LONG-TERM CARE FACILITIES, the epicenter of the COVID-19 pandemic in Massachusetts, are starting to enter their own Phase 1.

The Baker administration is slightly easing visitation restrictions at the state’s long-term care and assisted living facilities, while launching surveillance testing of staff and preparing to discipline nursing homes that have had problems passing infection control audits.

The moves are significant as long-term care facilities are where two-thirds of all COVID-19 deaths in the state have occurred and where, on many days, most of the ongoing fatalities continue to occur.

Gov. Charlie Baker said cutting off all visitation at long-term care facilities saved lives and was the right thing to do, but he said it came at a heavy personal cost for the residents of those facilities and their families.

Reopening will take place slowly. At nursing and rest homes, residents can meet with visitors outside for no fewer than 30 minutes. Residents can also begin to eat together in dining halls and hold group activities outside as long as social distancing is practiced.

At assisted living facilities, residents can meet with guests outdoors and can now meet with them in their own units, as long as no staff or residents have tested positive for COVID-19 in the last 14 days.
On-site salon and barbering services can also resume under the guidelines that have been issued for those services on a standalone basis.

Tara Gregorio, the president of the Massachusetts Senior Care Association, issued a statement saying the state’s “careful actions” are welcome so residents can visit with loved one and participate in group dining and recreational activities.

“It is critically important that we continue to tend to the safety and clinical care needs of our residents, as well as their emotional wellbeing,” Gregorio said. “Nursing facilities remain vigilant against covid and have implemented strict infection control protocols, which have led to sharply declining infection rates.  Maintenance of state supplemental funding and supports are essential to ensuring continued progress and protection against covid in nursing homes.”

The reopening measures come at a time when the state is stepping up testing of staff at long-term care facilities and also launching surveillance testing.

At state expense, all staff at long-term care facilities are required to be tested by July 19. If no positive cases turn up at a facility and the facility is located in an area of the state where the seven-day average is less than 40 positive cases per 100,000 residents, 30 percent of the staff must be tested every two weeks. If the facility is located in an area where the seven-day average is higher than 40 cases per 100,000 residents, all staff will be tested every two weeks. If a positive test pops up at any facility, no matter where it is located, all staff will be tested weekly.

“At this time, recovered or previously COVID-19 positive residents and staff do not need to be tested as part of the long term care surveillance testing program,” the state’s guidance says.

The state has been conducting infection control audits of the state’s 360 nursing homes over the last two months. In the first round of audits, 37 percent, or 131 of the 360 facilities audited, failed. In the second round, 230 facilities were audited and 49, or 14 percent, failed. In the third round, 243 facilities were audited and 6 percent failed. In the fourth round, 172 were audited and 6 percent failed.

Of the 360 facilities, 47 failed audits two or more times. A handful failed audits three times.

Marylou Sudders, the governor’s secretary of health and human services, said some facilities will be disciplined in the next two weeks. She did not say what kind of discipline would be imposed.

Audit failures don’t appear to be an indication of higher fatalities from COVID-19. According to state data, the nursing home with the highest number of fatalities in the state is Courtyard Nursing Care Center in Medford, with 70 deaths. Courtyard failed one of three audits.  The Julian J. Levitt Family Nursing Home in Longmeadow has 66 fatalities and passed all four of its audits. Eastpointe Rehabilitation Center in Chelsea had 62 deaths, and failed one of three audits.