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Despite Policy Shift, Caregivers Say Nursing Home Visitation Remains A Struggle

One American Senior Communities facility said it was allowing in-room visits only to those vaccinated—something federal guidance advises against. (Joey Mendolia, WTIU/WFIU News)

The initial announcement was met with both hope and optimism, but two weeks after regulators instructed facilities remove most visitation restrictions, many caregivers say little has changed. 

Throughout Indiana, long-term care visitation policies vary widely. Some are adhering to the guidance; others remain fully closed to unvaccinated outside visitors. 

The federal government’s policy is clear. A memo from the Centers For Medicare & Medicaid Services instructs:  

“Facilities should allow indoor visitation at all times and for all residents (regardless of vaccination status), except for a few circumstances when visitation should be limited due to a high risk of COVID-19 transmission (note: compassionate care visits should be permitted at all times).” 

Those conditions have to do with current facility outbreaks, if the county where a facility is located has a high positivity rate or if the resident is currently in quarantine after exposure.

While some variation is expected, and certain visitation restrictions are common, caregivers say they’re losing patience.

Last week, State Health Commissioner Dr. Kristina Box said families can file complaints with Indiana’s Department of Health if their loved one’s facility isn’t following state or federal guidance. 

“Really, visitation inside should be open pretty much at all times,” she said. “It shouldn’t be just a half an hour visit anymore. If you’re having struggles with that, our website will have this information and how we’ve directed the long-term care facilities.”

Box also insists ombudsmen can be valuable resources.  

But for caregivers, the prospect of lodging a state complaint can be a loaded decision.  

Caregivers Endure Changing Policy That Is Far From Uniform

Mary Charleson is the primary caregiver for her mother—also named Mary. Her facility restricts visiting hours, and that makes her twice daily visits complicated.  Currently, she has to rush home after her school bus route to ensure she can make the facility’s final appointment. 

“This is a place that my mom is going to be probably for the rest of her life," Charleson said. "So, would I want to burn any bridges? No.”

She insists the facility’s employees have taken care of her mom throughout the pandemic. 

Charleson doesn’t blame the facility’s staff, and insists they’ve provided good care for her mom, but wishes the facility’s corporate owners would provide more clarity on their visitation policy. 

“Do I feel like the employees that are in there are care for my mom and love my mom? Yes."

“Do I feel like the employees that are in there are care for my mom and love my mom?" she said. "Yes."

Zach Cattell, the President of the Indiana Health Care Association and the Indiana Center for Assisted Living, believes facilities will meet the guidance quickly as they have with past policy changes.  

Visitation was never an issue prior to the pandemic, and I think everyone is eager to return to normalcy within the ambit of these being open and welcoming communities,” he said. 

According to Cattell, long-term care facilities are meant to be home-like environments. 

READ MORE: 'It Is Abuse:' Indiana Caregivers Say Nursing Home Visitation Policies Don't Put Residents First

“We’re coming out of a year’s long restriction with a lot of still nuanced guidance that we have to follow,” he said. “So, I think just a little bit of grace for folks as they figure out these intricacies of what’s restricted and what’s allowed based on the state and federal guidance is helpful.”

The toll COVID-19 has taken on long-term care facilities since the pandemic began has been unprecedented.

Nearly half of Indiana’s deaths have occurred among residents of long-term care facilities. The congregate settings proved to spread the virus effectively among vulnerable populations.

Many caregivers accepted the visitation restrictions, but after residents received vaccine priority, many residents and their caregivers are getting restless.

“I don’t think anyone is purposefully dragging their feet,” Cattell insisted.

Charleson largely agrees, but struggles to understand the logic behind some policies. Her mom is fully vaccinated, and Charleson says she’ll soon receive her second dose. In her mom’s facility, appointments are permitted only between 9:00 a.m. and 4:30 p.m. for a specific amount of time.

“They should want us to be able to see our loved ones, and they should want to be able to have the residents happy."

The CDC confirmed the risk of contracting severe disease from COVID-19 after receiving a vaccine is rare—though variants add doubt. 

“They should want us to be able to see our loved ones, and they should want to be able to have the residents happy,” she said.

One Corporate Operator, Numerous Policies

Charleson’s mom resides in a facility owned by American Senior Communities, and visitation policy varies widely in its facilities. 

Representatives from at least three American Senior-owned Communities said their facilities were not allowing in-room visitation. Others said in-room visits were permitted from 8 a.m. to 8 p.m.  

One ASC facility said it was allowing in-room visits only to those vaccinated—something federal guidance advises against.

A company spokesperson provided a statement, but declined an interview. Neither addressed the variation or any specific facility’s policy.

“American Senior Communities is tremendously excited to facilitate visitation between our residents and their loved ones,” it read, in part. “While there continues to be variant factors that influence visitation, we work diligently to create person-centered visits that are comfortable and private.”

READ MORE: National Guard Deploys To Nursing Homes, Indiana Resists More COVID-19 Restrictions 

It’s not just American Senior Communities. Caregivers in other facilities describe vastly different experiences when coordinating visits with loved ones. 

Charleson believes regulators should publish stricter guidance. 

“They're not making it mandatory,” she said. “If a facility decides to go ahead and do this and something happens that it escalates then it's [the facility’s] problem.”

Charleson says she and her mom look forward to the day when they’re able to go outside for a walk or enjoy a carry-out pizza from the Pizza Hut a short distance away.

Charleson admits the hardest part is when her mom asks to leave with her.

“She’ll ask me, you know, if she can go somewhere with me, and I have to always tell her ‘No, you can't. You can't go with me, Mom, I'm sorry. We have to wait.’”   

But for now, they’re just grateful to have the opportunity to hug and sing to each other in person.

This arrangement is far better than visiting through a window on a step ladder, Charleson said.

Update: On March 29, 2021 Mary Charleson was informed visitation at her mother's American Senior Communities-owned facility would be permitted from 8:00 am to 8:00 pm, without an appointment. 

For the latest news and resources about COVID-19, bookmark our Coronavirus In Indiana page here.

Want to contact your legislators about an issue that matters to you? Find out how to contact your senators and member of Congress here.

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