North Dakota bill considers 'designated caregivers' to remedy tight pandemic visitation policies in nursing homes

BISMARCK — Responding to the months of pandemic-induced lockdown that have faced many seniors in North Dakota nursing homes, some state lawmakers are looking for ways to open more avenues for visitation in these facilities during future states of emergency.

With an executive order early in the COVID-19 pandemic, Gov. Doug Burgum closed off visitation in nursing homes, and while the state has relaxed these policies since then, many long-term care facility residents have remained in isolation because of federal restrictions continuing to limit visitation, especially during North Dakota's fall surge.

"All residents of the state of North Dakota should be allowed to have someone visit them," said Sen. Kristin Roers, R-Fargo, a lead sponsor on the bill and a registered nurse. "We all need human contact, just for emotional and physical well-being."

If approved, the bill would allow nursing home residents to assign "designated caregivers" who could come and go from their facility, opening an emotional support line. These caregivers would be subject to standardized safety protocols, and individual facilities would have leeway to ask for some additional precautions. But any policies stemming from the bill wouldn't override more restrictive federal limits on visitation.

Roers noted that her legislation is in part a response to some long-term care facilities that she said have technically been eligible for visitation in the pandemic, but have remained under lockdown out of an abundance of caution.

"I get that they're trying to do the right thing, but at the same time we have to balance it with the emotional well-being of these residents," she said.

Rep. Kathy Skroch, R-Lidgerwood, said she isn't familiar with the particulars of Roers' bill yet, but noted that she supports broad efforts to reform nursing home visitation. Recounting the "severe impact" that the isolation of the pandemic has had on her own mother, who lives in a nursing home, Skroch said that "for the first time in her life she has told me she'd rather be dead than live like this."

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Nursing homes have been the epicenters of North Dakota's COVID-19 outbreak, and more than 800 of the state's long-term care residents have died with the virus since March, well over half of the state's reported death toll to the coronavirus.

But while North Dakota Republicans and Democrats have frequently butted heads over the particulars of responsible pandemic policy, Roers' nursing home visitation bill seems to have found some political common ground.

"There has been great angst in terms of visitation of their family members who are in a nursing home," said Sen. Tim Mathern, D-Fargo, who has been a vocal critic of the state's pandemic response. Mathern noted the importance of prioritizing the safety of nursing home residents, but added that he doesn't think this visitation bill would dramatically or dangerously rewrite existing policy.

"It's a narrow look at, how can we create a great opportunity for the family to have a connection with a loved one?" he said.

Still, federal guidelines have overruled the visitation preferences of North Dakota regulators during the pandemic, and avenues to circumvent those higher-level policies are limited.

Roers' bill notes that overarching federal restrictions, like those currently in place by the Centers for Medicare & Medicaid Service (CMS), would supersede any policies resulting from her legislation.

For this reason, Chris Jones, the director of North Dakota's Department of Human Services, which oversees long-term care, was skeptical that the bill would alleviate much of the problem, even if it went into effect today. North Dakota nursing homes that are cleared for visitation by CMS are already free to allow visitation at their own discretion, and Jones said he doesn't think many facilities have remained in lockdown if they could avoid it.

"I could be wrong," he said. "If it makes a difference, I'm all for it."

Since CMS stepped in to close off visitation in North Dakota nursing homes during the fall's COVID-19 surge, Jones and his department have lobbied federal regulators to relax their restrictions, arguing against a "one-size-fits all" approach. Critics of the CMS policy have pointed out that cold winters in North Dakota render outdoor visitation almost impossible, but Jones said the feds haven't shown any signs that they would make a special exception for the state.

"You're never going to make everybody 100% safe. You have to manage risk," he argued.

But even if the pandemic is resolved before North Dakota has a chance to revise its own visitation policies, Roers said she believes her bill could move the needle now, while also providing options for families in future times of crisis.

"I think that the conversation will help," she said. "Likely we'll be beyond this crisis prior to this going into place, but this is for preventing a situation like this happening again."

Readers can reach Forum reporter Adam Willis, a Report for America corps member, at awillis@forumcomm.com.