As COVID-19 cases in nursing homes rise again, some states have begun requiring visitors to show evidence that they are not infected before entering facilities, sparking frustration and frustration among family members.

Officials in California, New York and Rhode Island say the new COVID testing requirements are necessary to protect residents — an extremely vulnerable population — from exposure to the highly contagious variant of the omicron. But many family members said they were unable to get tests amid high demand and scarce supply, preventing them from seeing their loved ones. The feeling of being turned away is unbearable, like a never-ending nightmare.

Severe staffing shortages complicate the job of keeping facilities open while keeping them safe; these shortages also jeopardize long-term care facility care — a concern for many family members.

Andrea DuBrow, a 75-year-old mother with severe Alzheimer’s disease, spent nearly four years in a nursing home in Danville, California. She said her mother forgot who she was in the months before the pandemic when Dubrow couldn’t see her.

“This latest restriction is basically another lockdown,” Dubrow said last week at a conference on California’s new rules. “While my mom was away, she could recognize me in some locked up little part of her as me, her daughter, cleaning her, feeding her, holding her hand, singing her favorite Song – that time is being stolen from us.”

“It’s a huge inconvenience, but the most disturbing thing is that no one seems to have any long-term plans for families and residents,” said Ozzie Rohm, whose 94-year-old father lives in a San Francisco nursing home.

Roma wondered why family members were subject to testing requirements that did not apply to employees. Do household members pose a greater risk than staff following these procedures if they are vaccinated and boosted, wear masks, stay in residents’ rooms, and perform strict hand hygiene?

California was the first state to announce new policies for visitors to nursing homes and other long-term care facilities on Dec. 31. These policies go into effect on January 7 and last for at least 30 days. To see a resident, a person must show evidence of a negative COVID rapid test within 24 hours or a negative PCR test within 48 hours. In addition, a COVID vaccine is required.

In a statement announcing the new policy, the California Department of Public Health cited the “greater transmissibility” of the omicron variant and the need to “protect particularly vulnerable populations in long-term care settings.” Nursing home residents have had disproportionately high rates of illness and mortality throughout the pandemic.

New York followed California on Jan. 7 by announcing that nursing home visitors would need to show proof of a negative rapid test taken no more than a day earlier. On January 10, Rhode Island announced a new rule requiring proof of vaccination or a negative COVID test.

Patient advocates worry that other states may take similar steps. “We’re concerned that omicron will be used as an excuse to shut down visitation again,” said Sam Brooks, program and policy manager for the National Voice of Consumer Quality Long-Term Care, an advocacy group for people living in these facilities.

“We don’t want to go back to the last two years of lockdown in nursing homes and resident isolation and neglect,” he continued.

It’s also a priority for the Centers for Medicare and Medicaid Services, which has emphasized since Nov. 12 that residents have the right to receive visitors without restrictions, as long as safety protocols are followed. CMS guidance explains that nursing homes may encourage, but do not require, visitors to take a test in advance or provide proof of COVID vaccination. Safety protocols include wearing masks, strict hand hygiene and maintaining adequate physical distancing from other residents.

However, with the rise of the omicron, the facility took a backseat. On Dec. 17, an organization representing nursing home medical directors and two national long-term care associations sent a letter to CMS administrators asking for more flexibility to “keep residents safe” and “impose temporary visitation restrictions in nursing homes.” On Jan. 6, CMS confirmed residents’ visitation rights, but said states could “take additional steps to make visitation safer.”

When asked to comment on the states’ recent actions, the federal agency said in a statement to KHN that “a state may require nursing homes to test visitors as long as the facility offers rapid antigen testing and sufficient testing supplies are available. … However, if there are not enough supplies for rapid testing, access must be allowed without testing (while still adhering to other practices such as wearing masks and physical distancing).”

The testing shortage could ease under the Biden administration’s new plan to distribute four free tests to every household. But for family members who visit nursing home residents a few times a week, the supply won’t be too large.

Tensions over the balance between security and residents’ visitation rights have intensified since the beginning of the year. In the week ended Jan. 9, 57,243 nursing home workers reported Covid-19 infections, nearly 10 times as many as three weeks earlier. During the same period, the number of residents infected rose to 32,061, almost eight times the number three weeks ago.

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However, today’s outbreak is taking place in a different context. According to CMS, more than 87% of nursing home residents have been fully vaccinated, and 63% have also received booster immunizations, reducing the risk posed by COVID. In addition, nursing homes have also accumulated experience in dealing with the epidemic. The toll of nursing home lockdowns – loneliness, hopelessness, neglect and physical deterioration – is now better understood.

“We’ve all seen the negative impact of restricting visitation on the health and well-being of our residents,” said Joseph Gogler, a professor of long-term care at the University of Minnesota’s School of Public Health. “Getting nursing homes back into bunkers and shutting everything down is not the solution.”

With severe staffing shortages, “we need people in these buildings who take care of the residents, who are often visitors who basically act as unpaid certified nursing assistants: grooming and toileting the residents, turning and repositioning them, Feed them, stretch them, and exercise them,” said Tony Chicotel, an attorney with California nursing home reform advocates.

According to the U.S. Bureau of Labor Statistics, nearly 420,000 workers have left nursing homes since February 2020, exacerbating existing shortages.

When DuBrow learned of California’s new testing requirements for tourists, she scheduled a Jan. 6 PCR test at the testing site, with results expected within 48 hours. Instead, she waited 104 hours for a response. (Her test was negative.) Eager to visit her mother, Dubrow called all CVS, Walgreens and Target within a 25-mile radius of her home to ask for tests, but the results came up empty.

The California Department of Public Health said in a statement that the state has established 6,288 COVID testing sites and sent millions of home tests to counties and local jurisdictions.

In New York, Democratic Gov. Kathy Hochul has pledged to provide nearly 1 million coronavirus tests to nursing homes, where tourists can get tested on the spot, but that has created problems. “We don’t want to test visitors who are queuing at the door. We don’t have clinical staff to do this, we need to focus all of our staff on the care of residents,” said President Stephen Hans. CEO of the New York State Sanitation Association, an industry group.

With the current staffing shortage, trying to ensure visitors wear masks, maintain physical distancing and adhere to infection control measures is a “tax on employees,” said Janine Finck-Boyle, vice president of regulatory affairs at Leading Age, which doesn’t represent a for-profit group. Sexual long-term care providers.

“Really, the challenge is huge,” said Gogler of the University of Minnesota. “I hope there are simple answers.”

Kaiser Health News is a national health policy news service. It is an independent editorial project of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.