Steve Piskor believes the state’s coronavirus policies are failing Ohio nursing home residents, and he’s confident he knows what will help.
It’s a simple fix to a misguided mandate and it wouldn’t cost the state or the nursing home industry a penny, says the Northeast Ohio advocate for long-term care residents and founder of Elderly Nursing Home Abuse Advocate.
Let the loved ones of nursing home residents see them in their room.
It’s as simple as that.
Not outside. Not peering through a window, and not on a computer screen.
In their room.
Anything short of that — such as the outside visitations that began July 20 at the discretion of individual nursing homes — fails to adequately protect those most vulnerable to COVID-19, he says. In effect, he argues, the rules have done more to shield nursing homes from examination than protect residents.
Piskor also sees intent in the rules, citing recent interest in the Ohio General Assembly in passing an immunity law to protect nursing homes from lawsuits. In late May, in fact, the Ohio House passed legislation that would insulate nursing home operators and health care providers from coronavirus lawsuits. The Ohio Senate has followed suit.
But Piskor, a Cleveland resident who documented abuse of his mother while she was in several nursing homes, says relatives and loved ones act as a necessary check on neglect and abuse. In the coronavirus crisis, banning visitors — except in end-of-life situations, which rules permit — keeps loved ones from adding to the care of the residents and, possibly, preventing death from a COVID-19 infection, he says. In addition, it keeps family members from checking for bruises and other ailments unrelated to COVID-19, he says.
"Not having visitors in nursing homes is a really bad situation," Piskor says. "Visitors in nursing homes is what keeps nursing homes on their toes."
Before and during the pandemic, he has advocated for Esther’s Law, named after his mother, Esther Piskor. The law would allow residents to place cameras in their rooms to document abuse, but it has languished in the Ohio General Assembly in the post-coronavirus era.
Instead of helping, Piskor says, the coronavirus visitation rules mandated by Ohio Gov. Mike DeWine have only exacerbated the problem. He is currently circulating a petition online, calling for the governor to change his orders restricting nursing home visitors. In the petition, Piskor argues that families and friends of residents are willing to go through the same testing regimen and safety protocols that staff do to see their loved ones.
As of 5 p.m. Friday, Piskor had more than 3,100 signatures on his change.org petition.
Like other advocates, Piskor argues that visitors weren’t the primary infection source as nursing home deaths began piling up in April. As of July 31, Ohio Department of Health statistics show 1,966 of the state’s 3,489 deaths were long-term care residents — 56.3% of the state total. Those numbers may be low because the state didn’t begin counting nursing home deaths until April 15 and they are calculated weekly on Wednesdays.
As of Friday, according to Summit County Health Department records, 163 nursing home residents in the county have died from COVID-19, or 75.5% of the 216 total. The agency tallies 512 cases among residents of long-term care facilities, 16.3% of the 3,152 total.
As of Wednesday, the latest ODH update, there have been 19 deaths of long-term care residents in Medina County, 20 in Portage County, 40 in Wayne County and 90 in Stark County, according to ODH records.
Families frustrated
Joyce Takacs, a Hiram resident whose mother is in a Fairview Park nursing home, said her 84-year-old mother contracted COVID-19, but she wasn’t permitted to visit. Phone calls were useless because her mother is deaf, and video visits have been a challenge to schedule with the home.
"I can’t get in to see if she has bruises on her, to see if she’s been bathed properly," Takacs said. "I go up there and are they telling me the truth or not? I don’t know."
Outside visits are inadequate because she’s unable to examine her mother to see if she is all right and to communicate in a private setting. A brief visit outside can’t enable a loved one to keep a resident from dehydrating. And the lack of in-room visitation contributes to the psychological state of residents, who often become depressed in isolation.
Takacs said she’s angry at the governor for allowing the state’s businesses to open, yet being unable to find a way to permit family to visit their loved ones in long-term care facilities.
"If they don’t do something, you’ll probably see me on the news because I’ll break in," she said. "This is just killing people. It’s breaking people’s hearts."
A Summit County resident who did not wish to be identified detailed how her elderly relative, after being diagnosed with COVID-19, was placed in a nursing home to recover.
While there, the relative languished, nearly dying from dehydration and COVID-19 related symptoms, including breathing difficulties. Only a last-ditch effort to get the relative treatment at an emergency room and the treatment provided there and, subsequently, at home enabled a recovery.
Outside visits
A June 29 news release announcing the decision to allow outside visitation lists five organizations involved in developing guidelines for visitation. All of them are long-term care or assisted living trade associations. No advocates for nursing home residents are listed.
One of the organizations, the Ohio Medical Directors Association, has a Facebook page that lists its mailing address in East Lansing, Michigan.
An official at another of the organizations said the guidelines are an effort to make the situation better in a challenging environment.
Jean Thompson, executive director of the Ohio Assisted Living Association, said outside visits have been permitted for assisted living facilities since early June and were extended to long-term care facilities beginning July 20.
The prohibition of inside visitations, she said, is an attempt to reduce exposure to potential sources of the coronavirus.
"It’s just given the nature of COVID-19 and the susceptibility of the vulnerable populations that we serve, the more people that come in, the greater is the potential for exposure," she said.
Thompson said the outside visits were developed as an attempt to address issues of loneliness and depression seen in residents — and their loved ones.
"This is a very, very difficult situation not just for providers in long-term care but for all society," she said. "I think everyone at some level is lonelier than they were before this all started."
Thompson said her organization counts it as a victory that the state altered its rules to allow outside visits in June at assisted living facilities.
"We’re very happy that we were able to demonstrate to the state successful outdoor visitation, which we did, clearly, because they then went ahead and about a month and a half later provided outdoor visitation in nursing homes," she said.
Sam McCoy, senior vice president for elder rights at Direction Home Akron Canton and a member of the Summit County Nursing Homes and Facilities Task Force, called the coronavirus deaths in Summit County and beyond "tragic." As a long-term care ombudsman, McCoy is a state-sanctioned advocate for nursing home residents.
"When I look at the number of deaths attributed to COVID-19 in long-term care facilities, it makes me shudder," says McCoy. "It horrifies me that we have allowed this to occur for whatever reason."
Even as DeWine relaxed rules to allow outside visitations, his amendment didn’t require them, and many facilities are hesitant to start the practice.
"The order allows a lot of leeway for a lot of flexibility on how visits can be arranged," he said. "What we’re hearing in the first couple of weeks, what we’re seeing, is facilities are reluctant to open for visitation."
Like Piskor and others, McCoy believes a family provides unmatched care and attention to a loved one. And he acknowledges that depression and loneliness are increasing among the isolated residents. But he’s unsure when indoor visits not involving a near-death situation will be permitted.
"I don’t have a good sense on when something will change," he says. "I’m all for it; I’d love to see things loosen up, just a little bit."
McCoy, too, says any move to allow visitors would likely be accompanied with caution and adherence to established precautions such as pretesting, distancing from other residents and staff, and masks.
Piskor says advocates across the nation are suggesting to states with restrictive visitation rules that they allow a designated or "essential" family member to be appointed.
That person would be pretested for the virus, would wear Personal Protective Equipment and have unlimited or expansive visitation rights and help provide care and companionship for their loved one.
Piskor says families with loved ones in nursing homes are becoming increasingly frustrated with the governor’s inability to find a safe way to permit visitation more than four months into the coronavirus crisis.
As that frustration grows into anger, it will play a role in the elections and force a change, Piskor believes.
"Not having family members is going to turn out worse than the virus," he said.
Alan Ashworth can be reached at aashworth@thebeaconjournal.com. Follow him on Twitter at @newsalanbeaconj.
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