By Rose Hoban
On Wednesday, lawmakers gave impassioned speeches on the floor of the legislature about patients who have endured hospitalizations and even deaths alone, without someone at their side.
Throughout the COVID-19 pandemic, hospitals, in an effort to reduce the number of people infected with the deadly virus, have restricted visitation for their patients. That’s led to heartbreaking incidences where patients have died without a familiar hand to hold, or a familiar voice in their ears.
During hearings about Senate Bill 730, the No Patient Left Alone Act, lawmakers heard testimonials from members of the public, as well as from their colleagues about these tragedies.
“We have all heard from real people, real people who are going to live with the fact that their loved one died alone,” said Sen. Joyce Krawiec (R-Kernersville) during a June 11 meeting of the Senate Health Care Committee. “We had a situation in my family. My husband’s brother died alone. His wife was with him every day until all this happened. And for two months, he was there all alone, and finally passed away.”
“Those are examples, all over North Carolina. And we just can’t let that happen.”
The bill easily passed the Senate last week before heading to the House.
Already required, with exceptions
Even as the bill was making its way through the Senate, Republican lawmakers from the House ripped into Health and Human Services Secretary Mandy Cohen over the no visitation policies, which they pinned on Gov. Roy Cooper’s executive orders.
“We are now experiencing … regulations that are tearing asunder some of the most essential bonds in human life, bonds that have lasted between people for four or five and even six decades,” said Rep. Perrin Jones (R-Greenville) who works as an anesthesiologist when he’s not at the legislature. “What do you propose now to do to rectify the inhumane consequences of our state’s public health policies?”
But it turns out that regulating hospital visitation is not just about the governor.
“We already have federal regulations through the Joint Commission and [the Centers for Medicare and Medicaid Services] that pretty much require that we allow our patients to have visitors unless there’s a medical or clinical reason to limit visitation, like a pandemic, like a pandemic, or the flu, or a hurricane,” said Cody Hand, vice president for advocacy and policy with the North Carolina Healthcare Association.
“Having visitors with the patient is always better for outcomes,” he said.
According to Hand, one of the main concerns for hospitals at the beginning of the pandemic was the lack of personal protective equipment. There were few masks or gowns for medical personnel, much less to protect family members in a facility where a deadly disease was present and there was little understanding of how the disease spread.
Now that the state has a more adequate supply of PPE and there’s a better understanding of how COVID-19 spreads from person to person, hospitals have been loosening their visitation policies. In the past week, Duke Health, Atrium Health, Novant and UNC Health, among others, have all signaled that patients can have a person with them at the bedside.
An updated version of No Patient Left Alone, amended to conform with federal regulations, passed the House of Representatives on Wednesday by a vote of 117-1. Now it has to go back to the Senate which will need to concur with changes made in the House before it gets sent to Cooper.
Senior care facilities still a risk
While hospitals have been finding it easier to loosen visitation restrictions, managers of senior living facilities such as nursing homes and adult care homes still struggle with allowing outsiders to spend time with their residents.
During a presentation to the House Health Committee on Wednesday morning, Jeff Horton, who runs the North Carolina Senior Living Association, described the difficulty of managing a COVID-19 outbreak in a nursing home or an adult care home.
In North Carolina, an adult care home is a facility with seven or more beds licensed to provide residential care for older or disabled persons whose principal need is a home. They are mandated to provide supervision and personal care for people who need only occasional routine medical care. Skilled nursing facilities, more commonly known as “nursing homes,” provide daily licensed nursing care, but do not require the medical consultation and support services available in an acute care hospital. A nursing facility receiving Medicaid funding must be licensed by the state as well as complying with federal rules and regulations. According to Jeff Horton, head of the NC Senior Living Association, “probably the biggest difference is nursing homes have licensed health care staff nurses that provide 24-hour nursing care. They typically have sicker residents, whereas assisted living homes aren’t required to have licensed staff, although some do.”
In North Carolina, an adult care home is a facility with seven or more beds licensed to provide residential care for older or disabled persons whose principal need is a home. They are mandated to provide supervision and personal care for people who need only occasional routine medical care.
Skilled nursing facilities, more commonly known as “nursing homes,” provide daily licensed nursing care, but do not require the medical consultation and support services available in an acute care hospital. A nursing facility receiving Medicaid funding must be licensed by the state as well as complying with federal rules and regulations.
According to Jeff Horton, head of the NC Senior Living Association, “probably the biggest difference is nursing homes have licensed health care staff nurses that provide 24-hour nursing care. They typically have sicker residents, whereas assisted living homes aren’t required to have licensed staff, although some do.”
In North Carolina, nursing home residents comprise more than 51 percent of the deaths during the COVID pandemic, the result of 108 separate outbreaks. Residents in other types of care facilities, such as adult care homes, make up another 8 percent of deaths from 62 outbreaks.
Horton described how balancing the need to keep vulnerable residents safe and the need for family members to see loved ones is challenging.
“You got residents, some of them are confused and don’t understand,” he said. “I’ve had some providers tell me they see the deterioration in some of the residents just because they don’t see the family or loved ones.”
How best to support facilities
Lawmakers had various suggestions to help the homes cope. Rep. Carla Cunningham (D-Charlotte) proposed providing funds so each resident could have access to a cell phone or providing iPads for residents to have video chats with loved ones.
“Logistically, just buying the devices, supporting the devices, having a staff dedicated to help use those devices, it would be a difficult thing to do and some facilities are using them,” Horton responded. “I think, uniformly across the state, I think it would be pretty, pretty difficult to implement.”
One thing Horton said was that owners of adult care homes could use help with testing for employees, which often costs $100 per test.
“Many of the staff are uninsured,” he said. “Most providers can’t afford to provide health insurance. So then how do you pay for their testing?
“And that’s really the folks you want to test because if it’s getting into a facility that’s probably how it’s getting there, it’s been brought in by staff.”
Horton also noted that some county health departments have been more willing and some more able to work with facility owners around testing than others. He also noted that in some rural towns, it can be more of a challenge to find a testing site.
When asked why there have been so many more deaths in nursing homes than in adult care homes, Horton said part of the difference is the intensity of the care provided in nursing homes.
“Even though we have some heavy care folks in adult care homes, nursing homes have heavier care folks, they’ll be touched, handled more, I think, which probably leads itself to maybe spreading the virus,” he said.
He noted how both types of facilities have struggled with obtaining personal protective equipment, which is not as routinely used as it is in hospitals.
He described what one of his members told him: “‘I know folks want to open up visitation but let me tell you I’ve had an outbreak in my facility and once you get an outbreak, your life is turned on its head. Once you get through it you’ll do anything you can to keep one from getting there again.’”
“So the talk of loosening visitation,” Horton said, “I think makes a lot of folks very, very nervous.”