Anne Kuczkowski of Hamburg has experienced all the starts and stops for nursing home visitation in New York state over the last 21 months.
There was the initial visitation ban at the onset of the COVID-19 pandemic in March of 2020, the soft reopening with outdoor visits in July of 2020, as well as the former rule that nursing homes must shut down visits for two weeks if they have a single positive case.
“It's been a flip-flop back and forth, and we never knew from day to day how it was going to be,” said Kuczkowski, whose 92-year-old mother, Mary Jane Meinzer, is a resident of Schofield Residence, a 120-bed nursing home in Kenmore.
More recently, limited visitation hours and the requirement to call ahead had become the norm.
“And then all of a sudden, I call to make an appointment and [the nursing home says], ‘Oh, well you can come whenever you want. Now you don't have to make an appointment,’” Kuczkowski said.
That’s because last month the U.S. Centers for Medicare and Medicaid Services, which regulates nursing homes at the federal level, revised itsguidance to require nursing homes allow visitation at all times. The guidance was published Nov. 12 and subsequently adopted by the New York State Department of Health four days later.
The guidance prohibits limiting the length of visits, frequency of visits and number of visitors. It also prohibits requiring advance scheduling.
“There are no longer scenarios related to COVID-19 where visitation should be limited,” the guidance reads.
Kuczkowski said her visits with her mother are “basically back to where we were” before the pandemic, aside from mask wearing and temperature checks, which she doesn’t mind. She’s now looking forward to seeing her mother on Christmas Day.
“Last year we all had to drop our gifts off in the vestibule in a laundry basket and hope that they got to her,” Kuczkowski said. “So being able to hand her the gifts and help her open it, watch her open it and see her appreciation, make sure she gets what we're bringing … I’m very glad that it’s open for the holidays.”
Yet the lifting of restrictions also comes amid the emergence of a new strain of the coronavirus. The Omicron variant became the dominant strain in the U.S. this week andmay be four times more contagious than the previous strain Delta.
Western New York,already hit hard by Delta, has a positivity rate of 9% and new case rate of 56.6 per 100,000 people, according tostate data. There’s currently nearly 500 people in the region hospitalized with COVID, including over 100 in the intensive care unit.
“I think people have to be extremely cautious and judicious about these visits,” said Dr. Thomas Russo, chief of infectious disease at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.
Although 89% of New York nursing home residents are vaccinated, they often have comorbidities and weakened immune systems, which can lessen the vaccines’ effectiveness, Russo noted.
New York nursing homes saw 30 residents die of COVID last week, a death rate of 0.35 per 1,000 resident weeks in nursing homes, according todata from the U.S. Centers for Disease Control and Prevention. That was well below a high death rate of 4.44 in January, but up from a low death rate of 0.1 in July.
Russo said he strongly recommends nursing home visitors get vaccinated and receive a booster dose, wear a well-fitting mask, and cancel the visit altogether if they have any symptoms. If a visitor is unvaccinated, perhaps a grandchild under the age of five, he recommends getting tested the day of the visit.
“Vaccines are imperfect, our masks are imperfect,” he said, “but if you use all of the measures together — optimal vaccination, high-quality mask used properly, testing where appropriate, and if you have symptoms, stay home — that will minimize risk.”
But while masking and symptom screening are part of the new CMS guidance, vaccines and testing are not. The guidance states nursing homes should encourage visitors to get vaccinated and tested, but that they cannot require it.
CMS could certainly reconsider that, Russo said, especially if Omicron proves to be problematic. Notably, the CMS guidance was published Nov. 12, exactly two weeks before the World Health Organization identified Omicron as a variant of concern.
“If we've learned anything during this pandemic: information is dynamic and we've had to adjust on the fly and be very fluid with our recommendations,” Russo said.
Nursing homes aren’t calling for a vaccine or test mandate for visitors just yet, but they would like to see some adjustments to the guidance.
The American Health Care Association (AHCA), a trade group representing over 14,000 nursing homes and assisted living facilities across the country, sent aletter to CMS last week, asking that facilities be allowed to temporarily restrict visitation if they feel it's necessary for resident safety.
“We are concerned that the absolute, unconditional language may pose a risk to nursing homes and their residents, placing skilled nursing facilities in precarious situations when outbreaks occur,” the letter states.
Beth Martino, AHCA senior vice president for public affairs, said in an email that, “we must carefully balance the risks to our vulnerable residents with the need to ensure they are able to see their loved ones.”
As for a potential vaccine mandate for visitors, Martino said the association at this time is simplyurging members of the public to get vaccinated.
As of right now, nursing homes could be subject to citation and enforcement actions if they don’t adhere to the CMS visitation guidance. A state Department of Health spokesperson did not directly respond to an inquiry as to whether any New York nursing homes have been fined for not following the new guidance. The latest state and federal data on nursing home penalties is from before the guidance went into effect.
If a resident or family member suspects their nursing home is not following the guidance, they can make a complaint to the state Department of Health either online or by calling its hotline, said Bria Lewis, an attorney with the Center for Elder Law and Justice, a Buffalo nonprofit legal firm that represents nursing home residents.
Lewis noted nursing home residents have a right to visitors underfederal law.
“Even though a resident is living in a nursing home, this is still their home. They should still be allowed to receive visitors and to see their family members,” she said. “It shouldn't be restricted just because they're living in a nursing home.”
Kuczkowski worries visitation restrictions will come back. The new guidance has made things easier, as she can now visit her mother on weekends as opposed to only on weeknights after work. She also likes being able to enter her mother’s room again, as it makes for easier conversation. Plus she can organize her belongings.
“I'm always on the edge of my seat waiting for a message [that] it’s shut down,” she said. “Is today the day they're going to say, ‘No, we're not doing it this way anymore, we're going back to the old way.’ But I'm hopeful that it stays this way.”
As for the threat of Omicron, Kuczkowski said she got vaccinated and boosted, and even avoids going out to certain places, so she can safely visit her mom, but the fear of COVID is always in the back of her mind.
Still, she said not visiting her mom would also be detrimental to her health.
“It's about quality of life. If we stopped visiting her just because we were afraid we were going to get her sick, then she would just as soon not be here, I'll be honest” she said. “If we stopped going to see her, that would be devastating, it would be worse than getting sick, I think. We're cautious, but not to the point of not ever seeing her.”
