Guideline Confusions: Visitation restrictions have Florida families asking ‘Where’s AHCA?’

While Kim is not her father’s legal guardian, as his daughter, she can be deemed an essential caregiver.
Published: Feb. 25, 2022 at 6:59 PM EST
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TALLAHASSEE, Fla. (WCTV) - In Sept. 2020, Florida Gov. Ron DeSantis signed an executive order allowing for the restoration of in-person visitation at long-term care facilities.

Since then, residents have been able to designate essential caregivers, a family member or friend, that must be allowed into a facility to see their loved one, in person.

Many families said the system was working well, until about six months ago, when the Delta and Omicron variants of COVID-19 started popping up.

That’s when people with loved ones in assisted living and memory care facilities said visitation started being restricted again.

Kim Kesten said this happened at her father’s facility, Reflections Memory Care in Bradenton, Florida.

“We had pretty much full freedom up until a few weeks ago. It was like we went from full freedom to we walked in and literally couldn’t take him out,” Kim said.

In late Jan. 2022, Kim was told visitation at the facility was shutting down because of a COVID-19 outbreak on her father’s unit.

“They were going to quarantine them basically for seven days after each new case. So as soon as a resident in memory care was diagnosed with COVID, seven days again, they had to restart their quarantine. And it continued to happen,” Kim said.

While Kim is not her father’s legal guardian, as his daughter, she can be deemed an essential caregiver.

Acting in that role, Kim said she had a very hard time getting direct answers as to why the facility was shutting down visitation entirely when the state and CDC guidelines she saw were saying that couldn’t happen.

Kim said the executive director of Reflections Memory Care told her they were following guidelines from the Manatee County Health Department.

“The Manatee County Health Department has repeatedly told me they are not locking these facilities down. This is the facility choosing to do so,” Kim said.

We reached out to Reflections Memory Care; a family-owned company based in Illinois.

They emailed the following statement to WCTV:

“The community recently experienced an outbreak of 25 cases of COVID-19 in a very short timeframe. Per current CMS guidelines, two or more cases in a 48-hour period is considered an outbreak. As part of our daily operations, we refer to CMS, AHCA and the Manatee County Health Department for the management of COVID-19 outbreaks and its required protocols. Given the size of the outbreak, we conferred with the Manatee County Health Department and decided to quarantine the community and restrict visitation for a short period of time. As we continue to follow the multiple agencies, they are not always aligned in their guidance or protocols. The pandemic has caused many adjustments and updates across these agencies. This is continuously causing confusion when interpreting and following the guidelines established. Our visitation restriction was communicated to our residents’ responsible parties during this process. We resumed normal visitation and operations once the community cleared reopening guidelines. We certainly expect this to be the one and only time this situation required this level of intervention. We are hoping the pandemic is in its final stages so we can all move forward and enjoy the post-pandemic lifestyle. We are happy to report that there was no loss of life with the 25 cases, and all recovered from the outbreak. Kim is not the legal guardian for her father. We have been continuously working with the legal guardian who is aware of their loved one’s condition and is, and has been, very happy with our services.”

Kim said she asked to see a copy of the guidelines the Manatee County Health Department gave the facility allowing for the lockdown. She said so far, she still hasn’t received a copy.

WCTV reached out to the Manatee County Health Department to ask if they mandated Reflections Memory Care to go on a total lockdown of visitation.

In an email, their communications director said the Manatee County Health Department can only offer recommendations based on scientific findings and guidance related to COVID, coming mostly from the CDC.

They can suggest a facility lockdown based on the number of COVID cases but can’t mandate facilities to do it.

Marshall Kapp, professor emeritus in FSU’s Department of Geriatrics, said that’s because the CDC isn’t a regulatory agency.

“It provides advice and recommendations based on its scientific expertise, but it doesn’t have any enforcement power,” Kapp said.

Left with more questions, Kim said her next stop was to file a complaint with the Agency for Health Care Administration, or AHCA.

This is the state agency that regulates assisted living and memory care facilities in Florida.

“They told me they have two to 90 days to respond to our complaints,” Kim said.

So WCTV reached out to AHCA communications and its secretary, Simone Marstiller.

From Jan. 31, 2022, to Feb. 20, 2022, WCTV emailed the agency 12 times.

Nine of those times, WCTV asked Secretary Marstiller for an on-camera interview to discuss these ongoing issues.

AHCA responded three times with information already available on their website.

“It really is as a family member, it’s exhausting trying to do all of this work on our end,” Kim said.

Finally, a little more than three weeks after her father was quarantined, Kim was able to visit her father in person.

On Feb. 16, 2022, she said she arrived in his room to find it covered in trash and piles of dirty and soiled laundry.

She also found her father wearing socks covered in his own feces.

“I was devastated. I was embarrassed for my dad. And his dignity. I was maddened that he had been forced to walk around in socks like that for I don’t know how long. And just shocked honestly,” Kim said.

Picture of soiled socks taken by Kim Kesten on 2/16/22 after seeing her father's room for the...
Picture of soiled socks taken by Kim Kesten on 2/16/22 after seeing her father's room for the first time at Reflections Memory Care in Bradenton, Fla., after a three week quarantine with no visitation.(Kim Kesten)
Picture of dirty laundry taken by Kim Kesten on Feb. 16, 2022, after seeing her father's room...
Picture of dirty laundry taken by Kim Kesten on Feb. 16, 2022, after seeing her father's room for the first time at Reflections Memory Care in Bradenton, Fla., after a three week quarantine with no visitation.(Kim Kesten)

At that point, AHCA still hadn’t responded to Kim’s complaint, so she directly emailed AHCA’s secretary and wrote the following:

“Secretary Marstiller, After many cries for help, ignored phone calls and emails, you are now seeing the results of unlawful, unnecessary lockdowns. THIS is happening under YOUR rule. You are supposed to be our line of defense. I demand an explanation. Where are you AHCA?!”

Kim said immediately she received a call back directly from Secretary Marstiller.

“She did apologize and said she would make this right,” Kim said.

While Kim said she was happy her father’s situation was getting taken care of, it shouldn’t have gotten to this point.

“Rather than get a quicker response from our local AHCA, I had to go higher, to the capitol basically, and then they bounced it back to our local AHCA,” Kim said.

Kim said the local AHCA office told her they were overwhelmed with cases and needed more help.

“She said that a three-week response for them is actually really good. I think it’s unacceptable. You see with my dad what can happen in a matter of three weeks,” Kim said.

Because Kim isn’t her father’s legal guardian, she can’t take him out of Reflections Memory Care.

WCTV did reach out to Reflections Memory Care and asked about the photos Kim took documenting what she saw and why her father was found in this condition.

So far, we have not heard back.

As for AHCA, Secretary Marstiller said she will follow up with Kim once an investigation is complete.

There was no word yet on an on-camera interview with the secretary.

But, WCTV still has many questions for AHCA, including does the agency need more people to help with complaints?

WCTV has filed a public records request with AHCA to try and get those answers.

The First Amendment Foundation of Florida told WCTV, upon request, access to public records must be promptly provided. A definitive timeframe is not spelled out in Florida statutes, but WCTV will continue working to gain access to those records.

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