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Despite risks, governor relaxes visitation limits at nursing homes

STORY BY MICHELLE GENZ (Week of October 29, 2020)

Citing a decline in COVID-19 cases in long-term care facilities and a need for seniors to have social contact, Gov. Ron DeSantis further relaxed visitation limits at nursing homes and assisted living facilities last week.

His revised order removes the five-visitor limit, allows children in, and lets residents leave for overnight stays without being tested as they leave or when they return. In addition, outdoor visitation will now be allowed even if there is an active COVID-19 outbreak going on inside a facility.

The changes come just in time for Thanksgiving, and just when families – including college kids – come home to Vero.

With the nation hitting its highest COVID-19 numbers yet, odds are most visitors will be coming from places where there is more COVID-19 than in Indian River County, potentially increasing the risk that grandparents returning to their facilities after visiting with their families could bring the virus back with them.

Florida does not require visitors to be tested before going to see loved ones in long-term care and the residents themselves won’t have to be tested before they return to their apartments. Instead, the governor said last week, he will leave it up to families and facilities to do what they feel is necessary.

“We want to empower facilities and families to make good decisions,” he said.

DeSantis was emboldened to loosen restrictions because reinstated visitation has gone well so far. Since the ban on visitation in long-term care facilities was lifted Sept. 1 – a move that coincided with schools reopening – fears of rampant viral spread have not materialized.

The previously mandated 14-day pause on visitation triggered by an outbreak will still be in place for indoor visits, as will all the other rules regarding mask-wearing, handwashing, supervision of visits and adherence to social distancing.

DeSantis cited a 70 percent decline in long-term care cases since visitation resumed two months ago.

“We were bracing to see some outbreaks, and yet it’s been a really steep decline,” DeSantis said at a news conference at a Fort Myers senior facility. “I think the families have universally been very, very happy with being reunited with their loved ones.”

With the eventual delivery of more than 400,000 Abbott BinaxNOW tests – $5 tests that require no equipment to process – facilities should be able to test liberally at Thanksgiving, even though they are not required to.

“We’re going to keep sending these tests to the facilities, so you can test your visitors and your staff as much as you want to,” DeSantis said.

“People are saying, ‘Oh, well, you shouldn’t be having Thanksgiving this year.’ And I’m just thinking to myself: Should individuals be in a position to make those determinations? If the families are behaving in a safe way, and the facilities are doing what they should be doing, we need to be able to have family connections,” he said.

He spoke of the importance of “well-being,” including mental health, noting that many of the seniors in group living were nowhere near the end of their lives.

“You’ve got to look at the whole enchilada in terms of health,” he said.

Visitation has “really boosted morale” at Vero’s Brookdale facility, according to Heather Hunter, a spokeswoman for the 38-facility Brookdale chain, which operates an assisted living facility with memory care near McKee Botanical Gardens.

“With the outside world opening up, Brookdale recognizes the importance of getting to some sense of ‘normal’ for our residents, their families and our associates,” Hunter said. “We also recognize the importance of taking a conservative approach to opening. There are a number of safety guidelines necessary when setting up visits.”

“There has been a steady flow of visitors since reopening,” said Michael Smith, a spokesman for Acts Retirement-Life Communities, which owns Indian River Estates, where it operates an assisted-living and nursing home.

Last week’s changes liberalize an order issued by DeSantis on Sept. 1 that reinstated visitation in senior care homes after five and a half months during which visitors were banned due to the perils of COVID-19 contagion among Florida’s most vulnerable population.

In June, more than half the coronavirus deaths in the state were linked to long-term care facilities. One Vero nursing home, Consulate Health Care, has seen 17 COVID-related deaths, while Palm Garden has lost 12 residents to the virus. In July, Sea Breeze had 57 positive cases among residents and staff. It has seen seven residents die with COVID-19.

Lately, the infection and mortality numbers have been much lower in Vero’s nursing homes and assisted living facilities than they were over the summer, but that decline has come hand-in-hand with a reduction in testing.

It’s not clear whether lack of staff and resident testing is contributing to the lower COVID rates. In at least one Vero assisted living facility with a very low COVID count, residents have not been mass tested since May, the last time the state ordered all nursing home residents tested.

It’s been more than a month since the state canceled its contract with Curative, a California company, to do bi-weekly testing of staff in nursing homes and assisted living facilities. The emergency rule requiring that testing expired Sept. 13, and since then, Florida’s 1,350 assisted living facilities have not been required to test staff routinely.

While testing has been reduced, it has not been eliminated.

Nursing homes are still required to test staff and sometimes residents under a federal rule that relies on one of two triggers – an outbreak, or a high positivity rate in the county where the facility is located. The outbreak can be a COVID-19 positive result in as few as one staff member or resident.

For now, with the county’s positivity rate under 5 percent, unless there is an outbreak, homes are only required to test monthly.

As of Monday, out of 25 nursing homes and assisted living facilities in the county, nine facilities had active COVID cases with the total number of cases at 42, including four new cases in the past week.

Those nine facilities would have to restrict indoor visitation for 14 days – allowing only the newly permitted outdoor visitation – provided the infection originated in the facility. If any new case shows up in the same facility, visitation would be called off for another 14 days.