As Arizona nursing homes reopen to visitors, state guidelines cause confusion

Many nursing homes and assisted living facilities in Arizona reopened to visitors earlier this month after being closed to most outsiders for months because of the coronavirus pandemic.

Visiting elder loved ones in care facilities during the coronavirus pandemic



But rolling out the welcome mat has been anything but smooth.

Senior advocates and operators of long-term facilities say guidelines issued by Arizona Department of Health Services are causing confusion, with some managers incorrectly interpreting the guidelines to limit visits to only 15 minutes.

a bedroom with a bed and desk in a room: Abuse or neglect in nursing homes can have serious consequences for seniors.

© Wavebreakmedia, Getty Images/iStockphoto
Abuse or neglect in nursing homes can have serious consequences for seniors.

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Other requirements — such as proof of a negative COVID-19 test within 48 hours and quarantining before each visit — make scheduling indoor visits difficult or impossible for working families.

Some nursing homes and assisted living facilities are setting their own stricter rules, such as limiting visits only to weekdays. Others require a staffer to be present during visits, creating privacy concerns for residents and their families.

“I’ve talked to both operators and family members, and there’s a lot of confusion,” said Mark Clark, president and CEO of Pima Council on Aging, a nonprofit group based in Tucson that advocates for seniors.

Clark is one of several members of the state’s Task Force on Long Term Care, a volunteer group established by Gov. Doug Ducey, that helped draft the visitation guidelines. When the committee approved the guidelines last month, members acknowledged the directives were far from perfect but were a start toward resuming in-person visits.

On Tuesday, members voted to make changes designed to provide more flexibility for visitors. A key change: Each resident can have up to two people who are a “designated essential visitor,” who can visit with fewer restrictions and less frequent testing.

The testing requirements will match the federal COVID-19 testing requirements for long-term care staff, which vary depending upon the number of COVID-19 cases being reported in a county. For instance, most of Arizona’s counties now are classified as yellow, or moderate, for COVID-19 spread, which would mean weekly testing for essential visitors and staff.

State officials this week published three pages of updates to the guidelines that are effective Oct. 1. They are also working on a list of “frequently asked questions and answers,” to help guide visitors and long-term care managers.

Rep. Regina Cobb, R- Kingman, said she has heard from constituents that getting visiting access has been difficult. Some facilities are only allowing outdoor visits and only on certain days, which creates a barrier for some families.

“There’s huge confusion over the need for testing,” said Cobb, who serves on the long-term care task force.

To visit indoors in most Arizona counties, visitors need proof of a negative COVID-19 test within 48 hours of the visit. Some family members have been turned away because their test results didn’t come back in time.

Christina Corieri, who chairs the task force and is a senior policy adviser to the governor, said visitors are not required to get a test for outdoor visits. The 15-minute limit is only if the visitor is going into the resident’s room, she said, and is not the limit for the entire visit. The rest of the visit could take place in another room or outside.

She also clarified on Tuesday that clergy will be permitted to visit patients in long-term care facilities. The updated guidelines also state that at least one weekend day shall be open for visitation. 

‘Like a celebration’

Scott McCutcheon, chief operating officer of LivGenerations, said his assisted-living communities offer two visit options: An outdoor visit without a COVID-19 test or an indoor visit with a negative COVID-19 test.

Most families opt for outdoor visits because there is no testing requirement. He said some family members haven’t been able to get test results back within 48 hours of the visit.

Sun Health Communities, which operates three senior communities for more than 1,000 residents in the West Valley, allows outdoor visits and is making plans to start indoor visits.

For now, visitors meet on patios with coolers to lower the temperatures. Visitors must wear masks and remain socially distant. But they don’t need a COVID-19 test visit. The visits are typically 30 minutes, though people can request additional time.

“These are very special moments for our residents, families and staff. We want to make it as meaningful as possible. It’s almost like a celebration time,” said Bhakti Gosalia, vice president of operations for Sun Health.

a person posing for the camera: Bhakti Gosalia, Vice President of Operations, Sun Health Communities

© Courtesy of Bhakti Gosalia
Bhakti Gosalia, Vice President of Operations, Sun Health Communities

She said there are details to work out to allow indoor visits, including making sure there enough staff to disinfect surfaces between visits.

Helen Sarno of Sun City was unable to visit a 92-year-old friend at Freedom Plaza Care Center, a skilled nursing facility in Peoria, for several months during the pandemic. Then, as coronavirus cases subsided, she said the facility set up a visiting space where her friend was inside and she was outside. They both wore masks and were separated by a plastic window.

Even though she could only visit twice a week, for 30 minutes each time, she was happy with the arrangement.

When the state’s guidelines came out in late August, Sarno said a Freedom Plaza staffer told her outdoor visits would be replaced by 15-minute visits inside and she would need a negative COVID-19 test within 48 hours of the visit.

Sarno said she worried about getting test results in time so she stood outside her friend’s window last week and called him on her cell phone. They could see each other, but it was difficult to hear him at times, she said.

After that visit, Sarno said she got a call from Freedom Plaza, telling her she could resume outdoor visits that don’t require a COVID-19 test. Sarno said she doesn’t fault Freedom Plaza, saying staff there has been “wonderful” and the communication has been great. But she wishes the state guidelines were clearer.

Freedom Plaza’s Director of Social Services David Schroyer said Freedom Plaza offers indoor visits with proof of a negative COVID-19 test within 48 hours and outdoor visits through a plastic window where no test is required. He said Freedom Plaza hasn’t had anyone do an indoor visit yet.

More visitation options expected

Across the country, long-term care facilities have become the deadliest settings for COVID-19, the respiratory disease caused by the new coronavirus. Long-term care is an umbrella term that in Maricopa County includes skilled nursing care, assisted living and hospice. 

Residents are often cared for by the same staff in long-term care settings, putting them at higher risk of contracting the virus than the general population. Many patients are over 65 and have chronic medical conditions, making them vulnerable to complications if they become infected.

a close up of a fence: COVID-19 deaths in Maricopa County are shown in this graph. The dark blue bars represent deaths in long-term care facilities. The gray bars are deaths elsewhere. The information is shown by date of death so the more recent information will likely change as more deaths are identified by date.

© Maricopa County
COVID-19 deaths in Maricopa County are shown in this graph. The dark blue bars represent deaths in long-term care facilities. The gray bars are deaths elsewhere. The information is shown by date of death so the more recent information will likely change as more deaths are identified by date.

In Maricopa County alone, long-term care residents account for 34% of the county’s  total COVID-19 deaths. More than 3,900 residents and 2,300 staffers have been infected, and more than 1,000 residents have died.

As COVID-19 cases have subsided, states are in various stages of reopening long-term care facilities to visitors. Many states are taking a phased approach, first allowing outdoor visits with social distancing; then indoor visits provided visitors can prove they are free of COVID-19.

On Monday, Seema Verma, the head of the federal agency that oversees skilled nursing homes tweeted that the Centers for Medicare & Medicaid Services is encouraging nursing homes to offer outdoor visitation.

Tiffany Wilkins, vice president for operations of Spectrum Retirement and a member of Arizona’s long-term care task force, said it’s important to assure families that the visitation guidelines are a first step. She expects visiting options to continue to grow.

“Most people are understanding of that, as long as we’re giving them additional options like the outdoor visits,” she said.

Reach the reporter at [email protected] or 602-444-8072. Follow her on Twitter @anneryman.

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This article originally appeared on Arizona Republic: As Arizona nursing homes reopen to visitors, state guidelines cause confusion

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