State Allows Outdoor Nursing Home Visits While Eying Virus Numbers

Updated 4:48 p.m., date of nursing home visitations corrected
COLUMBUS, Ohio — Despite a “significant week,” where the state saw the most hospitalizations for COVID-19 for more than two months, Gov. Mike DeWine says the state will begin allowing outdoor visits at nursing homes provided certain safety measures are met.

During his press briefing Monday, DeWine said stories of families unable to visit loved ones in nursing homes have been among the most troubling. While the original stay-at-home order was put in place to protect nursing home residents and staff, he recognizes that visits from families “adds value to life” for those residents, and the inability for visits to take place has been “gut-wrenching” for families, he said.

Starting July 20, nursing homes can begin outdoor visits as long as the nursing home meets specific safety standards, he said. A similar allowance for assisted living and intermediate care centers was put in place June 8.

When assessing their readiness to permit such visits, nursing homes should consider the number of coronavirus cases in the community as well as the case status in the nursing home itself, staffing levels, the local hospital capacity, and having adequate access to testing and personal protective equipment for staff and residents.

The state consulted with advocates and providers in the aging and developmental disabilities communities to develop the visitation guidelines, and has reviewed guidelines jointly developed by the Academy for Senior Health Sciences Inc., LeadingAge Ohio, the Ohio Assisted Living Association, the Ohio Health Care Association and the Ohio Medical Directors Association.

“Assisted living has worked out pretty well as far as we can tell. And now we want to extend that to nursing homes,” DeWine said. “We’re confident that our approach provides each facility the flexibility needed to access their readiness to safely facilitate outdoor visitation. And to do so in a transparent way that keeps residents and families informed.”

Through the efforts of the Ohio National Guard, the state is in the process of testing every nursing home in the state. In May, the DeWine administration deployed Congregate Care Unified Response Teams comprised of the National Guard, local health departments and local and state Medicaid offices to test nursing home residents and staff.

Last week, the Ohio Department of Health reported the lowest weekly death toll among nursing home residents since tracking began in mid-April. The 89 residents who have died since June 17 bring the state’s total number to 1,580. In the Mahoning Valley there have been COVID-19-related deaths in long-term care centers.

Once a nursing home has been tested and can meet the requirements, it can begin hosting outdoor visits, DeWine said.

Of the 960 care centers in the state, the National Guard has tested more than 258 with more than 25,000 people, reported Major Gen. John Harris Jr., Ohio Adjutant General with the Ohio National Guard.

In addition, the National Guard has worked to build the state’s testing capacity via pop-up testing sites, Harris said. Thus far, the guard has organized 19 of the temporary sites, testing more than 5,000 Ohioans.

“This is a step in the process,” Harris said. “As with the nursing homes, where that starts with a clinical assessment, this also ideally starts with an assessment by the Department of Health.”

The guard works with closely with local departments of health to monitor a number of leading indicators, allowing the guard to identify the communities where the risk is highest, he said. Hosting pop-up testing sites at those areas helps “control the spread of the virus before it becomes an outbreak,” he said. “That’s the ideal situation.”

Without other measures taken, however, testing “doesn’t do anything,” Harris said. The general reiterated the importance of keeping to social distancing guidelines, wearing facial coverings in public and maintaining proper hygiene, as well as performing contact tracing when a positive diagnosis is made.

Hospitalizations for COVID-19, the disease spread by the coronavirus, are in the state, DeWine reported. Not just daily admissions, he clarified, but of those patients who are occupying beds. Those numbers peaked at 1,000 in late April and had declined to a low of 513 on June 20, he said.

Last week, the state saw 550 total COVID-19 patients in hospitals – the highest increase in more than two months, the governor said. Usage of intensive care units and ventilators is “holding steady,” but is also increasing, he added.

Areas where those increases are most apparent are in Regions 2, 3 and 6, which include Cleveland, Dayton and Cincinnati, he said. Mahoning, Trumbull and Columbiana counties are in Region 5, which is south of Region 2.

Though hospital utilization for COVID-19 is increasing, capacity is still “adequate” for Ohio hospitals as no region has reached the concern threshold of 80%, he said. However, as states like Texas, Florida and Arizona have shown, “that could very quickly change,” he said.

“Some people think and are wondering at least if the increased cases we are seeing is simply because Ohio is testing more,” DeWine said. Some of the increase is because of testing, he offered, but it’s not just the testing.

The positivity number is evidence of that, the governor said. When testing began in the state, it was very restrictive to those who were displaying the most severe COVID-19 symptoms. But as testing has increased, it was expected that the positivity number – the percentage of those tested being positive – would in turn go down.

“That would be the normal thing you would expect,” he said. “That has not happened.”

While the positivity number for the state hasn’t “gone up dramatically,” it has not dropped either. It currently holds steady between 4% and 6%.

Southwestern portions of the state continue to be a concern, with Hamilton and Montgomery counties being of chief concern, DeWine said. During a call with the White House Coronavirus Task Force Monday, the two counties, which include Dayton and Cincinnati, were specifically identified by White House officials.

“They told us they would give us added help in those two counties,” DeWine said.

In Hamilton County, the daily average of positive cases per 100,000 population was holding steady at 30 at the end of May and into June. This week, those numbers spiked to 100 cases. Montgomery County saw a similar spike in its daily average to 40 up from 10, the governor reported.

Doctors and other health-care providers are seeing more patients displaying COVID-19 symptoms who are then diagnoses positive, he said.

From June 15 to 22 in Hamilton County, daily doctor visits doubled to 78 from 40. Hospitalizations in the county have doubled from a low of 65 on June 11 to more than 130 this past weekend.

Daily outpatient visits in Montgomery County increased to 27 from seven, he added.

“By reviewing other health care indicators, we can see this is not solely because of increased testing,” DeWine said. “COVID-specific hospital utilization is approaching levels not seen since the earlier peak of the pandemic in April.”

During his briefing on July 2, the governor will address the next phase of guidelines for the state, including the state’s work on plans to reopen schools.

Copyright 2020 The Business Journal, Youngstown, Ohio.