COVID-19 Restrictions in Nursing Homes

There has been so much negative information and press about the COVID-19 virus and the nursing home population. Residents in nursing homes are very much an at-risk population but suffer from isolation, and it continues to be a real issue. Group activities have stopped, socialization during meals has been extremely limited, and physical and occupational therapy have transitioned to individual sessions in the resident’s room.

I was interested in learning more about this issue, specifically, how facilities are coping, mitigating risk, and analyzing the effects of how COVID-19 has impacted residents in skilled nursing facilities and assisted living facilities. More importantly, how COVID-19 will impact those in the near future that really need the services of a skilled nursing facility.

I spent some time talking with an associate, Briana, a Skilled Nursing Facility Care Transition Coordinator here in Florida. The information that I am sharing is not true for every skilled nursing facility in Florida and certainly not true for every skilled nursing facility outside of Florida. What is true is that COVID-19 has had an immense impact on the nursing home industry and on those who require the services.

If placement of a skilled nursing facility or assisted living facility is something that you or a family member is considering, I strongly recommend researching as the first step. Do not assume being admitted to a skilled nursing facility is a “death sentence.” Make contact with the transition coordinator or admissions coordinator, ask questions and compare facilities. Briana and her staff have developed very creative and heartfelt interventions for residents and families to keep them connected and thriving during such a difficult time.

Begin your search by exploring the facility policy on COVID-19 testing for staff and residents. Briana shared that at her facility, every resident is tested upon admission even after a test was done 48 hours prior to being discharged from the hospital. A positive test moves the resident to a separate wing of the facility for a 14-day quarantine with supportive care for patients with symptoms. Complicated symptom management results in a transfer back to the hospital. After admission, every resident and staff member are tested every two weeks. Staff is screened daily prior to the start of the work day.

In Florida, and possibly many other states, it may have been difficult in the past few months to find a skilled nursing facility with no COVID-19 patients. Briana shared with me that there are certain long term care facilities in the state accepting only COVID-19 positive patients, providing post-hospital care as well as rehabilitation (thus limiting the number of available nursing home beds within different communities). As of last week, approximately 62% of Florida facilities have not had a positive case since August 11 (reported by the Agency for Health Care Administration).

If a patient is being considered for short-term skilled nursing home placement, Briana cautions that her facility, and possibly many others, are reviewing each applicant carefully for rehab potential. The facility is being very selective in the acceptance process. The goal is for a positive rehab experience over a short period of time in preparation for the resident to discharge to home. The patient with a chronic condition or limited treatment option may be declined admission. As a result, this has forced patients and families to face mortality and some tough decisions a lot sooner than they were prepared to do. Hospital discharge planners and social workers are encouraged to open this dialogue well before the discharge plan is finalized.

When Briana and I spoke, the big question in Florida was when the no visitor restriction will be lifted. As of last week the nursing home task force in Florida recommends two visitors at a time wearing protective equipment with masks. In order to lessen visitor restrictions, facilities will be required to go 14 days without any new COVID-19 cases among staff or residents. Several other states such as New York, California and Texas are allowing visitation with restrictions. There is hope for the future!