COLUMBIA — South Carolina Gov. Henry McMaster abruptly changed course Thursday and delayed the release of guidelines aimed at reopening visitation at the state’s nearly 200 nursing homes, which have been locked down since March.
The reopening had been seen as a welcome step for those who say a watchful family member is often the best way to ensure vulnerable residents receive proper care. But McMaster said the timing just wasn't right given the state's surge in coronavirus cases.
"We must protect the lives of our elderly and at-risk citizens and protect the lives of the front line healthcare workers in these facilities," the governor said in a series of tweets. "This is a heartbreaking situation for loved ones, but the rising rate of COVID-19 infections and hospitalizations leaves us no choice."
The coronavirus has infected more than 2,600 patients and staff at 184 nursing homes and other long-term care facilities. According to data released earlier this week, those infections have killed 328 people — just under half of the state’s confirmed virus-related deaths.
The Department of Health and Environmental Control had not yet released its plans to allow homes to reopen, and McMaster's order puts that process on hold. But, according to Randy Lee, president of the state’s nursing home association, preliminary discussions had called for visits to take place outside the facilities.
And Lee did not expect every nursing home to reopen its doors — the decisions would be likely left up to each facility, he said. Lee also stressed that visitors would not be allowed into isolation units.
“We are very concerned about this, but we also are very concerned about their residents who have not had visitation for quite a while,” Lee said. “We very much see the need for residents to see their families.”
For Robert Rikard, a Columbia attorney who handles litigation involving nursing homes, such arrangements would not go far enough. He contends it’s critical that families have more direct access to their loved ones’ care-taking. For him, that means inside the facilities.
That helps fend off neglect and a chance to spot other issues, he said — everything from a developing bedsores to soiled sheets that need washing. During the pandemic, he said, it could be even more important — helping ensure that nursing home staff wear proper protective gear, or diligently monitor symptoms.
“It’s a huge gap in the ability for problems to be noticed, or prevented from getting worse,” Rikard said.
McMaster announced plans on June 26 to open the homes to visits from relatives, under limited circumstances. He directed the state’s public health agency to come up with a plan for immediate family members only, possibly only those over a certain age.
But COVID-19 infections have continued to explode across South Carolina in the days since, with more than 1,600 cases and 19 deaths reported on Thursday alone.
The most recent data suggests confirmed infections at nursing homes have slowed, and the deadly toll has dropped off. But the data may not portray the full picture because it wasn’t immediately clear how regularly residents and staff are being tested.
After universal testing of some 40,000 patients and staff at the homes throughout May, DHEC has since left testing to the discretion of the homes themselves, a DHEC spokeswoman said.
A DHEC spokeswoman stressed that the agency has provided its own oversight of nursing homes through on-site inspections of infection-control practices. Those have covered 162 of the state’s 194 nursing homes so far, spokeswoman Laura Renwick said.
To be sure, any visitation carries some risk. But lawyers said visitors should be allowed indoors if they are required to have their temperature checked and wear protective gear.
Lee stressed that administrators must remain diligent to keep the virus out of nursing homes, where the contagion preys on the elderly and vulnerable.
Outside visitors were an early concern. DHEC restricted them at nursing homes in mid-March. But that didn’t stop the facilities from quickly becoming host to COVID-19, which likely spread from people who were sick prior to the lockdown, or staff who were free to come and go.
In the month that followed, the homes were ground zero for South Carolina’s outbreak.
By the end of April, more than 800 were infected at these facilities in virtually every corner of the state.
Though family members were banned from the facilities, concerns about care began to trickle out.
The Post and Courier reported that the virus spread quickly at nursing homes with some of the state’s poorest records of care, including those with histories of understaffing or infractions for their infection-control practices.
At Heartland Health and Rehabilitation Center in Hanahan, which carries one of the lowest federal ratings in South Carolina, 16 have died at the 135-bed facility, the second most in the state, according to the most recent data from DHEC.
A representative for that facility has stressed that staff moved quickly to isolate infected patients and have followed federal guidelines for controlling the spread of the virus.
But a nurse who eventually contracted the virus told The Post and Courier in April that he was not given the proper protective gear, forced to wear the same thin surgical mask while tending to infected patients and patients who were not isolated.
That has amplified the concerns for some advocates, who say that’s exactly the kind of issue that a visit from a family member could help quickly address.
“There’s no accountability if no one can go in there and see what’s going on,” said Nathan Hughey, a Mount Pleasant lawyer who practices nursing home litigation.
He and other lawyers share a concern that homes with large outbreaks will remain closed off to visitors. Greenville lawyer Matt Christian said for those that only allow outdoor visits, that likely will preclude a significant segment of residents who are not physically able to leave their beds.
“If you leave it up to each facility’s discretion, I’m very concerned they’re going to make it the most restrictive as possible,” Christian said.