The following letter was sent April 7 from AARP Massachusetts to Governor Baker regarding nursing home and long-term care regulations during COVID-19:
Dear Governor Baker,
On behalf of 775,000 AARP members in Massachusetts, we are writing regarding the Massachusetts Department of Public Health order dated March 10, 2020 providing guidance on MassHealth regulations for transfers and discharge of long-term care facility residents, 130 CMR 456.701 through 456.704. In addition, we are writing regarding 610.028 through 610.032, for the limited purpose of safely transferring and discharging all residents living in a long-term care facility that is intended to be used as a designated COVID-19 facility.
We deeply appreciate the state’s focus on protecting the health and safety of our state’s older population, nursing home residents and LTSS recipients, which is paramount. We are, however, very concerned that current state guidance does not adequately protect nursing home residents during this public health emergency.
Release of Information on Facilities with COVID-19 Positive Cases
We urge Massachusetts’ Department of Public Health to release publicly the names of nursing facilities with confirmed COVID-19 cases. Contrary to concerns that such disclosures would violate a patient’s health privacy, we do not believe HIPAA precludes a state health agency from releasing the names of facilities because a facility is not a covered entity as defined by federal law. We believe transparency and notice to the public is critical for public health. Moreover, caregivers and family members need and deserve to have this information for their own health decisions and as they consider possible next steps and interventions for their loved ones.
To be clear, we are not advocating for the disclosure of any HIPAA protected patient information. However, we do believe that disclosure of the names of nursing facilities with confirmed COVID-19 cases would benefit the health of Massachusetts residents by allowing people to make informed choices.
Transfer of Residents
Nursing home residents are some of the most vulnerable members of our society. Many residents need assistance with activities of daily living due to physical and/or cognitive limitations. Moving these residents from their nursing homes can be unsafe and/or traumatic for them and their families, particularly when a move is involuntary and sudden.
Transfer from a facility can have both immediate and longer term negative impacts on a resident’s health. Many nursing home residents, especially those who are cognitively impaired, develop a physical, psychological and emotional dependence upon their surroundings and any disruption to this environment can cause serious emotional and psychological damage and physical stress.
Moreover, transfer without offering appropriate and effective counseling and planning can lead to isolation and despair and the lack of predictability maximizes fear and anxiety.
Proactive Communication with Caregivers
During these times of great uncertainty, when families are prevented from visiting their loved ones in a facility, we believe nursing homes should be required to provide proactive communications to the primary caregiver(s) of nursing home residents regarding their physical and emotional health and more general updates with information for families. We urge the state to modify its guidance to reflect that nursing homes must also create additional or increase listserv communications; assign staff as primary contact for families; offer a phone hotline for family members to get information about their loved one’s care, and establish other opportunities to maintain communication between residents and their families.
We urge the state to adopt similarly strong language with regards to residents and their family members and family caregivers residing in other long term supportive service settings and residential settings, such as assisted living facilities and rest homes.
Virtual Visitation
In addition, we are concerned that nursing home residents going weeks or even months without any visits from loved ones is extremely serious, and the state directives should reflect this by requiring nursing homes to prioritize virtual visits and caregiver communications.
The Department of Public Health ordered that skilled nursing facilities should “restrict all non-essential visitors”, but didn’t make an allowance for virtual visitation. CMS guidance also contains a restriction on visitation, but only advises that facilities “should consider” offering “alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video- communication, etc.).”
During this stressful and difficult time when in-person visitation is very restricted, we strongly recommend that Massachusetts immediately modify its guidance to require nursing homes to offer and facilitate reasonable and practicable alternative means of communication for individuals who would otherwise visit, such as virtual communications. Such virtual visits can be essential to the emotional, mental, physical, and social well-being of nursing home residents. For some residents, these virtual visits may be the difference between life and death.
Given the widespread adoption of video-chat options (from FaceTime to Skype to Zoom and so on), AARP Massachusetts believes these virtual visitations must include the ability to communicate on video, not only for the emotional well-being of the resident, but also so family caregivers can ensure their loved ones are being well cared for. If funding is needed to ensure video-chat options, we encourage the provision of such funding and consideration of how such communications could be part of telehealth.
Conclusion
We appreciate the efforts of you and your Administration to ensure the health and safety of older Massachusetts residents living in the community and in residential settings such as nursing homes, rest homes and assisted living facilities. We urge you to address the above-listed concerns immediately.
AARP Massachusetts