New guidance from the N.C. Department of Health and Human Services allows outdoor visitation at some residential care facilities.
The updated guidance took effect at 5 p.m. Friday and applies to adult care homes, behavioral health/Intellectual and Development Disabilities facilities, intermediate care facilities and psychiatric residential treatment facilities with more than seven beds.
Nursing homes are not included.
In-person visitation has been discouraged since March, following Gov. Roy Cooper’s emergency declaration for COVID-19, and it was banned, in most circumstances, in April.
The novel coronavirus spreads easily in congregate-living settings, where residents share common areas and sometimes bedrooms.
More than 170 nursing homes and residential-care facilities have had an outbreak, and at least 764 residents have died, according to state health data updated Friday. They account for more than 58% of deaths in the state attributed to the virus.
However, advocates have warned that visitation restrictions can have negative health effects too.
“Literally — I say this without any facetiousness or sarcasm — literally, people are dying from the depression and the loneliness and the isolation and the sadness,” Lauren Zingraff, the executive director of Friends of Residents in Long-Term Care, said in an interview earlier in the week.
According to the new guidance, facilities cannot have in-person visits if they have an ongoing outbreak, as listed by NC DHHS.
Visitors will be screened for coronavirus symptoms and will be required to wear a face covering. The guidance says that visitors can only visit the resident they intended to and must remain six feet apart from them at all times.
There are additional facility, resident and staff requirements. The criteria are to “balance the needs of families and residents to see each other in person with the need to protect residents from COVID-19,” the document says.
Marc Maready, chief operating officer for Ridge Care, called the new guidance “tremendously beneficial” for residents. Ridge Care currently has 16 assisted living facilities, including Preston House in Charlotte.
“Our residents need it so badly,” Maready said.
On Friday, the state health department also issued guidance for smaller residential facilities that allows for indoor visitations, communal dining and other group activities. These guidelines are for facilities with six beds or fewer, such as family care homes and supervised living groups.
All facilities will be required to write plans for visitation, communal dining and group activities that address the factors listed in the guidance.
Visits must be scheduled with facilities ahead of time. Availability of visits will vary based on facility space and the availability of staff and personal protective equipment, known as PPE.
Depending on factors such as disease transmission in the community and visitor non-compliance, the guidance gives facilities the discretion to change visitation practices.
NURSING HOMES EXCLUDED
The N.C. Health Care Facilities Association expressed support for the state’s decision to continue the ban on in-person visitation in nursing homes, where many residents have more extensive medical needs than in other congregate settings.
“Nursing homes care for our state’s most vulnerable citizens, so we support precautions that will better protect our residents from COVID-19,” Adam Sholar, the nursing home trade group’s president and CEO, stated in a news release.
“We are eager to begin welcoming visitors back into our nursing homes. But we know that before that can safely happen, we must slow the spread of the virus in our communities,” he stated.
State data show COVID-19 cases and hospitalizations on an alarming upward trend, prompting Cooper to slow the pace of the state’s economic reopening. On Wednesday, Cooper issued Executive Order 147, extending Phase Two of reopening until July 17. The order restricts visitations for skilled-nursing facilities and combination homes.
Still, many families with loved ones in nursing homes hope they can visit soon.
“I think we could safely permit some outside visitation,” said Roger Regelbrugge, whose 90-year-old father lives at The Cypress of Charlotte.
He has asked state health officials for the change and reached out to advocates and legislators to help push for it.
“It’s been absolutely terrible,” Regelbrugge said of the months that have passed without seeing his father in person. Before the pandemic, they spent every weekend together.
While Regelbrugge has been happy with The Cypress, he can’t help wondering if residents are getting the same level of care now that family members can’t check in on them. He knows the pandemic has exhausted staff.
“I think people just feel very overworked, and I think morale is just generally low for a lot of these workers because they know it’s low for a lot of the residents,” Regelbrugge said.
“To me, that’s an environment where over time, you will get less compliance with regulations, not more, and so I feel like these restrictions sort of become more futile the longer they last.”
Pat Weaver bought a vinyl enclosure called an Under the Weather Pod in an effort to be able to see her husband, who lives at a Triad-area nursing home, in person.
Her husband has a condition that makes communication difficult. Video chats and window visits were confusing to him, but when Weaver visited her husband of 40 years in the pod two weeks ago, the couple was able to connect in a way that felt real for the first time in months.
“When I was able to see him that way, he was able to hear me say, ‘I love you,’ and he said, ‘I love you,’ back,” Weaver said.
The new guidance for residential care homes gave Weaver a sense of optimism. She had been researching policies in other states, like Kentucky, where officials revealed a plan to reopen assisted living facilities, then nursing homes.
“This makes me think that North Carolina is hopefully going to follow a similar path in taking a step by step approach and opening in assisted living first, and then moving to skilled nursing, hopefully in a couple of weeks,” Weaver said.