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Missouri bill granting patients right to visitors could affect hospital operations

Since March, 3,762 nursing home residents in St. Louis County have contracted the coronavirus and 593 have died, accounting for nearly 60% of all COVID-19 deaths countywide.
Nat Thomas
St. Louis Public Radio
A bill passed by the Missouri legislature would allow nursing home residents and hospital patients to have two designated caregivers for physical and mental support. Advocates for nursing home residents, families and hospital patients applauded the measure, saying visitor restrictions during the coronavirus pandemic kept many people isolated from their families.

Missouri lawmakers want to require hospitals to allow patients designated caregivers

The Missouri legislature passed a bill that would give hospital patients and nursing home residents greater access to visitors and loved ones.

The No Patient Left Alone Act now heads to Gov. Mike Parson. The bill requires health care facilities to allow patients to have at least two designated caregivers who can provide physical and mental support for the patient. The patient will also have access to a designated caregiver during a statewide emergency.

The bill mandates that health care facilities allow at least six hour visits for compassionate care. Facilities can ban visitation for up to 45-days within a one-year period, but a single suspension cannot exceed one week. The bill includes provisions requiring visitors and designated caregivers to comply with a facility’s guidelines, such as wearing personal protective equipment.

Advocates for nursing home residents and families called on the legislature to act. They said while protective measures at nursing homes and hospitals helped keep the coronavirus from spreading, restrictions on visitors isolated patients from their loved ones.

St. Louis Public Radio’s Chad Davis spoke with Dave Dillon, Missouri Hospital Association vice president of public and media relations, about the bill and how hospitals will respond.

Chad Davis: Are there any concerns that the hospital association has about the final bill that has been passed, especially when it comes to restrictions for hospitals and their ability to enact restrictions and keeping people safe?

Dave Dillon: The level of burnout after a number of years of dealing with this is going to cause long-term ripple effects in the health care workforce. It does set some very specific standards for requirements for the number and type of visitors and their availability during what would be considered normal visiting hours, which are generally speaking not enforced unless there is a specifically reason to enforce them or even during an emergency. Hospitals have limits on their ability to request a variance from the changes included in this new law.

I think there's the message that has been certainly received by hospitals that our reaction to the initial limits and visitation were an overreach, that message has been heard loud and clear. The real question in the long run will be depending upon what other type of health emergency we will face, whether this could create barriers that were problematic to the way we will be required to run our operations. And it's unknowable at this point, whether that will create problems or not.

Davis: The bill does have some provisions for hospitals to still keep people safe and to still have certain regulations. Do you think those will be sufficient enough to keep patients safe, to keep visitors safe?

Dillon: We testified at the hearings related to these bills that we are a firm believer in the healing value of having individuals that can support either the idea of care, to be there for the people who are hospitalized and be part of that team and help them communicate and help them address the psychological part of being an inpatient in a hospital, which is generally speaking not a particularly pleasant experience. We are for that. We are for the positive value that adds both to the patient's experience and to their healing in the clinical environment. But we also know that that then adds a layer of complexity.

To some degree, that's a judgment call about risk, which is something that people in health care deal with every day, where that balance between the value provided by having that support, whether that's as a compassionate care visitor as an essential caregiver. The value of that support versus the risk to not only be that patient but to all of the patients in the facility as well as the staff. I don't think there's an easy answer to that, but I do think that is in general helpful. So balancing it between that value and then the risk of an infectious disease will always be the things that the clinicians look at.

Davis: What do you want patients, hospital patients and visitors to know specifically about this bill, what this bill does and how to keep themselves safe when they're at the hospital, visiting patients or their loved ones?

Dillon: For one, ask. If you are not moving through the emergency department and you're putting together a plan to be with a patient, ask the hospital what their policy is. Because it's most likely to be very flexible. We really do understand that value. So it comes to the question of what the patient and what the facility are addressing.

Just for the purposes of illustrating, if you have someone that is undergoing a bone marrow transplant, they're going to be in an environment that has to be exceptionally clean because a big portion of their immune system is going to come down. And the best thing you can do for that patient is to follow whatever the clinical guidance is for care and assistance for someone going through that kind of treatment.

Alternatively, if someone had to have a knee replacement, and is overnighting at a hospital for observation afterwards, visitation is probably not an issue at all, unless there's something else going on in that facility. So the hospital and the clinicians at the hospital will be able to give you the best guidance on what the policy is for that individual.

Davis: Is this something that you think you'll see other states pass at this stage in the pandemic and future pandemics or future health care emergencies? Do you think this will be something that we’ll see across the country?

Dillon: This is likely more of a local or state challenge. And what we're seeing is it being addressed at the state level primarily.

We all learned a lot in the last two years. We know where there was overreach for the purposes of protection. We also know that we would have done some things probably more vigorously than we did. But all of those decisions were made by the information that was relative to the information that was available at the time those decisions were made. And this was a result, and I wouldn't be at all surprised if we see an increasing number of states have some on-the-books version of this type of limitation on visitation. I'm not certain that's bad, as long as it gives flexibility in the end and reduces risk in the end result.

Follow Chad on Twitter: @iamcdavis

Chad is a general assignment reporter at St. Louis Public Radio.