Visitation resumes amid COVID in Michigan nursing homes — with limits

Michigan’s nursing home residents — many isolated and having not felt the touch of loved ones for nearly a year — are once again able to accept visitors, two at a time and under restrictions.

The new Residential Care Facilities Order, enacted Tuesday, clears the way for visitors, even in areas that have higher levels of the coronavirus, and encourages other policies that will help relieve loneliness among the state’s most vulnerable residents.

Under the order signed by Elizabeth Hertel, director of the Michigan Department of Health and Human Services, the level of COVID risk in a given county — outlined on the MiStart dashboard — is stripped from the state’s formula for determining whether a facility reopens. 

Now, visitation is allowed in all counties as long as nursing homes and a range of care facilities have not had a new COVID-19 case in the prior 14 days.

The order also: 

• Encourages — but does not require — communal dining and group activities for residents.
• Requires visitors 13 years and older to be tested for COVID before visiting. Facilities should provide rapid testing “whenever possible.” When such testing is not available, the visitor must find an alternative test within 72 hours of the visit, and provide proof of a negative result before they enter the facility.
• Requires visitors to wear face masks or other personal protective equipment in nearly all circumstances. 
• Requires visitors to maintain a social distance of at least six feet in all but the most extreme circumstances, such as end-of-life visits.

The order, effective immediately, opens up visitations to long-term care facilities — nursing homes, adult foster care homes, homes for the aged, substance use disorder residential programs, and hospice care.

Many have banned indoor visitation altogether since March 14, first under an executive order signed by Gov. Gretchen Whitmer and later under orders, extended and tweaked, by the MDHHS after Whitmer lost some of her emergency powers.

While those state orders had prohibited indoor visitation based on the risk level assigned on the state’s MiStart map, even nursing homes in counties  with safer risk levels have sometimes continued to keep their doors locked, multiple advocates and family members have told Bridge. 

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• Amid the isolation of COVID, Michigan Alzheimer’s deaths soar
• He had dementia and COVID. She wanted to hold him when he died.

Nursing homes have said they are not only at the mercy of MiStart map levels but also could only open after being been COVID-free for 14 days. They also said they have faced confusing layers of guidance and requirements from the state and the U.S. Centers for Medicare and Medicaid Services.

For example, the state has allowed visitation since April for residents “in serious or critical condition or in hospice care,” but even that has not always happened.

“Providers weren't clear in probably —  in some cases still aren't clear — what ‘end-of-life’ visits really mean. Some interpreted that to mean that residents had to be actively dying,” David Gehm, president of Wellspring Lutheran Services, which operates several facilities around Michigan, told lawmakers last week during a Michigan House Oversight Committee.

Under the new order signed Tuesday, facilities “must support and accommodate” indoor visitations in nearly all circumstances.

“Due to the trends that we're seeing, we're taking a step forward, but a cautious one,” Hertel, the MDHHS director, said Tuesday in announcing the changes.

At the same time, Hertel and Whitmer loosened restrictions on restaurants, retail, casinos, gymnasiums and other recreational facilities. Whitmer also announced a new task force to study the return to in-person work.

“The only reason we are at this point is because we've been doing the right thing every day to protect yourself and your family and your community, by wearing a mask and washing your hands and maintaining social distance,” Whitmer said during the announcement. “We know that these are the three pillars of pandemic public health.”

In fact, confirmed COVID cases in Michigan nursing homes fell to just 44 cases last week, down from 827 on Dec. 28, following a statewide campaign to prioritize vaccinations to nursing home residents and staff. Overall, cases, hospitalizations and tests positivity have generally dropped in recent weeks, but COVID-19 continues to threaten the state and its long-term care residents, said Dr. Joneigh Khaldun, the state’s chief medical executive.

Khaldun also noted, however, that the state had confirmed 402 cases of the more contagious B.1.1.7 variant by Tuesday.

“We are at a critical time in our fight against this pandemic. Case rates have dropped significantly since the fall surge, but … they are no longer dropping,” she said.

The slow reopening of senior care facilities isn’t enough for some, who argue that it’s isolation, not infection, that is the bigger threat in nursing homes now.

As Bridge reported in January, Michigan deaths from Alzheimer’s jumped 18 percent in 2020 from the previous six-year average. Similar rises were noted nationally.

Nearly every resident in the state’s long-term care facilities who wants a vaccine has received at least one dose now; and most have had their second dose as well of the two-dose regimen.

Michelle Thompson, an administrator on the Facebook page Michigan Caregivers for Compromise, which has pushed for visitation, said she has been able to visit with her 87-year-old mother, Norma Thompson, since last summer only when she left her nursing home and was hospitalized for several days.

She worries that Tuesday’s order still leaves too much discretion to nursing homes to keep visitors away.

“They’re still making us wear masks. They’re still making us stay six feet away. It’s nothing — absolutely nothing,” she said of the order, tearfully.

But Paula Cunnningham, director of Michigan AARP, lauded Tuesday’s announcement. The decision to open is “being done in a careful deliberate manner,” she said during the news conference.

Melissa Samuel, president and CEO of the Healthcare Association of Michigan, which represents nursing homes, called the new rule a “significant” change for nursing homes because it simplifies reopening. The testing requirement for visitors further reassures facilities worried about COVID spread, she said.

Samuel said she’s confident facilities that have been reluctant do reopen will do so now. “They acutely understand the importance of residents being connected with their families, and they understand what this extended period of time has done,” she said. “As long as it's safe to do, and they can do it within the guidelines, I'm confident that facilities will be" reopening, she said. 

Visitation and other measures, though, must be monitored closely for any resurgence in infection rates, said Dr. Teena Chopra, an infection disease expert in long-term care and a professor at Wayne State University who heads infection control at the Detroit Medical Center.

Additionally, visitors should continue to stay outside until they are vaccinated, she told Bridge Michigan. While residents may be vaccinated, they may still be susceptible to the new coronavirus variants, including B.1.1.7.

“If we get too relaxed, too complacent, these new variants can take over,” she said. “Right now, it’s a race, it’s a fight, between the variants and the vaccines.”