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No Visitors Policies Make It Tougher To Advocate For Residents At Facilities

An older woman smiling while looking at a cell phone. She is participating in a video call.
Georg Arthur Plueger/Unsplash
Federal guidelines advises facilities to implement a no visitors policy to mitigate COVID-19, but this make it tougher to advocate for residents.

Coverage of novel coronavirus is supported by the Mick Hitchcock, Ph.D., Project for Visualizing Science, a science reporting project from the Reynolds School of Journalism.

About a quarter of Nevada’s COVID-19 deaths are associated with various state-regulated facilities. And for Washoe County, the ratio is even higher, accounting for more than half of the county’s 54 deaths.

KUNR’s Anh Gray reports that due to the no visitation policies implemented at these care facilities to mitigate infections, it’s been challenging for advocates who aren’t able to see residents.

The Older Americans Act is a federal law that requires each state to have a long-term care ombudsman program to advocate for the safety and the rights of people at facilities like nursing homes, assisted living facilities, and board and care homes.

Lori Smetanka is the executive director for The National Consumer Voice For Quality Long Term Care, an advocacy organization nationwide.

“They play a very critical role in not only helping to resolve problems and ensuring that residents’ rights are being respected,” Smetanka said, “that they're getting the care that they need and deserve, but they also help to prevent problems from escalating into big issues.”

Smetanka says the outbreaks at facilities across the country during the pandemic highlight that there are more systemic issues that need to be addressed.

“We really do as a society need to relook at how we are providing long-term care in this country,” Smetanka explained. “What that looks like, how it's paid for, what choices are available for the residents? Looking at how we can better ensure quality care in a way that meets the residents needs and protects them from things like we're experiencing today.”

Jennifer Williams-Woods supervises the Nevada State Long Term Care Ombudsman Program, which is with the state’s Aging and Disability Services Division. The program has more than a dozen staff members who advocate for residents statewide.

The common issues they hear about range from how and when residents are discharged, complaints regarding the violation of the dignity and respect of residents, and medication-related concerns.

During the pandemic, she says she hasn’t seen an increase in complaints. She explains why.

“And so oftentimes whenever our staff go into facilities, they'll actually bring information back, and we'll open cases from that information from those visits,” Williams-Woods explained. “But I think the decrease is probably due to the fact that we're not physically in the facilities having those conversations with residents.”

Since federal guidanceadvises facilities to implement no visitation policies to protect residents, ombudsmen across the country haven’t been able to meet with them in-person.

In Nevada, there have been 101 COVID-19 deaths at various types of state-regulated facilities as of May 27, which include nursing homes and assisted living communities.

In Washoe, an outbreakat Lakeside Health and Wellness, a skilled nursing facility in Reno, resulted in the death of twenty residents and one staff member. And seven residents at Arbors Memory Care in Sparks, a care community for seniors with Alzheimer’s or dementia, have also died.

But Williams-Woods says the program saw a slight decline in their case work statewide recently. There were 104 cases to follow-up on in April 2020 compared to 138 in April 2019. She said there was a slight decrease for March as well.

Instead, what Williams-Woods is hearing more of lately is that families want more information about their loved ones.

“We've had a few family members call and just wanting to know what their process is for maybe notifying families about potential positive cases at a facility,” Williams-Woods said, “but we really haven't received that many calls, as of yet, specific to COVID-19.”

In 2018, the Nevada ombudsman program provided more than 2,300 facility visits. For now, Williams-Woods says they are finding alternative ways to find out how people in facilities are doing. 

“We're really relying on additional individuals to provide us with information as to what they've encountered as well,” Williams-Woods explained. “Family members, guardians, powers of attorney, et cetera, in addition to what the resident is telling us on the phone and what the facility is telling us. And also, requesting more documentation from the facilities.”

Families act as advocates too, and they are also barred from visits at this time as a safety measure. Williams-Woods says she’s been working with facility administrators to provide residents with access to technology so they can stay connected with loved ones.

It’s unclear at this point when health officials will deem it safe for ombudsmen and families to resume onsite visits. Richard Whitley is the director at Nevada’s Department of Health and Human Services. He spoke at a state Legislative Committee on Health Care during a virtual meeting on May 20th.

“We've worked with facilities to be as creative as possible, but again, I think nothing, you know, someone can tell you, someone can show you a picture, even the video, but it doesn't replace [a visit],” Whitley said, “that's the feedback that I get when family members call out of concern.”

Staff at some facilities are also reaching out for help. Whitley says that the state has received complaints from staff members working at hotspots.

“We do take complaints, we take anonymous complaints as well as, you know, named complaints about facilities,” Whitley explained. “We do get a fair number from staff in a facility who feel at risk for their jobs. That's confidential information on who is reporting it, but we do go out to the facilities.”

Even though ombudsmen have been unable to enter facilities during the pandemic, Whitley said state inspectors were able to go onsite to investigate and remained there until concerns were remediated.

Whitley identified specific issues that he said have led to some outbreaks in Washoe. Those issues were primarily improper infection control measures including the misuse of personal protective equipment, the lack of isolating infected individuals from healthy ones, and ineffective handwashing. He said those facilities are required to submit a plan of correction to the state, and then inspectors will return to those sites to follow up.

Anh Gray is a former contributing editor at KUNR Public Radio.
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