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Arkansas hospitals wrestle with question of in-person visits

Patients pine for loved ones, but facilities must weigh risk by Tess Vrbin | October 17, 2021 at 3:57 a.m.
Nurse practitioner Naomi Crume, with the vascular access team, gets her equipment ready in the hallway of one of the Covid wards at University of Arkansas for Medical Science on Thursday, July 22, 2021, in Little Rock. .(Arkansas Democrat-Gazette/Thomas Metthe)

Harold Jobe of Hensley doesn't remember the calls with his wife, Andrea, when he was severely ill with covid-19 and hospitalized at the University of Arkansas for Medical Sciences in late summer.

The only call he remembers was after he had started to recover. He does not remember if it was a FaceTime call or a phone call, but he said his "spirits were just lifted up" for the first time in 2½ weeks.

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"It put a wellness in me," he said. "I wanted to live. Just hearing her voice was enough for me to be ecstatic."

The Jobes found themselves in the middle of one of the hardest realities of the pandemic for hospitals and patients alike: How should health care facilities balance the need of patients to see their loved ones with the need to prevent the spread of a highly contagious virus?

For patients and their advocates, the presence of a loved one gives the patients something doctors and nurses can't always provide -- the will to live.

Health care providers see the positives, too, but for the most part, hospitals have decided that the risks outweigh the benefits. However, a limited number of facilities in the U.S. have begun to loosen visitation restrictions for covid-19 patients.

Hospitals in Central Arkansas have allowed family members of covid-19 patients to speak to their loved ones virtually but have limited in-person visits, frustrating both patients and their families.

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The U.S. Centers for Disease Control and Prevention's recommendation remains against allowing in-person visits for coronavirus patients.

UAMS only allows in-person visits at the end of a covid-19 patient's life or in the case of "complex medical decision-making that the family needs to be a part of," said Dr. Stephen "Steppe" Mette, CEO of UAMS Medical Center in Little Rock.

During those rare in-person visits, the hospital provides visitors with personal protective equipment: an N95 mask, a hospital gown and protective eye wear.

Most people have been "very gracious and accepting" of the visitation policy, Mette said, and the hospital listens to every request and evaluates it on a case-by-case basis.

"We're big believers in families being with their loved ones, and always weighing the relative risk of covid and what that means for the visitor and the patient against the benefit to the patient to have a visitor," Mette said.

Harold Jobe said he understands that "no one needs to get covid," but he still wishes the hospital could have helped him be aware that his wife was contacting him when his illness was at its most severe and he was heavily sedated.

When her husband was sick, Andrea Jobe had covid-19, too, she said, but she did not need to be hospitalized. At the time her quarantine period ended, UAMS had moved Harold Jobe to the intensive care unit. She said she would have "suited up" with protective gear for a visit if she had been allowed, especially since calling was not sufficient.

"If I could have touched him, he could have known I was there," she said.

SUPPORT PERSON

The No Patient Left Alone Act, which became state law in March, affirms the right of patients in hospitals and hospice care to have a "support person," whether a parent, guardian, spouse or other family member, physically present with them during treatment.

"That support person is doing much more than holding their hand and talking to them," said state Rep. Julie Mayberry, R-Hensley, the law's primary sponsor. "That's a big part of it, but they're keeping an eye on the medication, they're often the first person to call for help, they're explaining to the doctor what's wrong or explaining to the patient what's going on if they don't understand it. They often know the patient best. They're looking out for the patient's best interest."

Mayberry said some frustrated constituents had already told her that they were not allowed to be with their loved ones who were hospitalized, whether for covid-19 or for other reasons. Additionally, she was often present when her 19-year-old daughter was a patient for three months at Arkansas Children's Hospital, which continued to allow parents to be with their children during the covid-19 pandemic, she said.

"I thought, 'Why am I allowed to be here when other families are not allowed to be with their loved ones?'" she said.

The law seems to have had its intended effect so far, she said.

"I'm not getting phone calls [anymore] from people saying, 'My spouse just had a heart attack' or 'My spouse was in a car accident and I can't get in to see them,'" Mayberry said.

The law states that hospitals may limit or restrict visits when in-person contact "would be medically or therapeutically contraindicated," and Mayberry said this applies to covid-19 patients. The law gives hospitals "some wiggle room" and does not prohibit them from allowing visitors for covid-19 patients, but it was written with covid-19 safety in mind, she said.

"In designing the law, we had to allow some hospitals to make decisions on a case-by-case basis," Mayberry said. "That's the only way we could get it passed."

Mette said the visitation policy for non-covid patients at UAMS has changed more than once throughout the pandemic, especially in light of the No Patient Left Alone Act. Visiting hours were 10 a.m. to 2 p.m. a year ago but last until 8 p.m. now, and some family members are allowed to stay in a patient's room overnight if the patient would benefit from it, Mette said.

Baptist Health's area hospitals set up virtual visits for covid-19 patients and usually do not allow in-person visits, communications specialist Brandon Riddle said in an email, but exceptions are allowed "on a case-by-case basis, depending on the nature of the patient's condition."

"There have been times it was difficult to enforce these visitation measures," Riddle said. "However, we take safety very seriously and are committed to protecting patients, visitors and employees."

Mercy Health facilities in Northwest Arkansas have the same policy as UAMS, according to its website. Covid-19 patients are not allowed visitors except during end-of-life care, and non-covid patients are allowed one visitor at a time.

The Northwest Health System in Bentonville and Springdale allows patients one visitor at a time, including in the ICU, according to the Northwest Health website. The policy on the website did not distinguish between covid and non-covid patients.

Neither hospital responded to requests for comment last week.

'NO QUALITY TIME'

William Williams of East End said he and his five siblings were only allowed to visit their mother once while she was dying of covid-19 at Baptist Health Medical Center-North Little Rock.

During the visit, their mother was "so far gone" from both bacterial and covid-induced pneumonia after more than two weeks in the hospital, Williams said.

"There was no quality time," he said. "Every time she tried to talk to us, her oxygen would drop really low and we had to get her to stop talking. It was really saddening and heartbreaking."

He said he is frustrated that the hospital did not allow in-person visits earlier, complete with the required protective equipment.

Earlier in his mother's stay at the hospital, Williams was delivering some items she had requested, including her Bible and reading glasses, when the drop-off became an impromptu visit because she was having a panic attack, he said. The hospital staff allowed him to put on protective gear, enter the room and help his mother calm down.

If he and his siblings had been allowed to visit their mother before she was close to death, Williams said, at least one of them would have been there every day.

Williams went through his own hospital stay for covid-19, he said, but his case was less serious than his mother's. He was conscious and able to speak, so he talked with his family on the phone every day, he said.

"The people that are bad off in the hospital, [who] can't get up and walk by themselves, I think it's more important that their family members come by in person and try to lift their spirits," he said.

Mayberry said she understands the importance of preventing the spread of covid-19 but still finds it "heartbreaking" that safety means limiting contact between patients and their loved ones.

She said one of her constituents was hospitalized with covid-19 and "was on the decline" until a family member's in-person visit kicked off a recovery.

"No medical personnel is going to be able to provide that health care for someone," Mayberry said. "Only a loved one can do that. They give them the will to live and the desire to keep fighting."

Mette said UAMS administrators have "wrestled with" the issue of whether to allow more visits for covid-19 patients as long as visitors wear the necessary protective gear, but they agree that visits should continue to be restricted for the moment.

"As more Arkansans are vaccinated, we hope we will be able to safely allow more visitation, but we aren't there just yet," Mette said.

Print Headline: Hospital visits are tricky issue for covid cases

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