N.J. eases rules at nursing homes to allow more indoor visits

Posted Oct 21, 2020

The Department of Health on Wednesday issued new directives aimed at allowing more families see their loved ones in nursing homes after weeks of criticism from relatives who said they have been denied entrance.

All long-term care facilities in the state with no new COVID cases in the last 14 days may allow expanded indoor visitation under a set of new criteria outlined in the Health Department directive.

The changes will also permit the use of cheaper and faster test kits to screen guests for COVID-19, which the state had been reluctant to approve because of concerns over their accuracy.

“This amended directive provides a balance in enabling expanded visitation by loved ones and continuing to do so in a way that keeps residents and visitors safe,” said Health Commissioner Judith Persichilli in a statement. “We know COVID-19 remains in communities, and we have to maintain our vigilance to ensure the appropriate safeguards are in place for these vulnerable residents.”

Nursing home operators applauded the changes.

“We welcome the state’s revised guidance that allows for indoor visitation for our residents and their families and recognizes the benefits of antigen testing," said Andrew Aronson, director of Nursing Home Advocates of New Jersey, a coalition of some of the state’s largest nursing home operators. “With the additional testing that’s becoming available to nursing homes, and mitigation measures including social distancing and universal masking, we believe that visitation can happen safely.”

Aronson added that at the same time, community spread is directly correlated to rising cases in facilities.

“So we have to be diligent and we have to be careful,” he said.

The Health Care Association of New Jersey, another industry lobby group, said it has been working with the state over the issue.

"Their continued diligence in upgrading their visitation guidelines, and vigilance in comporting state testing directives with the federal directives, has clearly put the safety and well-being of our residents first, said Jan Siegal, director of Quality, Clinical and Regulatory Affairs for the association.

Currently, 162 long-term care facilities in New Jersey are experiencing outbreaks. More than 6,800 nursing home residents have died from the coronavirus, according to reports filed with the state.

A state memo in August first permitted limited indoor visits in New Jersey’s nursing homes, after months of a virtual lockdown in long-term facilities across the state. But dozens of families recently told the state Long-Term Care Ombudsman that many residents were still facing the kind of isolation that began when the pandemic struck seven months ago.

The executive directive by Persichilli issued on Aug. 10 listed the requirements long-term care facilities needed to meet in order to permit visitors, including a relative or close friend deemed an “essential caregiver” to visit up to twice a week. But families complained that some nursing home operators have dragged their feet in developing a policy, or have looked for reasons to deny access. Ombudsman Laurie Brewer, the state-appointed advocate for people in long-term care facilities, said her office is investigating more than 50 complaints.

Brewer on Wednesday called the latest directive “unquestionably a positive step forward for thousands of residents of long-term care facilities who are lonely, isolated and desperate to connect with their families and friends."

Creating a pathway for safe, indoor visits is necessary now that outdoor visits are, for the most part, no longer feasible for vulnerable elderly residents," she added.

Long-term care facility operators must cooperate and stop making families "have to jump through hoops to meet some subjective and ill-defined criteria for what constitutes ‘essential care,’ ” Brewer said.

Under the state rules set over the summer, facilities could only allow non-compassionate care indoor visitations if the facility had never had an outbreak or had no new probable or confirmed coronavirus cases identified through two COVID-19 incubation periods — specifically 28 days — in addition to other minimum criteria.

The new directive calls for indoor visitation by appointment to be permitted in every phase. The updated directive brings New Jersey in line with Centers for Medicare & Medicaid Services guidelines.

Visitors must be screened and masked and meet any other infection control guidelines. They and the residents will also be required to acknowledge they are aware of the potential exposure of COVID-19.

Any facility with an active outbreak of COVID-19 will remain under maximum restrictions, the directive stated.

Bill Borrelle, who founded FACE for Seniors, a Facebook group that formed to advocate for relazing visitation policies, offered a mixed response to the state’s latest directive.

Borrelle praised the order because it “result in more families safely reunited with their loved ones, after nearly 8 months apart, such as permitting quick-response point-of-care antigen testing, loosening restrictions on Compassionate Care visits, and allowing indoor visitation by appointment.”

“At the same time, if a facility currently has or had within the past 14 days just one case of COVID-19, or if a facility chooses to not implement the directive due to the county case count or other implementation challenges, this updated directive will have little to no impact,” said Borrelle, whose mother lives in a south Jersey facility. “We encourage the Department of Health to aggressively enforce these positive steps forward and also consider safe, in-room family visitation with fewer restrictions.”

The issue of wider testing was a driver of the new policy.

The directive said so-called antigen testing will now be a permissible alternative to the more widely used — and far more accurate molecular diagnostic tests — in helping facilities to fulfill their weekly testing requirements for staff, as well as asymptomatic individuals at the facility’s discretion, said the Health Department.

There are basically two major tests used to fight the pandemic, with each taking a different path to detecting a virus that hides itself well in the early stages of infection.

The most reliable test for COVID-19 utilizes what is known as polymerase chain reaction, or PCR, to detect the nucleic acid of the virus. But although highly accurate, the turnaround time for the testing is slow. The delay makes it especially difficult to isolate staff who are likely the major carriers of coronavirus into nursing homes, say proponents of the faster tests. Asymptomatic workers who stay on the job while waiting for test results can infect others until the lab results come back, experts have noted.

The antigen tests seek do not look for the nucleic acid of a virus. Instead, they seek to identify proteins created by it. The tests do not require a lab and can be done anywhere. However, the proteins targeted by antigen tests may not be present in sufficient amounts to detect in individuals without symptoms. That makes them less accurate. Often they provide findings of false positives — or more worrisome, generate false negative test results that lead to an unwarranted sense of security.

Nursing home operators had been arguing for weeks that the quick-read tests could be a game-changer in their hard-hit facilities. Their position was that the lack of accuracy by antigen testing was offset by the ability to test more frequently, allowing real-time screening of visitors and workers, helping protect a vulnerable population that now accounts for nearly half of all COVID-19 deaths in the state.

Administrators had already begun to stockpile antigen testing supplies, as federal authorities pushed the quick test kits. But until Wednesday’s directive, the state had indicated it had concerns about the performance of those tests and would not permit their use.

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published this page in News and Politics 2020-10-22 02:36:47 -0700