hand, singing her favorite songs, that time they're stealing it."
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"This is a huge inconvenience, but the most annoying thing is that no one seems to have any kind of long-term plan for families and residents," said Ozzie Rohm, whose 94-year-old father lives in a San Francisco nursing home.
Why are family members subject to testing requirements that do not apply to employees, Rohm wondered.
If family members are vaccinated and boosted, wear good masks, stay in the resident's room, and practice rigorous hand hygiene, are they a greater risk than employees following these procedures?
New policies in some states
California was the first state to announce new policies for visitors to nursing homes and other long-term care facilities on December 31. These entered into force on January 7 and will remain in place for at least 30 days. In order to see a resident, the person must show that they were negative in the rapid covid-19 test carried out within 24 hours or in the PCR test carried out within 48 hours. In addition, it is necessary to be vaccinated against covid-19.
In a statement announcing the new policy, the California Department of Public Health cited "the increased transmissibility" of the omicron variant and the need to "protect especially vulnerable populations in long-term care settings."
Throughout the pandemic, nursing home residents have suffered disproportionately high rates of illness and death.
New York followed California with an announcement on Jan. 7 that visitors to nursing homes would have to show a negative rapid test taken no later than a day earlier.
And on January 10, Rhode Island announced a new rule requiring proof of vaccination or a negative COVID-19 test.
Patient advocates fear other states will take similar steps.
"We're concerned that omicron is being used as an excuse to shut down visits again," said Sam Brooks, director of programs and policy for National Consumer Voice for Quality Long-Term Care, an advocacy group for people living in these centers.
"We don't want to go back to the last two years of nursing home lockdowns, isolation and abandonment of residents," he continued.
More flexibility required
To be tested or not for covid-19?
The medical keys 2:05
That's also a priority for the federal Centers for Medicare & Medicaid Services (CMS), which since Nov. 12 has emphasized residents' rights to unrestricted visitation as long as guidelines are followed. security protocols. Nursing homes may encourage, but not require, visitors to be tested in advance or provide proof of vaccination against the COVID-19 virus, the CMS guidelines explain. Safety protocols included the use of masks, rigorous hand hygiene, and maintaining adequate physical distance from other residents.
However, with the rise of omicron, the establishments objected. On December 17, an organization representing nursing home medical directors and two national long-term care associations sent a letter to the CMS administrator asking for more flexibility to "protect the safety of residents" and "establish temporary restrictions on visits to residences". On Jan. 6, CMS upheld residents' right to visitation, but said states could "take additional steps to make visitation safer."
Asked for comment on the states' recent actions, the federal agency said in a statement to KHN that "a state may require nursing homes to test visitors as long as the facility provides the rapid antigen tests." and there are sufficient supplies for testing (…) However, if there are insufficient rapid testing supplies, visits should be allowed to proceed without a test (while adhering to other practices, such as wearing a mask and physical distancing).
"Bunker mentality is not a solution"
The Joe Biden administration's new plan to distribute four free tests per household may ease the testing shortage.
But for family members who visit nursing home residents several times a week, that supply won't be enough.
The website to request free covid-19 tests in the US is already working: what you need to know
Since the beginning of the year, tensions have intensified over the balance between security and visitation rights for residents.
In the week ending January 9, 57,243 nursing home employees reported Covid-19 infections, nearly 10 times more than three weeks earlier.
During the same period, resident infections reached 32,061, almost eight times more than three weeks earlier.
But the outbreaks today occur in a different context. According to the CMS, more than 87% of nursing home residents are fully vaccinated, and 63% have also received booster doses, reducing the risk posed by covid-19. In addition, nursing homes gained experience in managing outbreaks. And the effects of nursing home lockdowns are now better understood: loneliness, despair, neglect and physical decline.
"We've all seen the negative effects of restricted visitation on the health and well-being of residents," says Joseph Gaugler, a professor who studies long-term care at the University of Minnesota School of Public Health.
"For nursing homes to go back to a bunker mentality and shut everything down is not a solution."
Dire shortage of staff
Amid dire staffing shortages, "we need people in these buildings who can take care of residents, and often these are visitors who basically function as unpaid certified nursing assistants: cleaning and cleaning residents, turning and repositioning They feed them, stretch them and exercise them," said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.
Nearly 420,000 employees have left nursing homes since February 2020, according to the US Bureau of Labor Statistics, compounding existing shortages.
When DuBrow learned of California's new testing requirement for visitors, he arranged for a PCR test at a testing center on Jan. 6, expecting results within 48 hours.
Instead, he waited 104 hours before getting a response.
(His test was negative.)
Eager to visit her mother, DuBrow called every CVS, Walgreens and Target within a 25-mile radius of her home asking for a test, but got nothing.
"I'm constantly tired": Omicron variant puts essential workers under a lot of pressure
"I wish there were easy answers"
In a statement, the California Department of Public Health said the state had established 6,288 COVID-19 testing centers and shipped millions of home tests to counties and local jurisdictions.
In New York, Democratic Governor Kathy Hochul has pledged to send nearly a million Covid-19 tests to nursing homes, where visitors can take them on the spot, but that presents its own problems.
"We don't want to test visitors standing in line at the door. We don't have clinical staff to do that, and we have to focus all of our staff on caring for residents," said Stephen Hanse, president and CEO of New York State Health. Facilities Association, an industry organization.
With the current staffing shortage, trying to ensure visitors wear masks, physically distance and adhere to infection control practices is "exhausting for staff," said Janine Finck-Boyle, vice president of regulatory affairs at Leading Age. , which represents nonprofit long-term care providers.
"The challenges are really huge," said Gaugler, of the University of Minnesota, "and I wish there were easy answers."
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