North Platte resident Marsha Reece faces a tangle of COVID-19 rules and bureaucracy. Her father is the victim.

Reece’s father, Jim Beckius, 94, is a resident of Linden Court in North Platte.

His situation is similar to residents in care homes throughout the area and across the state. He has been confined to his room for nearly a year in the name of avoiding the contagious virus.

Personal visits from family members or other residents are prohibited. There are no communal activities, not even dinner in a large room.

And, although residents have now received their second dose of COVID-19 vaccination, the restrictions remain in effect. 

Beckius’ health is failing. He has little-to-no appetite and is losing weight, Marsha said.

As the end of his life apparently approached, the facility notified close family members and allowed them to make compassionate visits. When Marsha, her husband and son starting visiting Beckius, he started feeling better. His appetite returned and he gained weight. 

Ironically, as Beckius’ health improved, the visits ended, because compassionate care visits are only allowed when death is imminent.

That deadly catch-22 is the result of a federal restriction by the Center for Medicare and Medicaid (CMS), Director Nolan Gurnsey said.

The CMS can levy stiff fines for violations. In extreme cases, CMS can shut down a facility.

Gurnsey said it creates a heartbreaking situation for everyone involved, including he and his staff, but his hands are tied.

Vaccinations

Linden residents received their second shot of COVID-19 vaccine during the week of Feb. 8-12, which should eliminate the danger of spreading and catching the virus, but visitors are still forbidden.

For some reason, federal regulators have not caught up the fact vaccinations are relatively commonplace at Lincoln County care homes. Or, CMS might be hesitant to open the care home to visitors until more is known about the effects, and effectiveness, of the new vaccines, family members and staff say.

That doesn’t help Marsha Reece and her father at all. Family members are getting their fill of precautions.

“It’s not right,” Marsha said. “These people are dying of loneliness.”

Judy Kramer’s mother is another long-term care resident– Bessie Broeder, 87 — for whom the situation is critical.

“In June, we were told Mom was not going to make it,” Kramer said. “So we were allowed compassionate visits for three weeks. Within the first two days, Mom felt better. Everyone was pleased.”

Kramer said her mother has only one serious affliction – depression, because she has virtually no one to talk to.

“She has no other health issues,” Kramer said, “but she’s in her room all the time. The only time she gets out is to take a bath down the hall twice a week, and once a month she gets her hair fixed.”

“We visit through the window; we talk on cell phones,” Kramer said. “She cries every time we say goodbye. It’s just hard for all of us.”

“They are all vaccinated now,” Kramer said. “Why can’t they open up so we can see them?”

Asking for help

Marsha Reece contacted the governor’s office as well as federal elected officials — and the Bulletin.

She talked to staff members of Sen. Deb Fischer, Rep. Adrian Smith and Gov. Pete Ricketts and they asked detailed questions and promised to look into the situation.

Gurnsey said that’s the right thing to do. He provides family members with a list of elected officials and contract information. He also advises people to contact CJ Roberts, the regional ombudsman at the Aging Office of Western Nebraska.

The Aging Office website provides Roberts’ email and phone number but it won’t help much, if at all, to talk to her. True to the nature of bureaucracies, that phone only provides a recorded message, which ends by asking the caller to leave their PIN number. Only people who have registered their complaints with the Aging Office have a PIN number, so it’s pointless to call.

The Bulletin searched for Roberts and eventually found another phone number for her. She told us there is not much she can do anyway. She cannot even forward such complaints to officials who make the rules. She referred the Bulletin to the state ombudsman office to for that, but the state office didn’t respond to a voice message request for a return call.

However, we were able to talk to the governor.

Gov. Ricketts held a press conference on Feb. 17, as this report was first written for our print edition. Working through a helpful aide, the Bulletin described the situation and asked Ricketts if he could urge CMS to relax the restrictions.

Ricketts immediately agreed that the problem needs to be addressed.

“It’s important for the health of the residents to see their loved ones,” he said, and also noted that Nebraska’s vaccination process is generally going well.

He said skilled nursing facilities, where Beckius lives, are indeed under federal jurisdiction, and although the state has no direct authority there, he would bring it up to federal officials.

He said the “positivity rate” of cases – the number of positive cases of those tested — is an important factor, and the rate has been relatively low.

A positivity rate of less than 5% a critical indicator, and statewide, the rate has hovered around 5% through February, according the Nebraska Department of Health and Human Services.

Lincoln County has had an average of 5 cases per day for the last 7 days – which amounts to a daily average positivity rate of less than 1%, according to data from the Mayo Clinic, which keeps track of cases across the U.S.

Other indicators show the virus is on the decline in the Lincoln County area as well as most of Nebraska. Currently there are just eight COVID-19 patients at Great Plains Health regional hospital in North Platte, compared to about 40 per day during the height of the pandemic in late November, spokeswoman Megan McGown told the Bulletin on Feb. 22.

GPH officials credit better medications as well as increasing numbers of vaccinations for the turnaround. They have reason to believe the worst is over, unless new variants of the virus appear that cannot be treated.

The vaccination process is still in the early stages. Statewide, more than 7% of the population over age 16 has been vaccinated, according to the Nebraska Department of Health and Human Services. The rate is nearly 10% in the Lincoln County area. Those over age 75, including care home residents, have been vaccinated.

Ricketts told the Bulletin that restrictions should ease as care home residents and staff are vaccinated.

He added that assisted living facilities are under state jurisdiction, where he has more authority.

Essential caregivers

Gurnsey said if a family member is designated as an essential caregiver, the CMS allows them to visit a resident two times a week.

Essential caregivers are people who would spend a good share of their time caring for the resident if it were allowed. To qualify for the designation, they must fill out a written application.

Gurnsey had 30 applications on his desk as of Tuesday, Feb. 16.

Last summer, CMS relaxed visitation restrictions when the positivity rate was low. Occasional indoor or outdoor visits were allowed, so long as the rate remained low. But that didn’t last long. The positivity rate increased about the same time that program began, so visitation programs ended.

Marsha Reece tells her father to take care, because she is working hard to get the CMS rules relaxed. She said Beckius replied that he would like to be able to visit other residents from time to time, in addition to family members.

“He told me, ‘if I could just go to the dining room, it would help,’” she said.

(This report was first published in the Bulletin’s print edition on Feb. 17. It has been expanded and clarified for the website.)