TOPEKA, Kan. — Families and advocates for the elderly in Kansas argue that with most nursing home residents vaccinated against COVID-19, some facilities' visiting rules need to be relaxed, though the delta variant's spread is making operators nervous.
A state official who investigates complaints against nursing homes and the elder-care focused Kansas Advocates for Better Care are calling on the Kansas Department for Aging and Disability Services to crack down on homes that aren't open enough. They're concerned that the delta variant will prompt new lockdowns.
The aging department says it is working to ensure that residents and families have a voice in visitation policies, though some industry officials still see a need to proceed with caution.
The debate shows how operators feel they're still facing tough choices after nursing homes were COVID-19 hot spots early on during the pandemic. It also shows how residents' and families' anguish and anger still linger.
"We hear about the threat of the COVID and the death from COVID, and its real," Camille Russell, the state's long-term care ombudsman, said Tuesday. "What we don't understand is the pain and suffering and neglect and deaths that happen when there are not other people in the building."
Clusters of COVID-19 cases in nursing homes accounted for fewer than 5% of the 324,000 cases reported by Kansas as of Monday but for nearly 39% of the state's 5,200 reported deaths - more than 2,000 of them.
More than 90% of those cases and deaths happened before May 4, but they're still happening, with nine active clusters as of last week. Meanwhile, confirmed delta variant cases grew by 84% during the 10-day period that ended Monday.
"It's not time to fling the doors open with no guidance," said Debra Zehr, CEO of LeadingAge Kansas, which represents nonprofit aging-services providers.
Limits on visitors, including lockdowns early in the pandemic, were aimed at preventing people from bringing COVID-19 into nursing homes, where elderly residents were particularly vulnerable to severe complications.
"Our families - our base - have basically been very, very supportive for the most part," said Elizabeth Howarth, administrator of the Homestead Health Center in southwestern Wichita.
State and industry officials said homes' current visitation policies are driven by guidance from federal and state regulators and health officials. The guidance calls for restricting visitors when more than 10% of a county's COVID-19 tests are positive and fewer than 70% of a home's residents are vaccinated.
The state said its overall positivity rate was 8.1% on Friday, but the figure has been as high as 11.2% this month. The federal government says more than 84% of Kansas nursing home residents have been fully vaccinated, while the rate for staff is 55%.
Homestead Health in Wichita does not limit how many times family members can visit residents each week. But it requires appointments, keeps visits to 45 minutes and allows two adult visitors per resident.
Those policies took effect in March, when about 90% of the residents had been vaccinated. Howarth said most family members didn't want to visit without being vaccinated themselves.
And, she added, "That pandemic train is still coming down the track."
The aging department says it had received 40 calls about homes' visitation rules on a telephone hotline this year through July 13, without any citations. Deputy Secretary Scott Brunner said the agency told homes in December that they must discuss with all residents what they want and what's possible with visitors.
As for getting more aggressive about cracking down on homes that restrict visitors, he said, "We have to weigh more than just one consideration at a time."
Russell said the long-term care ombudsman's office took up 40 complaints from May 10 through July 10 and received hundreds of calls.
"Some facilities have perhaps gotten comfortable with being in charge of when residents can receive visitors," said Margaret Farley, executive director of Kansas Advocates for Better. Care. "COVID is still lingering as a good excuse."
In Ness City, Tatum Lee's frustration with rules at the local county-run nursing home where her grandfather lives pushed her to seek a Kansas House seat last year. Once in office, Lee, a Republican, sponsored a bill that sought to prevent county-run homes from restricting visits. It didn't pass.
She's still frustrated that visits with "my papa" are limited to an hour. Lee said family members monitor conditions and care at homes.
She said that last year, she had to ask workers at the local home when she saw them out in the community to give her grandfather hugs for her. Lee said she and others worry that homes will shut out visitors again if the area sees another wave of cases.
Lee also said families monitor their relatives' care and, "It matters to the health of these residents."
Ken Kennedy, a retired educator, said his mother's isolation early in the pandemic at the Prairie Sunset Home in Pretty Prairie, west of Wichita, was "the worst part of it all." In the fall, the home began putting up a tent in its courtyard for in-person visits, allowing him and other family members to see his mother regularly before she died in December.
The home's administrator, Aaron Kelley, said residents thrived once restrictions were lifted. Prairie Sunset posts regulators' guidance for visits on its website, but Kelley said he's not having employees police them strictly, adding that, "Somebody's going to hug somebody."
"We've got to get back to humanity," Kelley said.