Restrictions eased at nursing home

Houghton County administrator Kim Salmi is seen at her office recently. She said recent changes to federal requirements for nursing homes could help tackle issues she had addressed in an open letter on Facebook. (Houghton Daily Mining Gazette photo)

HANCOCK — Reduced restrictions on nursing homes announced last week could make it easier to fill staffing shortages, Canal View administrator Kim Salmi said.

The changes, announced by the CDC Sept. 23, base restrictions largely on the transmission rate, determined by percentage of positive tests and the number of new cases. They were also adopted by Centers for Medicare and Medicaid Services (CMS), which governs standards for nursing homes.

In the announcement of the new guidelines, the CDC said the changes were due to “high levels of vaccine-and infection-induced immunity and the availability of effective treatments and prevention tools.”

Salmi had called for reducing some restrictions in an open letter posted on Canal View’s Facebook page. The county board also approved a resolution in September backing Salmi’s advocacy for reduced restrictions for masking and testing requirements when appropriate, as well as approving a separate vote of confidence in Salmi. Salmi had submitted her resignation after the board voted down an earlier version of the resolution regarding restrictions.

Houghton County was still rated as high for community transmission of COVID, meaning masks still had to be worn inside Canal View.

Some changes took place immediately, which Salmi said had already boosted morale.

Vaccination status is no longer considered in masking, screening testing or post-exposure recommendations.

Residents no longer have to quarantine if they’re out of the facility for 24 hours. Salmi used the example of a resident who went to the hospital or visited family for the weekend.

“Previously, if they were not up to date with their vaccine status, then they would have to quarantine for seven to 10 days, and they don’t have to do that anymore,” Salmi said Monday. “Now it’s based upon, have they been exposed, was it a high-risk exposure, and a couple of other variables as well.”

When community levels are not high, facilities can choose not to require face coverings or masks except during an outbreak.

Salmi welcomed the changes, which she said made sense after the rise of the Omicron variant. Since January, she said, vaccinated people at Canal View had been as likely to test positive for COVID as unvaccinated people, though unvaccinated people still faced higher risk of a case requiring hospitalization. The CDC is still recommending vaccination.

Visitors and staff are now allowed to wear regular masks in times of high community transmission levels, as opposed to KN-95. Visitors are allowed to remove masks when visiting a resident in their room, provided everyone agrees.

CDC and CMS guidelines were in agreement, which Salmi said was a first during the pandemic. However, she was still waiting to hear if the Michigan Department of Health and Human Services was updating its guidance.

Salmi said the new requirements from the CDC addresses disparities that had existed between nursing homes and hospitals. Unlike nursing home employees, hospital employees were being tested only when they were symptomatic, versus twice a week for unvaccinated nursing home staff, Salmi said. Nursing home employees are also being screened daily, rather than by exception.

“I could say, ‘I’m running a fever, I have a stuffy nose,’ and it would send an alert to my manager,” she said. “We don’t have the capability to do that. We have to go through the kiosk and screen actively every single day that we work, and when we exit at the end of the day.”

Salmi hopes loosened restrictions will help Canal View attract workers, though more factors are involved, she said.

Canal View is down 25% to 30% from its pre-pandemic staffing levels. Because of federal rules regarding staffing levels for nursing homes, that’s led to Canal View operating at about 70 residents under capacity.

Over the past 20 years, Salmi said, there’s been a shift in the perception of certified nursing assistants. Where it was once viewed as a long-term career option, it’s now viewed as a springboard to medical school or to positions such as physical therapist.

Salmi also thought nursing homes had been unfairly villainized during the pandemic.

“Until we change that perception as well, where we honor and celebrate the successes that we’ve had here, that people are going to continue to avoid us as an overall industry,” she said.

During the special county board meeting earlier this month, Salmi asked for a bipartisan group of board members to meet with staff and residents. Commissioner Kevin Codere attended a Canal View meeting this week, which he reported on at a board meeting Thursday.

Salmi said she hoped commissioners would become aware of how nursing homes are relying on agency staff and how to bring healthcare workers into the area.

A lack of child care options in Houghton County is one problem. Salmi is working with the Keweenaw Family Resource Center, BHK Child Development and the Keweenaw Community Foundation about the lack of options for Canal View employees working nontraditional hours.

At a Houghton County board meeting Thursday, Iola Brubaker of the KFRC discussed a plan for a child care center for 60 children next to Canal View, where its employees would be given preference for slots.

There’s a shortfall of about 600 slots for licensed child care programs in Houghton County during the school year, Brubaker said.

More obstacles remain for keeping employees. Salmi said employees from outside the area run into problems getting flights to and from Houghton, or when their significant other can’t find work locally.

“They need to understand that every challenge the community has impacts what goes on with us,” she said. “We’re one of the bigger employees here, and we’re rarely called upon to discuss what’s going on with us.”


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