Last month, pharmacies finished administering the first dose of the COVID-19 vaccine at every nursing home in the state and the Connecticut General Assembly returned to session, two milestones that could impact socialization for residents.

It's been nearly 11 months since nursing homes were directed to restrict visitors due to the pandemic, and the resulting isolation has taken a hefty social-emotional toll on residents.

Mairead Painter, the state's long-term care ombudsman, said last Wednesday in her weekly update that as cases go down, she wants residents to have access to community life and small-group recreation inside nursing homes.

Family of residents have been asking Painter questions like, "Now that she's had her second dose, how soon can I hug her?" Painter doesn't have this kind of information yet but said she will do a Facebook Live as soon as she does.

"It's very hard, to say the least, especially for our long-term patients, because a lot of them don't understand why they can't see their family," said Laura West, a nurse at Pendleton Health and Rehabilitation Center in Mystic. "A lot of them think they're being abandoned, and we've lost a lot of people just to failure to thrive."

"We'll do window visits and they'll cry, and it breaks my heart," she said. But Pendleton residents recently got the second dose of the vaccine, and West has seen "more of a spark" among them. They're hopeful. She said Pendleton is now letting residents leave their rooms and leave their doors open.

At St. Mary Home in West Hartford, therapeutic recreation director Kaysee Amado said big parties and bingo have given way to FaceTime and room visits.

She said involved family members want FaceTime and phone calls with residents, but there are also a lot of residents who don't see family even without visitor restrictions, and they rely on room-to-room visits from staff.

"There's not enough time in the day to give everybody the attention that they need," she said.

Visitation, compassionate care and essential caregivers

Some family members have seen loved ones in nursing homes through compassionate care visits. In addition to end-of-life situations, the Centers for Medicare & Medicaid Services says other examples of situations that qualify for compassionate care include a new resident struggling with the change in environment, a resident grieving the recent loss of a friend or family member, and a resident "experiencing emotional distress, seldom speaking, or crying more frequently."

Painter explained that compassionate care involves meeting an individualized need for a resident. But she said due to fear of outbreaks, some long-term care facilities interpret guidelines on visitation and compassionate care "in a way that can be very limiting."

Stonington resident Linda Shafer said she was granted a compassionate care visit last month at Fairview, where her brother recently moved from Bayview, and that was the first time she heard the term.

Shafer has been pleased with Fairview, saying her brother is "very, very happy there" and calling the facility immaculate. Considering her brother had a stroke and can't speak, she finds it much more feasible to communicate with him in person — through gestures — than over FaceTime.

Sean Nugent's 88-year-old mother, who has dementia, has been in the skilled nursing facility at Fairview for about 15 months. He got his 91-year-old father an apartment in the assisted living complex at Fairview last summer, but because his father would be alone due to the pandemic, he instead has been living with Nugent and his wife in Preston. The idea is that when things become more normal, his father can live at Fairview to be close to his wife.

Nugent said Fairview's patio visits over the summer were too hot for his parents, but they have more recently been able to get compassionate care visits indoors. He said with in-person visits, his mother's total demeanor improved: "She was happy, she was laughing, she was telling stories again."

But he would like his father to be able to visit his mother every day as an essential caregiver, which would also allow staff to focus on residents who don't have family. He hopes the legislature can tackle an essential caregiver policy soon.

Nugent was a member of the Socialization, Visitation and Caregiver Engagement Subcommittee of the state's Nursing Home and Assisted Living Oversight Working Group, formed to make recommendations on proposed legislation for the current session. Painter co-chaired the subcommittee with Sen. Cathy Osten, D-Sprague. It was one of four subgroups that met in November and December and developed policy recommendations.

The socialization subcommittee came up with nine policy initiatives. Those included strengthening the Resident's Bill of Rights, requiring voices from resident and family councils to be heard, enhancing the ombudsman program and developing an Essential Caregiver Program.

In its 157-page report studying the response to the pandemic in long-term care facilities, released in September, Mathematica Policy Research group listed the designation of essential caregivers as a short-term recommendation, saying the state Department of Public Health should issue guidance. In her update this week, Painter said there are a couple of paths to essential caregiver status: through an order from DPH or the governor's office, or via legislation.

Painter's office has developed essential caregiver language and has sent it to various state offices and legislative committees. Such a program would go beyond the limited opportunities for socially distanced in-person visitation and compassionate care visits.

The document Painter sent defines an essential caregiver as "an individual designated by the resident, or the resident's representative, to have immediate access at any time as their chosen partners in care." An essential caregiver would continue to have access during a visitation ban.

The proposed language would require essential caregivers to wear the same personal protective equipment, or PPE, as staff and be tested under the same protocols.

Stonington resident Liz Stern was a member of the working group and the socialization subcommittee, and the essential caregiver designation is the issue about which she is most passionate. She said it's essential to make a distinction between essential caregivers and general visitation, saying they're very different and language must be clear on this.

She also said that because an essential caregiver would get tested and wear full PPE but only visit with one resident, that person is a lower risk than a staff member.

"I think Connecticut has the opportunity now to make the best essential caregiver program of any other state before it," Stern said last week. Both she and Painter have stressed that essential caregivers are meant to support staff, not replace them.

Legislation in early stages

Each policy initiative from the socialization subcommittee has been forwarded to either the Human Services Committee, Aging Committee or Public Health Committee in the legislature, with the Human Services Committee handling the Essential Caregiver Program.

Rep. Liz Linehan, D-Cheshire; Rep. Michelle Cook, D-Torrington, and Osten each have introduced a bill establishing an Essential Caregiver Program — H.B. 5676, H.B. 5998 and S.B. 493. Each bill has placeholder language of a few sentences at most rather than full text, and a public hearing hasn't been scheduled on the topic.

Osten has introduced other bills that would implement the recommendations of the socialization subcommittee. Cook also has introduced a bill that would require resident care plans in long-term care facilities to address isolation, risk of depression and social and emotional needs, and provide recourse if residents or family members feel they have inappropriately been denied visitation.

To follow bills, people can visit cga.ct.gov to do a bill information search for relevant terms — such as nursing home, long-term care, or essential caregiver — and then set up email or text notifications for certain bills through the bill tracking system. The Human Services Committee can be reached at (860) 240-0492 and the Aging Committee at (860) 240-0090.

Painter said she's working with team members to have a section on their website that informs the public what bills are coming up and the dates of public hearings.

Aging Committee Co-Chair Sen. Derek Slap, D-West Hartford, said while the Human Services Committee is looking at the essential caregiver piece, his committee is looking at legislation that ensures residents have a right to technology, both to protect them from abuse and to connect them with loved ones.

Slap said there's a "real sense of urgency about wanting to get this done as soon as possible," and he doesn't think the vaccine rollout has changed the conversation much, noting this legislation will be important for other health scares and emergencies that come up long after the pandemic is over.

e.moser@theday.com