TALLAHASSEE — For months, Floridians have been forbidden to visit their relatives at long-term care facilities.
Gov. Ron DeSantis said on Tuesday that it’s time for that to change, even as the state continues to report thousands of new coronavirus cases per day along with hundreds of deaths and hospitalizations.
“I think a lot of the family members understand that these are difficult circumstances. Clearly they would not want policies to be done that would lead to massive amounts of people in these facilities getting infected. But I think that if you have a way forward, I think that would put a lot of people at ease, knowing that there’s a light at the end of the tunnel,” DeSantis said at a discussion about the coronavirus in Jacksonville.
The Republican governor then began floating policy ideas that would allow some visits. For example, family members who have COVID-19 antibodies should be able to visit relatives, DeSantis said.
The governor’s office is forming a committee, which will include Florida Agency for Health Care Administration Secretary Mary Mayhew, to discuss which policies could be implemented to ensure safe visitation.
Is this a good idea?
Brian Lee, a former Florida long-term care ombudsman who now leads an organization called Families for Better Care, said he agrees lack of visitation is a huge problem in Florida. Oftentimes family members and other visitors are the first people to notice when their loved one is not getting proper care.
Even so, Lee said he does not think Florida is ready to re-introduce visitors given the high rate of infection seen in the state’s facilities.
“In theory, I can agree with the governor,” he said. “I want families and spouses to be together. But I don’t want to do it at the cost of killing them. This is nothing more than window dressing, political grandstanding, and it’s going to yield death and destruction.”
Long-term care facility administrators are dubious of the antibody proposal.
In a recent news release from the Food and Drug Administration, experts said “there are still many unknowns about what the presence of the antibodies may tell us about potential immunity” and that patients should not interpret the presence of antibodies as any level of immunity from the virus.
“The scientific jury is still out on that one,” said Kathryn Moore, the assistant administrator at Bay Oaks, an assisted living facility in Miami. “I would be concerned about having someone come onto our grounds who hasn’t been tested because they already have antibodies.”
Moore said on weekly calls with the Agency for Health Care Administration, herself and administrators from around the state have brought up concerns over visitation. It’s the number one question of both family members and residents, she said.
Moore has proposed Florida adopt a model similar to one she has researched in Pennsylvania, where visitors are allowed to enter the outdoor grounds of long-term care facilities like walkways and lawns, where they can visit loved ones wearing protective gear like masks and gowns.
Without proper distancing and personal protective equipment, she doesn’t think any sort of visitation is viable.
“I don’t see how it’s worth the risk,” she said. “None of our residents have been sick with COVID and we’d like to keep it that way.”
Democratic lawmakers like Senate Minority Leader Audrey Gibson say the proposal is not preventative but rather “after the fact,” and ignores the thousands of COVID-19 cases and deaths in long-term care facilities. Gibson, a Jacksonville Democrat, said in a statement Tuesday that the governor’s efforts “ring hollow.”
Examining possibilities
The idea of reopening long-term care facilities has been top of mind for administrators, families and residents alike. The Florida Health Care Association, the largest nursing home industry group in the state, sent recommendations to the state in May to suggest rapid tests at the door for all visitors, in addition to extra stockpiles of personal protective equipment.
Kristen Knapp, a spokeswoman for the group, said she recognizes that the state is trying to strike a difficult balance, but that if they approach different facilities with a personalized plan and consideration for disease spread in a certain area, she thinks it can be successful. The mental health of residents and their families is crucial, she added.
“Being able to wrap your arms around your mom, dad or spouse ... a Skype visit doesn’t take the place of that,” she said.
Knapp noted that only four nursing homes in Florida have received the rapid “point-of-care” antigen testing instruments being administered through the federal Centers for Medicare and Medicaid Services, but that Florida facilities are expected to be receive about 80 more in the first round of shipments. Antigen diagnostic tests rapidly detect fragments of proteins found on or within the virus by testing samples collected from a nasal swab.
CMS administrator Seema Verma promised every nursing home in COVID-19 “hotspots” would eventually receive the FDA-authorized antigen diagnostic test system, shipments of which started July 20.
Revisiting the idea
Tuesday was not the first time DeSantis floated the idea of allowing visitors. In mid-May, when Florida was reporting about 700 cases per day and a rate of positive cases in the single digits, DeSantis said he wanted “to get to ‘yes’ " on allowing visitors.
Over the next two and a half months, case numbers and positive test rates rose, indications that the virus spread far and wide through Florida. Spikes in hospitalization and death figures followed the spikes in cases.
Since the beginning of the pandemic, DeSantis has made long-term care facilities a policy priority. He initially banned visitors from the facilities in March, worried that visitors could spread the coronavirus to Florida’s population which is most at risk for the disease’s worst effects. And he often touts the state’s policy from the pandemic’s early days of banning sick patients from returning to nursing homes as a life-saving measure.
However, the more recent spread of the virus has imperiled the vulnerable residents at those institutions. On Tuesday the total number of reported deaths in long-term care facilities statewide hit 3,155. In July alone, the state reported more than 1,100 deaths in such facilities.
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