Brett Kelman Nashville Tennessean
Tennessee will permit hundreds of nursing homes and similar facilities to resume visitation next month under significantly lessened coronavirus restrictions.
Starting Oct. 1, nursing homes and other long-term care facilities will be allowed to hold outdoor visits and limited indoor visits if they’ve gone two weeks without a new case of the coronavirus inside their walls, according to an announcement from state health officials.
The state will also allow nursing home residents to resume communal dining and some therapeutic and social activities, plus visits from barbers and beauticians. Once facilities have reached 28 days without an infection, they can open their doors to “essential caregivers” who help residents with intimate activities like feeding, bathing and dressing.
State leaders described the policy shift as a necessary evolution of a cautious strategy that saved lives but came with a high price.
“We know there is a great cost to pay when loved ones in a nursing home are isolated from their friends and family,” Gov. Bill Lee said Thursday afternoon. “After months of isolation, those costs mount emotionally, physically and otherwise.”
These new rules are a significant loosening of coronavirus restrictions, which currently prevent nearly all visits at almost every facility in the state, and a major pivot point in Tennessee’s recovery from the peaks of the coronavirus. Nursing home residents are among the populations most vulnerable to the virus, and outbreaks inside nursing homes are exceptionally difficult to stop, so these facilities have faced stricter regulation than any other kind of business.
Health Commissioner Dr. Lisa Piercey said the state’s cautious strategy had saved "dozens if not hundreds of lives," but that "has come at the expense of valuable time with loved ones, many of whom are in their twilight years.”
The restrictions have prevented some tragedy but not all. At least 536 Tennessee nursing home residents have died from the virus, according to state data, which is fewer than most other states. Nationwide, about 40% of all coronavirus deaths are residents and workers at nursing homes, but in Tennessee these deaths amount to only 25% of the statewide death toll.
Nursing home outbreaks span Tennessee from tip to tip. More than 7,500 infections have occurred in facilities in 90 of Tennessee’s 95 counties, and outbreaks have struck more than a dozen facilities in Nashville, Memphis and Knoxville — each. Even in Ducktown, a remote Appalachian mining community with only 500 residents, one nursing home has suffered 76 infections and nine deaths.
At least 20 facilities have been struck by multiple waves of the virus and are now combating their second, third and possibly fourth infection cluster, according to infection data published by the Tennessee Department of Health.
Until now, nursing homes have been permitted to have visitors only if they are in counties that meet a threshold few have been able to reach.
Visits were allowed in counties with fewer than 10 new infections per 100,000 residents over the past 14 days. On Thursday, only two counties — Scott and Hawkins — met this requirement.
As of Oct. 1, this threshold will no longer apply. County infection rates will no longer control visitation, and whether a nursing home can welcome visitors will hinge entirely on the number of recent infections inside of that particular facility.
At least some disease experts are wary about the change.
Before the new visitation rules were announced Thursday, Dr. James Hildreth, an infectious disease expert who leads Meharry Medical College, said he believed nursing homes could conduct safe visitation amid the virus, but it would be safest in counties where infections were few and far between.
“The lower the community levels of virus are, the safer it will feel doing that,” Hildreth said. “So, I honestly think that last metric we’ve got to tackle — cases per 100,000 residents — we’ve got to get that below 10 first.”
When asked how he would respond if this threshold were removed, Hildreth said he had “some concerns.”
“I would want to make sure some really rigorous protocols were put in place to protect residents under those circumstances, and they have to be strictly enforced,” he said.
Debbie Bolton poses for a portrait at her home in Gallatin on May 29, 2020. Bolton is the daughter of Clara Summers, a resident of Gallatin Center of Rehabilitation and Healing, who died of the coronavirus.
Despite concerns like these, the new visitation rules will likely be welcomed by thousands of families that have been kept apart for months.
Bobby Cogdell, 75, has in recent months struggled to spend time with his son, Lee, who is a paraplegic and lives in a long-term care facility in Camden.
Cogdell said the prolonged separation was so devastating to his son’s physical and mental health that he was at one point moved into hospice care and is now confined to his bed. Each week, Cogdell sits in a lawn chair outside his son’s window and they converse through the glass.
Soon, maybe, the glass will be gone.
“The separation has been as bad as the wreck that paralyzed him 32 years ago,” Cogdell said, beginning to cry. “I don’t think I could hurt any more than when I couldn’t see him. It was just absolutely terrible.”
Under the revised guidelines released by the state, visitors will still be required to follow restrictions. Regardless of if the visits occur outside or in indoor common areas, residents will be limited only two visitors who must pass a temperature screening and maintain a 6-foot distance. Visits will be capped at 45 minutes.
Visitors will be allowed to enter a resident’s room under only narrow circumstances: The resident is unable to leave the room; the visitor has a negative test within 72 hours; and the visitor has a negative point-of-care test at the nursing home facility.
Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.
