The way visits to loved ones are allowed in nursing homes in NC remains controversial, so lawmakers have proposed significant changes to better comply with federal regulations.
By Thomas Goldsmith
Persistent confusion, personal anger, and legal issues still reign over the subject of visits from relatives and caregivers in the COVID era to North Carolina nursing homes.
After the chaos and heartbreak that COVID-19 has brought into a poorly prepared system, much remains to be resolved – likely with pending laws – said NC spokesmen, brought together by NC AARP for an update.
Rebecca Chaplin, Deputy State Director of the AARP Mountain Region, called the topic “a hot topic with a lot of confusion”.
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Senator Jim Perry (R-Kinston), longtime ombudsman for the Department of Health and Human Services Lindsay Tice (Stanly-Mecklenburg), and friends of residents gave facts, opinions and recommendations on how to officially address the issues in North Carolina from Bill Lamb, chairman of the board for Long term care. The virtual panel came at a time when the long months of a state-ordered ban on visits left a trail of mixed messages, irritations and advocacy for change.
“For many of my constituents, and just for many people in the state, the pandemic and lockdowns, as well as the security protocols that were put in place, even when well-intentioned, sometimes just went too far,” Perry said.
“There were times when we forgot that care was part of health care.”
The State Department of Health and Human Services has counted more than 53,000 cases and 5,480 COVID-19 deaths in nursing homes in North Carolina since March 2020. Governor Roy Cooper earlier this month announced a near-universal ban on visits to nursing homes that have been abandoned, leaving countless residents and caregivers banned from spending time with a dying relative before the end.
“I’ve interacted with people who have lost family members and, in some cases, their family members have died alone, and that shouldn’t be happening,” Perry said. “We know a lot more today than we did at the beginning, but these problems still exist. I think we need to further raise awareness and reduce unnecessary restrictions.”
Slow return to normal
Long-term care regulation in North Carolina, as in all states, is complicated. Assisted living nursing homes for adults generally operate under the state DHHS, with the federal centers for Medicare and Medicaid services providing oversight and funding for qualified residents.
For the more medically intensive care homes, which were formerly referred to as qualified care facilities, most of the supervision lies with CMS. However, DHHS government officials inspect facilities and report errors that can result in fines and even, infrequently, the closure of a residential center.
Cooper lifted most of the restrictions on nursing home visits on May 14, but conflicting practices persist, Friends of Residents Lamb said.
“I can tell you from the calls that family members are still struggling on a case-by-case basis for the privilege of visiting,” said Lamb. “We have many facilities that are very open to visits.”
Lamb shared the experience of a North Carolina couple this spring: The husband was denied the right to visit his wife under a policy of compassionate care that is often used only as a death approach to a resident and relatives who provide vital services Afford.
“There are many other circumstances in which a resident will find it difficult to adjust, when a family member is critical to that person’s wellbeing, when a resident really has a problem as many of those residents become depressed and stop eating or drinking Said Lamb.
“His wife was in a special care unit. She had terminal dementia. And this man went into the facility and fed his wife with every meal, breakfast, lunch and dinner. And then one day he was locked out without understanding what was going on and this woman stopped eating, ”he said. “She died a month later.”
Tice, who interacts with residents, families, and facilities in Stanly and Mecklenburg counties, and Lamb agree that most facilities are nearing pre-COVID status of allowing visits, although practices require a great deal of caution.
“One of the things we hear all over the state is that there are some institutions that are very reluctant to really start over,” Tice said. “There could be many opinions about it, but it is the resident’s right to have a visitor if they choose one.”
Preventing a repeat of 2020
Legislative efforts to ensure caregivers can pay a visit differs this year from the first stab in 2020, when the pre-vaccination effects of COVID were newer and worse. Rather than enact new state laws, Senate Bill 191 relies on the Importance of Visit as set forth in federal law and the Bill of Rights of Residents.
“We have studied federal disability law and continue to monitor CMS guidelines for these facilities,” Perry said. “Rather than using the Code of Federal Regulations against us to better understand it, we realized we can point it out because it is absolutely forbidden to keep patients in seclusion for long periods of time. State rules and guidelines already state that you can’t have a blanket no-visit policy.
“When we studied the Disability Rights Act, we found that regardless of the status of the pandemic, except for short periods of time, it was 100 percent illegal not to allow anyone to have a visitor.”
Federal regulators and Cooper lifted the general lockdown. However, proponents not only want the laws in force to be clarified, but also want to ensure that the same restrictions do not remain in place should another such situation arise.
The proposed law would have teeth in the form of heavy daily fines against qualified nursing homes that violate federal standards.
“It says, ‘Hey, either you are going to obey this in the state of North Carolina or we are going to put a mechanism in place to penalize you on a per-instance, per-day basis,” Perry said.
“That adds up pretty quickly. It doesn’t go as far as we’d like, but it does cover many of the situations we’ve faced. “
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