The Kansas agency that oversees nursing homes has been lax in ensuring that residents retain the right to have visitors when they want, advocates and families charge.
Since the Center for Medicaid Services (CMS) expanded visitation access in March, the state ombudsman for long term care facilities and the non-profit Kansas Advocates for Better Care say they have consistently heard from residents and family members about restrictions that are seemingly unrelated to control of the COVID-19 virus.
As the delta variant spreads across the state, complaints have only increased, said Margaret Farley, executive director of Kansas Advocates for Better Care. If facilities are following proper infection control and more staff members were vaccinated, Farley said, such restrictions would not be necessary.
Long term care administrators and trade associations say such restrictions are essential to prevent new outbreaks as delta poses new challenges and risks
State ombudsman Camille Russell said her staff is often able to resolve the issues directly with the nursing home. Some homes, she said, told her they didn’t have adequate staffing to accommodate visitors or that corporate policy is dictating their decisions.
In some cases, she said, complaints have been forwarded to the Kansas Department of Aging and Disability.
But, Russell said some families are hesitant to bring grievances to the department or speak publicly about their concerns “for fear of making their situation worse.”
The department said that since March it has received 29 complaints related to visitation. It has acted on none.
COVID has exacted a heavy toll on Kansas nursing homes.
Since March 2019, 15,682 cases and 2,023 deaths have been linked to long term care facilities. Many places shut visitors out completely to avoid major outbreaks, potentially harming the mental health of residents. It also kept family members, who advocates say are key watchdogs for ensuring proper care, at arm’s length.
But last March, as staff and residents gained access to vaccines, CMS loosened guidelines so that fully vaccinated residents could receive visitors.
Yet even with new guidance in place, homes kept imposing limits on visitation, Farley and Russell said. Some insisted that visitors could only stay for a limited time or come only a certain amount of time each week.
“We’re afraid that facilities are acting out of fear. And that fear is understandable but restricting access to residents visitors, that residents want to visit with is not a solution. It is creating further harm for residents,” Farley said. “The fact that families come into facilities is important in terms of the quality of life for residents. Family members often provide observations that can be communicated to nurse staff that they may not be aware of.”
There has been no statewide survey of facilities and their policies, Farley said, so it’s unclear exactly how widespread the restrictions are.
“When visitors come in they find problems and then (the homes) have to address the problems,” Russell said. “It’s just perpetuating the neglect that has already occurred to continue … A lot of the visitors that are coming in have vaccinated at fairly high rates because they have loved ones they want to go see. It’s still the staff that has not vaccinated at that high rate.”
In a statement, KDADS spokeswoman Cara Sloan Ramos said the state takes a balanced approach with investigating complaints and understands the difficult situation nursing homes are in.
“Through the COVID-19 pandemic and still today, KDADS recognizes that the prolonged separation of long-term care residents from their loved ones takes a significant toll on the health of everyone involved, including the health care workers in those facilities,” the statement said. “Visitation is a right for residents in adult care homes and facilities should make best efforts in accordance with CMS and KDADS guidance.”
But advocates say the lack of action is perpetuating restrictions.
“If the enforcement authority was coming out in a bolder way against these restrictions that could only benefit residents’ right to visitation being more freely granted,” Farley said.
Impact of delta
Debra Zehr, President of LeadingAge Kansas - an association of non-profit nursing homes, said facilities are in an increasingly difficult position and that advocates concerned about visitation have distorted the situation.
“There’s a reality check here,” Zehr said. “We have now the delta variant which is much more transmissible out there and increasing daily. It’s not advisable to further liberalize visitation at a time when you may put people at the highest risk.”
The 29 complaints to KDADS, she said, is relatively low considering more than 300 nursing homes operate in Kansas.
Low vaccination rates among nursing homes staff, Zehr said, further exacerbates the situation.
According to the Centers for Disease Control 86% of residents in Kansas nursing homes are vaccinated while only 57% of staff are fully inoculated.
If there is a coronavirus outbreak in a nursing home, CMS guidelines require the facility to shut out visitors while facility wide testing is completed.
According to the Kansas Department of Health and Environment there are currently COVID-19 outbreaks connected to 28 homes.
In an email to families last week Villa Saint Francis in Olathe announced it was closing out visitors because of positive COVID-19 cases. Shawnee Gardens Healthcare and Rehabilitation Center, in Shawnee, made a similar announcement on their website.
Good Samaritan nursing homes in Olathe announced last week that they’d begin requiring staff to be vaccinated. Joanna Randall, president of the Olathe homes, said she believed that the new requirement would help keep outbreaks at bay and visitors allowed.
“That takes out a huge piece of risk of COVID coming into our building,” she said. “As long as we don’t have any outbreaks, then we don’t have to limit any sort of visitation.”
Jennifer Schrack, a Johns Hopkins University epidemiologist who focuses on aging, said that while vaccines are effective in preventing serious disease or death, nursing homes must be careful and adhere to best practices like masking, social distancing and outdoor visitation when possible because of the vulnerable population they serve.
Most outbreaks in homes, she said, have been linked to unvaccinated staff but visitors can pose a risk as well and concerns remain that a new variant could bypass the vaccine.
“It’s important for us to understand that even though they are protected, we still need to be cautious,” she said.