TALLAHASSEE, Fla. — Florida should allow the resumption of face-to-face visits in nursing homes --- and let certain visitors touch residents --- under recommendations approved Wednesday by a task force and sent to Gov. Ron DeSantis.
SPECIAL COVERAGE: Coronavirus
The recommendations, adopted by the Task Force on the Safe and Limited Re-Opening of Long Term Care Facilities, still must be approved by DeSantis, who has been looking for ways to reopen facilities to visitors during the COVID-19 pandemic.
The recommendations, in part, set up guidelines for general visitation at nursing homes and assisted living facilities and would allow visitors to enter buildings without being tested for COVID-19, a move that was criticized by the senior-advocacy group AARP Florida.
But part of the task force's debate centered on people who would be categorized as "essential caregivers," who could visit residents regardless of whether long-term care facilities had COVID-19 cases.
Essential caregivers would be required to wear personal protective equipment similar to health care workers. They would be allowed in residents' rooms and wouldn't be required to stay 6 feet away from residents they are visiting.
Under the proposal sent to the governor, the task force agreed to add "emotional support" to a list of activities of daily living that essential caregivers would be allowed to provide to long-term care residents, a change opposed by state Surgeon General Scott Rivkees, a member of the panel.
Before the inclusion of emotional support, only caregivers who fed, bathed or clothed residents could be considered "essential" under the proposal.
Agency for Health Care Administration Secretary Mary Mayhew, who chaired the panel, helped champion the change, saying residents' mental health needs to be supported.
"Dr. Rivkees, we've got a lot of people in our nursing homes and assisted living facilities who are suffering from significant depression," Mayhew said. "We are talking about that, generally about the importance of mental health."
Also pushing for inclusion of emotional support was panel member Mary Daniel, a Jacksonville woman who rose to national prominence after getting a job at a facility where her husband, who has dementia, resides.
Daniel said the initial recommendation would have prevented some elderly people from visiting residents because they aren't physically strong enough to bathe, change or feed residents
Rivkees argued against the change saying that there could potentially be hundreds of thousands of visitors to long-term care facilities once a current ban is lifted. The ban was imposed in March to try to prevent the spread of the disease, which is particularly dangerous to seniors and people with underlying medical conditions.
"The more individuals going in there even using PPE (personal protective equipment), the more individuals are going to get COVID. I mean, this is just a risk," he said.
Rivkees said he had spoken Monday night with experts at the federal Centers for Disease Control and Prevention and reviewed policies in 30 states on reopening visitation at long-term care facilities.
"I'm not aware of any states that have allowed PPE being worn allowing direct contact," Rivkees told the panel.
But Daniel, who founded the group Caregivers for Compromise, said infections are occurring at long-term care facilities even with the ban on visitors and that keeping the ban would do more harm than good.
"I'm losing the very best time with him. Today is his best day. He will decline tomorrow and the day after and the day after," she said of her husband, Steve. "I am missing the time right now that he knows me and that he knows my love and he can feel it. I am missing that. What am I saving him from?"
Mayhew said her agency and others would move quickly to implement whatever changes DeSantis ultimately chooses to approve.
While Florida clamped down on visitation during the early days of the pandemic, pressure has been building to again allow family members to be able to visit nursing homes and other senior centers.
DeSantis said this month he was open to revamping the rules and created the task force to come up with suggestions. The panel met four times before finalizing the recommendations.
Ten states continue to ban visitation for the most part, according to AARP, with Florida, Arizona, Washington and Pennsylvania working on plans to reopen.
The latest data from the state shows there are 9,777 long-term care residents who have been infected with the virus at their nursing homes, assisted living facilities or intermediate care facilities for people with developmental disabilities.
In addition to the guidelines for essential caregivers, the recommendations also would allow general visitation at long-term care facilities so long as the facilities have gone 14 days without any new resident of staff COVID-19 cases.
An initial recommendation would have only included residents in the COVID-19 count. But Rivkees successfully argued that staff members also should also be included. When staff COVID-19 cases were taken into consideration, 60 percent of facilities had no new COVID-19 cases over a two-week period from Aug. 11 to Tuesday.
Mayhew said she expected the number of facilities that could allow visitation to be higher than 60 percent because the panel's recommendation is to allow visitation at facilities that have had no "onset of resident or staff COVID-19" for 14 days, which is a lower standard.
The panel's recommendations also would allow for general visitation so long as long-term care facilities have adequate staff to support the management of visitors. Visitation would be limited to two visitors at a time per resident. Additionally, visitors would be required to wear masks.
AARP Florida State Director Jeff Johnson issued a statement following the meeting that blasted the panel for not requiring visitors to be tested.
Initially the panel recommended that testing decisions be made at the facility level. But Rivkees opposed the recommendation, noting that the rapid tests now are only recommended for use on symptomatic individuals and that using such tests for asymptomatic people wasn't based on science.
Ultimately, the final recommendation would allow facilities to test visitors but noted that the testing "must be based on current CDC and FDA (U.S. Food and Drug Administration) guidance."
"AARP has been hearing for months from families of long-term care residents who have been torn between two worries: worry that their loved one would contract the deadly coronavirus and worry that their loved one was suffering emotional, mental and physical decline from the forced isolation mandated by the state's lockdown order," Johnson said in the statement. "AARP consistently has said that the path to easing the lockdown of facilities safely lies through quick-turn testing that can provide a level of certainty that staff and visitors are not unknowingly carrying the deadly virus into the facility. The (federal) Centers for Medicare and Medicaid Services recently began sending that type of test kit to facilities for use in testing staff. Why not test visitors as well?"