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For nearly 20 months, nearly 1.3 million Americans living in nursing homes and their families have grappled with strict visitation policies that, while designed to protect vulnerable residents from the coronavirus, have caused distress for their separated loved ones and have serious health consequences for many who are suddenly isolated. old people.

Initially, visitors were completely banned. Later, facilities enforced various rules: Some visitors were barred from entering residents’ rooms, visitors were only allowed outdoors and in short-scheduled windows, or only one visitor at a time.

Most of these restrictions were based on rules known as “guidance” mandated by the Centers for Medicare and Medicaid Services, the federal agency that closed facilities to visitors in March 2020. It has since released several revisions.

Now everything has changed. On November 12, the federal agency removed almost all these restrictions and recommended that the country’s nursing homes allow visitation “for all residents at all times.” The agency noted that 86 percent of US nursing home residents and 74 percent of employees are fully vaccinated, and Covid-19 cases have dropped drastically.

Update means that there are no longer limits on frequency, time, duration, location or number of visitors. Unless a roommate is vaccinated or immunocompromised, residents’ rooms are allowed access and no prior programming is required.

Federal policy still promotes vaccination and has emphasized infection control measures, including masks and distancing policies established by the Centers for Disease Control and Prevention.

“It makes an important statement,” said Lori Smetanka, executive director of the National Voice of Consumer Quality Long-Term Care, an advocacy group pushing for such change. Previously, “facilities have been given a lot of discretion,” he said. “But it’s pretty obvious: It puts rights back into the hands of residents.”

Facilities can ask visitors about their vaccination status and encourage testing, but cannot request vaccinations or tests for entry. As part of the new guidance, even during the Covid pandemic, nursing homes should allow visitors to enter, albeit wearing masks. Visitors who refuse to disclose whether they have been vaccinated are also required to wear a mask.

The rules only cover federally regulated nursing homes, but these can have a spillover effect. “I think many states will apply this to other settings, such as assisted living,” said Ms. Smetanka. For example, California has already responded: loosening some assisted living rules.

In nursing homes, with vulnerable and disabled residents, “there may be precautions, but cutting residents off from their families was unethical and was poor care,” said health researcher David Grabowski of Harvard Medical School. “These are not social visits.”

While there was a shortage of staff in nursing homes long before the pandemic, family visitors often helped to feed, wash and dress loved ones. They not only provided reassurance and incentive, but also the ability to monitor the safety and quality of the facility. For example, Dr. A study co-authored by Grabowski found that nursing home residents with dementia better care at the end of life if a family member visits regularly.

When the pandemic cut off such contact, families reported troubling health declines for more than a year in many cases. For example, a study of Connecticut nursing home residents found that significant increases in depression and unintended weight loss during quarantine; incontinence increased and cognition decreased.

Trish Huckin struggled with managers for nearly a year before being allowed to make supposedly compassionate care visits at her 96-year-old mother’s nursing home in Pinckney, Michigan. Even then, “the restrictions were absurd,” he said. The facility allowed him to visit the public for one hour three times a week by appointment only. If he couldn’t do one of the preset times, he couldn’t reschedule.

When the facility finally eased restrictions, Ms. Huckin – along with her wife, a hospital nurse – was finally able to see her dementia-stricken mother in her room. They discovered that in addition to losing weight and becoming depressed, her mother developed a bed sore and early pneumonia.

Claudia Hutchinson also found that her sister, who lived at a facility outside of Philadelphia, became depressed and lost weight and mobility because her visits were limited to an hour or less outdoors. “This downward spiral wouldn’t have happened if we’d been allowed in,” he said. “It wouldn’t be in government care.”

Some doctors and families are now worried that the pendulum swings so much that a full reopening will leave an already vulnerable population on another surge. Covid infections increase in nursing homes; flu cases increased nationally as well.

On the day the new federal guideline was announced, a Connecticut nursing home reported The deaths of eight residents with serious health problems resulting from an epidemic in late September.

Californian geriatrician and president of the Post-Acute and Long-Term Care Medicine Association, which represents health, Dr. “We know it’s not a good idea for people to come in and out during a pandemic,” said Karl Steinberg. care workers in long-term care.

As a medical director or specialist in three nursing homes, he saw the early death of the pandemic: “It was a bloodbath.” He wished the latest federal guidance would leave more flexibility to administrators. Medicare may also have waited until after the holidays, and until booster vaccines were more widely distributed.

Despite the lifting of federal restrictions, some administrators feel that state and local health regulations could replace new federal guidance and potentially blunt its impact.

Chief medical officer of the Greater Los Angeles Jewish House, Dr. “The standard rule is that a facility should follow the most restrictive rule,” said Noah Marco. He is cautiously optimistic that in a few weeks the state and county will also loosen their policies. But for now, the facility continues to require advance scheduling, limit visit time, and only allow one visitor at a time per resident interior.

Dr. “Our staff has been on the phone all the time,” Marco said since the new federal policy was announced. “Hearing that and ‘Yippee!’ We had family members who said. We had to say, ‘We’re very sorry, but not that fast’.”

A representative from the Centers for Medicare and Medicaid Services said state or local health departments may need to reinstate restrictions “for serious safety reasons”, but this is only in “isolated circumstances.” “Local authorities should not generally try to add rules and regulations that limit a nursing home resident’s right to receive visitors,” the representative added.

New federal policy backed by the Biden administration Requires all nursing home staff to be fully vaccinated By January 4th — it’s likely to loosen its more extreme local and state policies.

Alison Hirschel, executive attorney for the Michigan Elder Justice Initiative, counsels a woman whose 70-year-old relative suffered a brain injury after an accident and entered a nursing home a few months ago.

“It was very distressing,” Ms. Hirschel said of the out-of-state client. “He required seven hours of driving for a visit, and the visit was limited to 15 minutes – and only during weekday business hours.”

Then, a day after the liberalized federal policy was announced, Michigan releases new guide allowing visitors at any time, without any limitation on the duration of the visit or the number of visitors. “This really changes the rules of the game,” said Ms. Hirschel.