“Why do people put their parents in nursing homes when there are so many problems in them?”

It was not the first time my mom had asked this question. 

This time, it came after yet another report of an elderly woman’s death in a nursing home. The story ended with the largest jury verdict payout related to Florida assisted living homes, with the total reaching $12.5 million. The family had accused the home of negligence and causing preventable bedsores, which eventually resulted in her death.

Nursing homes are scary, my mom said, because the elderly often cannot speak for themselves, and understaffing may lead to mistakes and fatal oversights. 

Many nursing homes are, of course, compassionate and responsibly run. Many families depend on these facilities to care for loved ones with cognitive issues requiring more supervision than families can provide at home. But herein was a deep fault line of cultural difference: Many of my mom’s notions are based on stigmas rooted in a number of Asian countries. 

Putting a parent in a home is often interpreted as a sign of abandonment. It can be a source of deep shame. Though we know this may not be the case, traditional thinking can be difficult to shake. My mom noted that other countries approached elderly care differently and wondered why Americans can’t do the same. 

And that set me down a path, looking for the answer. 

I’m an anchor at KESQ, the ABC/CBS stations in Palm Springs, California. I’m the daughter of Taiwanese immigrants and a supporter of solutions journalism, in which we not only highlight problems across society but also offer potential solutions based on what other places are doing. This particular story came at the tail end of the coronavirus pandemic, when the slower-moving impacts of the pandemic were beginning to surface. And it was especially important to our audience in the Palm Springs and greater Coachella Valley area, which is largely known as a retirement community. In some cities, more than half the population is 60 years or older.

How we treat our elderly tells us a lot about ourselves. And how we treat our elderly can be traced back through our social structures as well as our culture. I knew I wanted to do a story on why care for our aging population is so lacking compared to other countries. I also knew we had to frame it through the lens of the pandemic. 

But how utterly depressing this report would have been if the takeaway was simply: If you get old in America, you’re on your own. Too bad! It was important to me to look for potential solutions, or at the very least, show how other countries may care for their elderly and succeed in ways the U.S. does not. With support from the Center for Health Journalism 2023 California Health Equity Fellowship, I took the following steps to tell my story: 

Step 1: Identify the problem. 

This came after several versions of the same conversation with my mother. Caregiving for elders has always been a fascinating topic. Why is life expectancy shorter in the U.S.? Why is our social net significantly weaker for the elderly, compared to other countries? The topical inroad here was the coronavirus pandemic and how it had severely worsened health outcomes for older people and caregivers.

What makes this country strong also makes it weak. Our ruthless individualism and worship of self-achievement has led to extraordinary entrepreneurship, creating some of the world’s biggest tech empires, which in turn, shape the world. It allows for sky-high dreams, even though we know our systems are not equitable and don’t always allow everyone to achieve their dreams because of systemic discrimination. Big dreams and the perception of individual exceptionalism define the United States.

At the same time, our individualism can make us selfish. It creates a society in which many look out only for themselves. This was apparent during the COVID-19 pandemic when people across the U.S. refused to wear masks to protect themselves and other people —- a refusal that confounded much of Asia, where people have masked up for decades to prevent contagious diseases. Branching from the mentality of individualism is the idea that once someone turns 18, the person is on their own, another idea that baffles many people in other nations. 

When they turn 18, my mother asked, do they stop being your child?

Step 2: Identify who else is dealing with this problem and who may handle it better. 

It wasn’t hard to find other countries with stronger social nets. But the tougher question to answer was what allows them to handle the challenges better. I started domestically, by looking at local and national reports on caregiving and how the pandemic had affected rates of depression, anxiety, burnout and more. I checked a variety of organizations and sources, including the Alzheimer’s Association, Caring Across Generations, Frontiers in Psychiatry and federal reports on social program funding for the elderly. I also spoke to people about the cultural differences that allowed different modes of elderly care to thrive in other countries. I found that U.S. history, political attitudes, and socioeconomic individualism are firm blockades to achieving what other countries have. 

All of this leads to the differing concepts of family and the expectation surrounding family. For Americans who negotiate the idea of self-sufficiency and obligation to family, it can be tough. What do you owe the parents who raised you? What do you owe yourself? How much of your own desires do you sacrifice for your family? For many Asian countries, it’s an expectation that aging family members live with the eldest child until they die. 

Step 3. Follow the money. Always.

Money tells stories. This is true across nearly every piece of journalism.

Every country has old, sick people. But stark differences in cultural attitudes and approaches toward the elderly are revealed in how countries support programs to assist them. My focus was on caregivers and how lives can pivot in a moment because a loved one has a devastating diagnosis. I found that several European and Asian nations invested much more in caring for their elderly than we do. In Finland and Taiwan, for example, government funding guarantees care for elderly citizens, with recipients given the option to receive care at home or in a facility. These countries see long-term elderly care as a social imperative. 

While Medicare and Medicaid offer either coverage with long waitlists or limited coverage for people who qualify, the U.S. has no federal long-term care program that works for everyone. If you need care in old age and you don’t qualify for Medicaid, you are primarily on your own. 

Step 4. Humanize the issue.

Advocates argue that caregiving in the U.S., for the old or young, is not a funding priority because it has been undervalued. This attitude has roots in historically racist and patriarchal structures reaching back to the nation’s founding, when caregiving was the work of Black enslaved women, according to Sade Dozan of Caring Across Generations, an advocacy nonprofit. Today, paid care is done largely by Black and brown workers, many of them undocumented immigrant women. The work is underpaid and not valued or respected because of the way we have marginalized these groups.

For all the statistics and cultural analyses — which certainly contextualize why we are where we are — the humanity of the crisis is how you get people to care. Through Alzheimer’s Association we found our main character, Davette Robinson. She put a face to the crisis and gave us access to her heartbreaking situation. 

After the story aired, we created a local resource list for people across Coachella Valley. Viewers emailed, thanking us for bringing the caregiver struggle to light and offering resources specific to our valley. 

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The Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin detailing actions that states can take using existing Medicaid authorities to drive better health outcomes for nursing home residents and improve staff pay, training, and retention efforts. The informational bulletin – issued by CMS’ Centers for Medicaid and CHIP Services (CMCS) – also provides examples of current state Medicaid initiatives to support this work.

Earlier this year, President Biden announced a comprehensive set of reforms to improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so potential residents and their loved ones can make informed decisions. As part of the implementation of these reforms, CMS is working to support state Medicaid agencies in ensuring the best care possible for beneficiaries living in nursing homes.

“Our loved ones living in nursing homes deserve the highest quality of care, dignity, and respect,” said Health and Human Services (HHS) Secretary Xavier Becerra. “At HHS, we’re taking another critical step to implement President Biden’s bold set of reforms to improve our nation’s nursing homes. We call on all states to work with us and ensure everyone has access to the high-quality care they deserve.”

“Today’s action is an important step toward accomplishing the Administration’s goals of strengthening the quality of care, accountability, and transparency in our country’s nursing homes for Medicaid enrollees. States can implement a number of initiatives described in this guidance immediately,” said CMS Administrator Chiquita Brooks-LaSure. “Medicaid enrollees residing in nursing homes will only experience better care through collaboration between states, CMS, providers, and other partners, and we look forward to working closely with them on this important effort.”

To ensure nursing homes are adequately resourced and staffed, CMS is urging states to tie Medicaid payments to quality measures that will improve the safety and quality of care.

“We know that low wages for staff can contribute to frequent turnover and dangerous staffing shortages at nursing homes, so we encourage states to work with these facilities to find solutions for training and improving staffing,” said Administrator Brooks-LaSure.

In addition to this informational bulletin, CMS continues to encourage states strongly to achieve a more equitable balance between the share of spending and use of services and supports delivered in home and community-based settings relative to institutional care like nursing homes. As another key priority of the Biden-Harris Administration, CMS is committed to strengthening the availability of Medicaid-covered home and community-based services (HCBS) as an alternative to institutional care. As a result of the American Rescue Plan, states are planning to invest $25 billion to expand, enhance, and strengthen HCBS, the largest investment ever in HCBS.

Read the full informational bulletin sent to states: Medicaid nursing facility payment approaches to advance health equity and improve health outcomes

Read the White House fact sheet: Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes

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The Centers for Medicare & Medicaid Services (CMS) issued its fiscal year (FY) 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) proposed rule, which includes asking for public feedback on how staffing in nursing homes and health equity improvements could lead to better health outcomes.

The proposed rule builds upon the Biden-Harris Administration’s commitment to advance health equity, drive high-quality person-centered care, and promote sustainability of its programs. The rule is an important step in fulfilling its goal to protect Medicare skilled nursing facility (SNF) residents and staff by improving the safety and quality of care of the nation’s SNFs (commonly referred to as nursing homes). The SNF PPS provides Medicare payments to over 15,000 nursing homes, serving more than 1.5 million people. Medicare spending to nursing homes is projected to be approximately $35 billion in FY 2022. Through the SNF PPS proposed rule, CMS is continuing its work to transform the SNF payment system to a more patient-centered model by making payments based on the needs of the whole patient, rather than focusing on the volume of certain services the patient receives.

“Everyone deserves to receive safe, dignified, and high-quality care, no matter where they live,” said Health and Human Services Secretary Xavier Becerra. “Today we are starting the necessary work to ensure our loved ones living in nursing homes receive the best care at the staffing levels they need. We are working hard to deliver on President Biden’s commitment to protecting seniors and improving the quality of our nation’s nursing homes.”

The SNF PPS proposed rule aims to realize the President’s vision for the nation’s nursing homes as outlined in his State of the Union Address, with a focus on providing safe, dignified, and appropriate care for residents. As part of this vision, the Biden-Harris Administration recently set a goal to improve the quality of nursing homes so that seniors, people with disabilities, and others living in nursing homes get the reliable, high-quality care they deserve. A key part of reaching this goal is addressing staffing levels in nursing homes, which have a substantial impact on the quality of care and outcomes residents experience.

“The COVID-19 pandemic has highlighted serious problems at some of the nation’s nursing homes that have persisted for too long. And we have seen the tragic impact that inadequate staff resources can have on residents and staff,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration has promised that we will work with all stakeholders to do better for nursing home residents, and today’s proposed rule includes important steps toward our goal to promote safety and quality of care for all residents and staff.”

In the SNF PPS proposed rule, CMS is soliciting input to help the agency establish minimum staffing requirements that nursing homes will need to meet to ensure all residents are provided safe, high-quality care, and nursing home workers have the support they need. This input will be used in conjunction with a new research study being conducted by CMS to determine the optimal level and type of nursing home staffing needs. The agency intends to issue proposed rules on a minimum staffing level requirement for nursing homes within one year. 

CMS is also requesting stakeholder input on a measure that would examine staff turnover levels in nursing homes for possible inclusion in CMS’ SNF Value-Based Purchasing (VBP) Program, which rewards facilities with incentive payments based on the quality of care they provide to people with Medicare. Looking at the relationship between staff turnover and quality of care, preliminary analysis by CMS has shown that as the average staff turnover decreases, a facility’s overall rating on CMS’ Nursing Home Five Star Quality Rating System increases, which suggests that lower turnover is associated with higher overall quality. CMS will use the stakeholder feedback to inform a proposal of this measure to include in the SNF VBP Program in the future. 

In January, CMS began posting nursing home staff turnover rates (as well as weekend staff levels) on the Medicare.gov Care Compare website, and CMS will be including this information in the star rating system starting in July 2022. This information helps consumers better understand each nursing home facility’s staffing environment and also helps providers to improve the quality of care and services they deliver to residents. 

 The proposed rule also proposes the adoption of 3 new measures into the SNF VBP Program:

• The Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (SNF HAI) is an outcome measure that assesses SNF performance on infection prevention and management.
• The Total Nursing Hours per Resident Day is a structural measure that uses auditable electronic data to calculate total nursing hours per resident each day.
• The Adoption of the Discharge to Community – Post Acute Care Measure for SNFs (DTC) is an outcome measure that assesses the rate of successful discharges to community from a SNF setting.

 To advance health equity and address the health disparities that underlie the U.S. health care system, CMS is requesting stakeholder feedback on the role health equity plays in improving health outcomes and the quality of care in nursing homes. Specifically, CMS is seeking comment on how to arrange or classify measures in nursing home quality reporting programs by indicators of social risk to better identify and reduce disparities.

CMS is proposing a 3.9%, or $1.4 billion, update to the payment rates for nursing homes, which is based on a 2.8% SNF market basket update plus a 1.5 percentage point market basket forecast error adjustment and less a 0.4 percentage point productivity adjustment. The proposed rule also contains a proposed adjustment to payment rates as the result of the transition to the SNF payment case-mix classification model  ̶  the Patient Driven Payment Model (PDPM) that went into effect on October 1, 2019. When finalizing the PDPM, CMS also stated that the transition to PDPM would not result in an increase or decrease in aggregate SNF spending. Since PDPM implementation, CMS’ data analysis has shown an unintended increase in payments. Therefore, CMS is proposing to adjust SNF payment rates downward by 4.6%, or $1.7 billion, in FY 2023 to achieve budget neutrality with the previous payment system. As a result, the estimated aggregate impact of the payment policies in this proposed rule would be a decrease of approximately $320 million in Medicare Part A payments to SNFs in FY 2023 compared to FY 2022.

For a fact sheet on President Biden’s remarks during the State of the Union Address on improving nursing home safety and quality, please visit: https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/

For a fact sheet on the FY 2023 SNF PPS proposed rule, please visit: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2023-skilled-nursing-facility-prospective-payment-system-proposed-rule-cms-1765-p

To view the FY 2023 SNF PPS proposed rule, please visit: https://www.federalregister.gov/public-inspection/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities

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COVID-19 infections are soaring again at U.S. nursing homes because of the omicron wave, and deaths are climbing too, leading to new restrictions on family visits and a renewed push to get more residents and staff members vaccinated and boosted.

Nursing homes were the lethal epicenter of the pandemic early on, before the vaccine allowed many of them to reopen to visitors last year. But the wildly contagious variant has dealt them a setback.

Nursing homes reported a near-record of about 32,000 COVID-19 cases among residents in the week ending Jan. 9, an almost sevenfold increase from a month earlier, according to the Centers for Disease Control and Prevention.

A total of 645 COVID-19-related deaths among residents were recorded during the same week, a 47% increase from the earlier period. And there are fears that deaths could go much higher before omicron is through.

Despite the rising numbers, the situation is not as dire as it was in December 2020, when nursing home deaths per week topped out at about 6,200. Experts credit the high vaccination rates now among nursing home residents: About 87% are fully vaccinated, according to CDC data.

COVID-19 shots and boosters provide strong protection against severe illness, hospitalization and death, but the sick and elderly are uniquely vulnerable to the virus.

Nursing home officials say they are responding to the outbreak by limiting visitors to common areas instead of allowing them into residents’ rooms, and by reinstituting social distancing.

Some states, like New York, have put their own measures in place, like requiring proof of a negative test for visitors and providing all with surgical masks.

Nursing homes are also working to drive up vaccination numbers, especially for boosters. Sixty-three percent of nursing home residents nationally have received an extra dose.

Booster numbers are much worse for staff members. About 83% are fully vaccinated, but only 29% have gotten an extra dose.

Nursing homes have been holding vaccine clinics and town hall meetings to stress the importance of the shots.

They also got another tool to increase vaccinations Thursday when the U.S. Supreme Court upheld a Biden administration vaccine mandate for most health care workers in the U.S.

About 57,200 nursing home workers — by far the highest number on record during the pandemic — had the virus in the week ending Jan. 9, a more than tenfold increase from a month earlier, according to the CDC.

Sharon Wheeler was shocked to learn that her 88-year-old, dementia-stricken father recently contracted COVID-19 at a Naperville, Illinois, nursing home. She said she hopes the fact that he is fully vaccinated and boosted will help him pull through.

She said she suspects visitors and residents coming and going around the holidays brought COVID-19 inside. Wheeler hasn’t been allowed to see her father, but the staff told her he had mild symptoms.

“I worked so hard to make sure he never got (COVID-19), because I was so terrified,” she said. “He’s such an older man, and I don’t want to lose him this way.”

Vaccines are just one of the many tools that should be used to defend the elderly against omicron, said Eric Feigl-Ding, an epidemiologist and senior fellow at the Federation of American Scientists. He also recommended testing of visitors, mandatory boosters and the use of medical-grade masks like N95s and high-efficiency air filters.

“We need to build a Fort Knox around protecting nursing homes, but we’re not doing that right now, and that’s why cases are surging,” Feigl-Ding said Thursday. “We’re going to have exponential numbers of hospitalizations and deaths.”

The virus dealt a devastating blow in late November to the New Hampshire nursing home Todd Fernald runs, called Webster at Rye, where 100% of residents and staff were vaccinated — but not boosted.

“COVID ripped through this building in 10 seconds,” Fernald said, recalling how, on the day that extra shots were scheduled to be administered, an outbreak occurred that would ultimately kill six residents, infect dozens of others and sicken 20 employees.

Since then, nearly all residents have been boosted, and employees are getting their third shots.

“I only lost one employee who didn’t want to be vaccinated and chose to resign their job,” Fernald said. “I’m having more and more people each and every week that I see are getting boosted and bringing me their booster cards.”

Making sure that facilities have supplies like tests is crucial too, said Lisa Sanders of LeadingAge, an association of nonprofit providers of aging services, including nursing homes.

“Older adults and the people they care for should be prioritized for support and supplies as they become available,” Sanders said.

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There’s no question that the coronavirus pandemic has hit the Golden State’s seniors hard. Californians age 65 and up make up just 15.6% of the state’s overall population, but state data indicates they account for 74% of coronavirus-related deaths. The statistics are even more stark for the very oldest residents — those 80 and up. That group makes up less than 4% of the population but accounts for nearly 40% of fatalities linked to COVID-19. 

Those living in group settings have been particularly hard hit. Social distancing in group settings, particularly in memory care facilities where Alzheimer’s disease and dementia are common, is difficult to enforce. Caregivers, already earning low wages for long, strenuous hours, have been overwhelmed by the demands of the pandemic — work that can quickly become life threatening when the virus invades. According to the American Community Survey, less than 2% of the state’s seniors live in nursing homes, yet nursing homes account for roughly 20% of the state’s pandemic-related deaths. Assisted living facilities, which are much more common, have also been hit hard. People of color have been particularly impacted. A study reported in the Journal of the American Medical Association found that those with the highest proportions of non-white residents experienced death counts that were more than three times those with mostly white residents. 

As more seniors and their caregivers receive coronavirus vaccinations and the thousands of facilities and individual families who provide care for seniors begin to emerge from the “crisis mode” of the last year, what will the lasting impact be? Will nursing homes and assisted living facilities alter their protocols or the type of care they offer in the wake of the deadly pandemic? 

Already, lawmakers in Sacramento — including Bay Area Assemblyman Ash Kalra — are spearheading new legislation aimed at increasing oversight of corporations that run nursing facilities. Will state lawmakers pass new legislation affecting elder care this year? Will new advocacy organizations form and will those already in existence become more powerful? Will families who might have considered a group living setting for a loved one before the pandemic ultimately decide to seek at-home care instead? Will seniors themselves rethink what they want in their final years? And will paid caretakers — often hourly, low-income people of color with few work benefits who have put their lives at risk for months — receive any new protections? 

I plan to pursue a project, to be published by the Bay Area News Group in print and online, focused on how the coronavirus affects elder care in California, with a particular emphasis on seniors from disadvantaged and low-income communities in the Bay Area.

I plan to approach this project for the 2021 California Fellowship from a number of angles, including a comparison of how well-resourced facilities have fared compared to facilities in hard-hit, disadvantaged communities. What works, what doesn’t, and what needs to change? I also intend to analyze public inspection reports that track violations at nursing homes and assisted living facilities and analyze the violations that occurred at places with high death rates, in particular. 

Throughout the reporting process, I also intend to speak with Bay Area families that have made or are making elder care decisions, examining the factors that go into those decisions, including everything from cost to cultural considerations. Will there be new efforts to support families opting for in-home care? 

Perhaps most importantly, I will highlight the voices of seniors and health care workers themselves. I’ve spoken with geriatricians at UCSF, Stanford and elsewhere during the pandemic who say one of the state’s main failings when it comes to seniors is that officials don’t involve them in decision-making processes and produce one-size-fits-all solutions that leave many seniors behind. I’ll talk to seniors in various living situations about the impact of the pandemic and what they want to see changed moving forward. I’ll also look at efforts by unions and advocacy groups to push for worker benefits and assess whether they have a chance of passing. 

The stakes are high. California has an aging population and while the state may not experience another event on the scale of the coronavirus pandemic in our lifetimes, residents will grapple with infectious disease outbreaks in the future. COVID-19 has laid bare the inequities and pitfalls in the current patchwork of care options for seniors and their families, and presents a unique opportunity to spark meaningful reforms that could affect where and how seniors live out their final years for decades to come. 

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An 88-year-old woman in Ohio broke down in tears as her son hugged her for the first time in a year. Nursing home residents and staff in California sang “Over the Rainbow” as they resumed group activities and allowed visitors back in. A 5-year-old dove into the lap of her 94-year-old great-great-aunt for a long embrace in Rhode Island.

Nursing homes, assisted living facilities and other kinds of elderly residences battered by COVID-19 are easing restrictions and opening their doors for the first time since the start of the pandemic, leading to joyous reunions around the country after a painful year of isolation, Zoom calls and greetings through windows.

The vaccination drive, improved conditions inside nursing homes, and relaxed federal guidelines have paved the way for the reunions.

There have been welcome-back parties, birthday celebrations, coffee hours on the patio and more in recent days, giving older Americans and their families a glimpse into what life may look like in a post-vaccine world.

“This is the beginning of the very best to come, hopefully, for all of us,” said Gloria Winston, a 94-year-old retirement community resident in Providence, Rhode Island. “The world is going in the right direction. We need the nourishment of each other.”

Long-suffering families say the reopenings are well overdue. Most elderly care residents and many staffers have been fully inoculated for weeks, since they were among the first vaccinated in the nationwide rollout.

Roughly 1.4 million residents and 1 million staffers at long-term care facilities are fully vaccinated, according to the Centers for Disease Control and Prevention.

COVID-19 cases and deaths in the facilities have also plummeted, from a peak of more than 30,000 cases and 7,000 deaths among residents in one week in December to fewer than 1,300 cases and 500 deaths in all of last week, according to the CDC.

(Overall in the U.S., the death toll has topped 540,000. Deaths per day have plummeted to an average of 1,000, down from an all-time high of over 3,400 in mid-January and the lowest level since early November. New cases are running at a still-troubling average of about 54,000 per day, plunging from a quarter-million per day in early January.)

Federal regulators, in recognition of the improving situation, recommended earlier this month that long-term care facilities allow indoor visits at all times.

COVID-19 took a frightening toll in nursing homes and other such institutions. Long-term care residents accounted for more than 130,000 deaths and more than 640,000 cases during the pandemic, according to government data. Staff members accounted for an additional 1,600 deaths and more than 550,000 cases.

In Rhode Island, the first visitors Winston welcomed into the Laurelmead Cooperative since the outbreak started were her great-niece and her 5-year-old great-great-niece.

The three shared a flurry of hugs last week before Cordelia Cappelano, Winston’s great-great-niece, retreated, shyly burying her head in her mother’s body.

“I think I’ve had better hugs in my day,” Winston teased. “It’s as if we’re not family anymore.”

But after nearly two hours playing and catching up, Cordelia warmed up. She dove into Winston’s lap for one last hug before it was time to go.

“To be able to be this close and have Cordelia melt around her has just been wonderful,” said Wensday Greenbaum, Winston’s great-niece. “It’s just a release of all that anxiety and sadness that comes with being isolated. It’s been a difficult year, and this is one step closer to normalcy.”

In California last week, Celia Olson sat on the patio with her 92-year-old mother, Connie, at the Chaparral House in Berkeley. It was their second time meeting since visits recently resumed at the nursing home.

“This is really nice,” Connie Olson said as her daughter placed a blanket over her.

Over the past year, Celia Olson, a 65-year-old veterinarian, was able to see her mother only through a window or via Skype. Now both are vaccinated.

“It’s been a year of everybody just being traumatized and trying to understand how to navigate through the coronavirus situation,” Celia Olson said.

In Cincinnati last week, Bernie Brungs donned goggles and an N-95 mask to hug his 88-year-old mother, Rose, during a special “compassionate care” visit.

Brungs recalled how his mother — who is paralyzed from the waist down and spends most of her time alone — cried and told him how much she missed him during their 15 minutes together.

He promised her he would stay longer and play her favorite game — Yahtzee — when indoor visits at Ohio nursing homes officially begin on Tuesday.

“It was wonderful,” Brungs said. “The hug I got from her, it was just unimaginable how much it made me feel.”

In Tennessee, Brandon Johnson was able to wrap his arms around his great-grandmother, Phyllis, on her 89th birthday earlier this month. Johnson said it was a joyful moment he had been praying for after a year of waving to his great-grandmother through windows.

“COVID robbed a year from us — a year where we couldn’t hug her, kiss on her and love her. That was tough, but now we’re making the most of it,” said the 27-year-old from LaFollette, Tennessee. “COVID is a nasty thing, but the one good thing about it is that it was a wake-up call to be really grateful for what you have.”

Other states are still reviewing and updating their policies to reflect the new federal guidance.

Many elderly residences say they will be taking a measured approach to reopening their doors, meaning stricter restrictions will probably persist in the short term in many places, to the frustration of families.

In Massachusetts last week, visits at the Hellenic Nursing and Rehabilitation Center in Canton, some 20 miles (32 kilometers) south of Boston, were still limited to sit-downs in the dining room, with guests and residents separated by a clear plastic barrier.

A staffer was on hand to limit encounters to 30 minutes and make sure hugs and other physical contact happened only at the beginning and end of the session.

Anne Darling, who was visiting her 86-year-old mother, Mary Claire Lane, on Thursday, said she hoped the home would loosen its restrictions soon to allow her to bring the family’s beloved dog and younger family members.

“We miss her and she misses us,” Darling said. “If we could just bring in the little ones, it would just bring a joy to her heart. I know she’s well cared for, but it just gets lonely.”

In Bristol, Rhode Island, Charlie Galligan said visits have been gradually improving at his mother’s nursing home, but not fast enough. Most visits at Saint Elizabeth Manor are still limited to 30 minutes in the common dining room with social distancing and other precautions, he said.

Galligan’s 88-year-old father, Jack, who has Alzheimer’s, and his 84-year-old mother, Audrey, who has a traumatic brain injury, were recently granted a compassionate care visit.

The couple, who can barely communicate with each other but spent nearly every day together before the outbreak, were allowed to hug twice and spend up to an hour together.

“It’s heart-wrenching,” Galligan said. “My dad has declined so much more in the past year. He’s lost without her.”

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“At President Trump’s direction, CMS has worked closely with states to complete focused infection control surveys of virtually all nursing homes in the country in just a few months,” said CMS Administrator Seema Verma. “These surveys fortified healthcare facilities around the country to prepare for and implement actions to prevent transmission of the virus and provided indispensable insight into the situation on the ground. As CMS resumes some survey and enforcement activities that were previously put on hold, the health and safety of America’s patients will always be our top priority.”

In the guidance released today, CMS directed the resumption of onsite revisit surveys, non-immediate jeopardy complaint surveys and annual recertification surveys as soon as resources are available. In addition, CMS is providing guidance on resolving enforcement cases that were previously on hold because of survey prioritization changes. The agency will also temporarily expand the desk review policy, when state surveyors ensure that facilities return back into compliance with Federal requirements without an onsite survey, to include all noncompliance reviews except for immediate jeopardy citations that have not been removed.

On July 31, CMS posted the latest results from the targeted nursing home infection-control inspections. Since March 4, CMS and its network of state-based inspectors have conducted more than 15,158 surveys, reflecting a 98.5 percent completion rate, with a total of 16,987 survey reports publicly available on Nursing Home Compare. CMS has imposed more than $15 million in civil money penalties (CMPs) to more than 3,400 nursing homes during the public health emergency for noncompliance with infection control requirements and the failure to report COVID-19 data.

CMS is also issuing updated guidance for the re-prioritization of routine state survey agency activities on Clinical Laboratory Improvement Amendments. This updated guidance will provide flexibility and discretion to state survey agencies so that they can resume their survey activities based on the status of COVID-19 infections in their states.

CMS is also posting updates to the “Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes.” The toolkit details actions and best practices by organizations, state governments nationwide, and U.S. territories to assist nursing homes in meeting the needs of nursing home residents since the onset of the pandemic. The toolkit is updated on an ongoing basis to ensure it contains the most recent information available for providers and administrators of nursing homes to learn from an array of creative plans that state governments and other public health entities have put in place in a short period of time to contain the spread of the virus in nursing homes and meet the needs of America’s most vulnerable

CMS is committed to protecting the beneficiaries it serves. The agency develops and enforces federal safety standards across the healthcare system. CMS’s network of federal and state inspectors, as well as private accrediting organizations for some types of providers with programs approved by CMS, physically visit Medicare and Medicaid-participating health care providers to ensure compliance with these standards – including over 15,000 Medicare and Medicaid certified nursing homes.

-cms.gov

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