At noon on March 23, 2020, Indiana Governor Eric Holcomb told all Hoosiers to stay at home for two weeks except for limited exceptions such as grocery shopping, pharmacy shopping, to visit a health care provider, or for essential services. Although essential services under the Governor’s Order include legal and accounting services, it is more likely than not Indiana’s law firms and accounting firms are closed and their staff working from home, as is the case with my law firm. Thus, our new normal is to shelter in place relying on internet access to our files, offices, and co-workers to provide our clients with necessary and timely legal services. That said, we have postponed depositions, mediations, and other meetings that normally occur in-person, and Courts are conducting business remotely as well with hearings that need to be conducted being conducted by telephone.
This is truly unprecedented in our lifetime and, frankly, a bit unnerving. It is not normal for all of us to work from home with little to no social interaction except for our loved ones trapped in our homes, apartments, and other living spaces with us.
Not only are our offices, factories, and other outside workspaces deserted, so too are our downtowns, our shopping malls, and other businesses so as to maintain the social distancing we are told is necessary to avoid contact with both the virus and others who have the virus. We are warned repeatedly to wash our hands and avoid hand-to-face contact. Nevertheless, the number of confirmed cases and, sadly, deaths rise with each day. It’s not only unnerving but downright scary.
But this article is not to tell you what you already know. As a member of Drewry Simmons Vornehm, LLP’s health law practice group and a member of both the Indiana Health Care Association and LeadingAge Indiana, I am inundated daily with CDC, and the Centers for Medicare and Medicaid Services’ (CMS) directives and orders. March 22, CMS ordered that nursing facilities deny entry to all but staff members and the Indiana State Department of Health ordered that nursing facility staff members must don protective gear while on duty.
Every day the access to loved ones in nursing facilities is further denied so as to protect this vulnerable population, some of the most vulnerable among us. This is especially disquieting for those with a loved one in hospice care or nearing their life’s journey’s end and so exceptions are being made for those nursing home residents who are perilously close to death allowing family members to visit under extremely controlled circumstances.
March 22, 2020, the Indiana State Health Commissioner issued guidance on nursing facility residents who want or need to leave the nursing facility. Dr. Kristina Box strongly discouraged voluntary leaves of absence to protect the nursing home resident and those in the nursing facility when the resident returns from a leave of absence. Nursing facilities were instructed to discharge all residents who insist on taking a voluntary leave or absence if the nursing facility reasonably determines the resident will pose a risk to others if allowed back in the nursing facility after the leave.
If a nursing facility permits a resident to return from a voluntary leave of absence, which is not a hospital stay or therapeutic leave, the resident must be re-admitted into isolation at the nursing facility.
Already Indiana’s nursing facilities were limiting communal exposure by serving meals to residents in their rooms rather than in facilities’ dining rooms. Additionally, CMS and the CDC have issued guidance on nursing facility staff, limiting interaction with nursing facility residents for non-essential staff and forbidding any staff member who has even potentially been exposed to COVID-19 from nursing home contact.
The Indiana State Department of Health surveyors who inspect Indiana’s long-term care facilities have essentially suspended those regulatory activities in favor of working directly with nursing facilities to address the challenges posed by this infectious virus including providing guidance on infection control measures. Thus, the ISDH is, in this instance partnering with nursing facilities to protect residents, staff, and visitors rather than pursue a regulatory approach. This is truly unprecedented and, I’m sure, quite welcome in our state’s nursing homes.
March 23, Indiana Family and Social Services Administration’s Chief Medical Officer encouraged Indiana’s nursing facilities to implement the CDC’s COVID-19 Preparedness Checklist for Nursing Homes and other Long-Term Care Settings. Dr. Dan Rusyniak also advised nursing facilities to limit contact with nursing home residents to only essential caregivers such as nurses, nurse aides, qualified medication aides, and hospice providers. He also advised those in direct contact with facility residents to wear a mask during their entire shift.
Additionally, FSSA advised all nursing facilities to have updated lists of all residents’ code status and to make plans for the provision of hospice services to COVID-19 residents who do not wish to be resuscitated.
The Indiana State Department of Health has a team available to come to nursing homes to rapidly test residents and staff who are suspected of having COVID-19. Nursing facilities can contact ISDH’s COVID-19 Response Logistics Coordinator Tami Johnson at (317) 412-2127 or tamjohnson@isdh.in.gov. Another ISDH resource is Casey Cummins, COVID-19 Outbreak Response Chief Nurse Consultant who can be reached at (317) 954-2591or ccummins@isdh.in.gov.
Indiana’s health care providers are not only on the front line of our new normal, they are at the same time facing additional stressors such as schools and day care closures and in some cases, although not in any Indiana nursing facilities or hospitals–of which I am aware–a shortage of protective gear. They are by definition, in close contact with those individuals most at risk for a bad outcome from COVID-19 and at the same time worried about who is minding their children, to whom they go home after each shift hopeful no one was exposed to the virus today.
Our new normal of working from home pales in comparison to the new and quite frightening normal for our front-line health care workers all of whom deserve our praise and prayers.
Between the time I write these musings and the time they are published a lot will have happened in this very fluid situation. But, the basic hygiene we must all adopt and adhere to will not have changed nor will the need for us to social distance for the time being. And, since it snowed in central Indiana on Sunday, March 22, any hope for warm weather to kill off this mutant virus is at best delayed. Just hours ago, it was announced the 2020 summer Olympic games will be delayed. This morning I read of a South African swimmer, a 2012 London Olympic gold medalist, who contracted COVID-19, and who really struggled with this nasty virus. He is a 31-year-old world-class athlete who was felled by a persistent cough, fever, and body aches for up to three weeks. His training for the 2020 Olympic games has been severely curtailed, but that is not the most salient point. He shared his story to emphasize this virus plays no favorites. We have been warned certain age groups and those with underlying health conditions are most at risk for poor outcomes and that is true, as is evidenced by the large number of deaths at a Washington State nursing facility at the beginning of this health care crisis. But even those of us in the best of health can become extremely sick from this virus for a long period of time, further underscoring the need to adhere to the guidance from the CDC, CMS and the Indiana State Department of Health.