Friday, August 20, 2021

Long-term care patient visitation bill clears state House

by Richard Craver
 
Sen. Joyce Krawiec
The state House fulfilled Wednesday its part of a legislative deal addressing patient visitation bills.

The House voted 88-14 to approve Senate Bill 191, titled “The No Patient Left Alone Act,” which sends it to the House Rules and Operations committee.

The bill was rushed to the House floor after clearing the House Rules and Operations committee earlier Wednesday.

Because of an amendment added to the bill on the House floor, SB191 goes back to the Senate to approve or reject the change.

SB191 cleared the Senate by a 40-9 vote May 6. Among its primary sponsors is Sen. Joyce Krawiec, R-Forsyth.

Krawiec said Wednesday that the House changes "should be acceptable."

The bill was placed in House Rules on May 10.

Bills from the other chamber typically are placed directly into Rules if the intent is putting the legislation in a holding pattern or to shelve it altogether.

SB191 was removed from Rules to Health on Aug. 4, where it sat until being addressed Wednesday.

On July 22, the Senate Judiciary committee inserted language from SB191 into Republican-sponsored House Bill 351, which has as its purpose securing visitation for hospital patients and long-term care residents during a state public-health emergency.

On Aug. 9, the Senate Judiciary committee agreed to remove language from SB191.

In exchange, Rep. Jimmy Dixon, R-Duplin, told the Senate Judiciary committee that the House would proceed on addressing SB191 in a timely fashion.

The compromise enabled HB351 to advance out of Judiciary on Aug. 10 and to the Senate Rules committee.

Bill differences

SB191 affects hospitals, nursing homes, Hospice care, residential treatment facilities and other long-term care facilities.

Meanwhile, the initial and now current version of HB351, titled “Clifford’s Law,” would direct the state’s health secretary to also establish visitation protocols for long-term care and Hospice care facilities during declared disasters and emergencies, such as the COVID-19 pandemic.

The number of COVID-19 outbreaks in Triad long-term care facilities has declined significantly in recent months.

However, N.C. Department of Health and Human Services recently reported The Citadel at Winston-Salem with an outbreak of at least 139 cases comprised of 102 residents, including five related deaths, and 37 staff.

That outbreak was dropped from the long-term care facility COVID-19 dashboard on Aug. 10.

“We must make sure that no patient in North Carolina is ever left alone in a hospital or nursing home while their spouse or family members are forced to wait at home or in the parking lot while their loved one is receiving care,” said Sen. Warren Daniel, R-Burke, and co-primary sponsor, during the Senate’s floor debate on SB191.

“A video call to a hospitalized patient, many who don’t know how to use a computer, cannot become a substitute for having a family member present during potentially life-and-death health care situations.”

Background

The latest version of SB191 has been broadened to apply the same patient’s rights protections to most long-term care facilities, Hospice facilities and certain residential treatment facilities.

Krawiec has said that non-COVID-19 patients are being adversely affected by the visitor restriction as well.

“There are a multitude of cases where residents are still not allowed to have visitors,” Krawiec said. “It should never happen again where patients are dying alone in facilities.

“There are also those who have diminished cognitive abilities who don’t understand why they are abandoned without loved ones or caregivers being allowed to visit them.”

“Isolation is a reason many residents in facilities ‘fail to thrive,’” she said.

SB191’s primary focus remains on concerns that emergency visitor restrictions can keep family members from being with loved ones and hampering their ability to serve as an advocate with hospital staff.

Family members are defined as a spouse, child, sibling, parent, grandparent, grandchild, spouse of an immediate family member, stepparent, stepchildren, stepsiblings and adoptive relationships.

The patient can designate the visitor “if they have the capacity to make decisions.”

On March 12, DHHS issued an order that long-term care facilities can allow in-person visitations — indoor and outdoor — “in most circumstances” based on changes made by the federal Centers of Medicare and Medicaid Services and the federal Centers for Disease Control and Prevention.

Those agencies cited “rapidly improving trends in long-term care facilities” for allowing more visitations.

DHHS cautioned in its updated guidance that outdoor visitations still remain the best option.

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