But relaxing restrictions is not without
risks.
Judith Graham / Kaiser Health News• July 13, 2020
States across the
country are beginning to roll back heart-wrenching policies instituted when
the coronavirus pandemic began and allow
in-person visits at nursing homes and assisted living centers, offering relief
to frustrated families.
For the most part,
visitors are required to stay outside and meet relatives in gardens or on
patios where they stay at least 6 feet apart, supervised by a staff member.
Appointments are scheduled in advance and masks are mandated. Only one or two
visitors are permitted at a time.
Before these
get-togethers, visitors get temperature checks and answer screening questions
to assess their health. Hugs or other physical contact are not allowed. If
residents or staff at a facility develop new cases of COVID-19, visitation is
not permitted.
As of July 7, 26
states and the District of Columbia had given the go-ahead to nursing home visits under
these circumstances, according to LeadingAge, an association of long-term care
providers. Two weeks earlier, the Centers for Medicare & Medicaid Services
clarified federal guidance on reopening nursing
homes to visitors.
As of July 7, 26 states and the District of Columbia had
given the go-ahead to nursing home visits.
Eighteen states and
the District of Columbia were similarly planning to allow visits at assisted living centers.
Visitation policies
may change, however, if state officials become concerned about a rise in
COVID-19 cases. And individual facilities are not obligated to open up to
families, even when a state says they can do so.
Relaxing restrictions
is not without risks. Frail older adults in long-term care are exceptionally
vulnerable to COVID-19. According to various estimates, 40% to 45% of
COVID-related deaths have occurred in these facilities.
But anguished
families say loved ones are suffering too much, mentally and physically, after
nearly four months in isolation. Since nursing homes and assisted living
centers closed to visitors in mid-March, under guidance from federal health
authorities, older adults have been mostly confined to their rooms, with
minimal human interaction.
The goal was to
protect residents from the coronavirus as the pandemic began to escalate. But
the virus entered facilities nonetheless as staffers came and went. And now,
families argue, the harms of isolation exceed potential benefits.
“My mother stopped
eating around the middle of April — now she just picks at her food,” said
Marlisa Mills of Asheville, North Carolina. “Every week, she becomes more
delusional.” Mill’s mother, 95, has dementia and lives in a nearby nursing home
that remains closed to visitors.
Residents “are dying
of broken hearts and neglect,” said Lelia Sizemore, whose 84-year-old father’s
health deteriorated precipitously after her mother stopped her daily visits to
his Dayton, Ohio, nursing home in early March.
Diagnosed with severe
dementia, blind and unable to feed himself, Sizemore’s father lost more than 10
pounds in two months and succumbed to respiratory failure on May 24. Even at
the end, the nursing home refused her mother’s requests to see him in person.
“I didn’t even get to
say goodbye,” sobbed Sizemore, who lives in Oregon and last saw her father in
July 2019.
Ohio began allowing visitors at assisted living centers on
June 8 and will permit outdoor get-togethers at nursing homes as of July 20.
New Jersey has the
second-highest number of COVID deaths in the country. On June 19, the state’s
health commissioner announced that all long-term care
facilities could accept visitors outdoors — just in time for Father’s Day.
Broadway House for
Continuing Care, a Newark facility, quickly notified families and arranged to
pitch a tent with chairs and tables underneath in a garden area.
“It’s time to open
things up some more: We’ve all been operating under a sense of being under
house arrest,” said James Gonzalez, chief executive officer of Broadway House
and chair of the board of the Health Care Association of New Jersey.
With weekly tests, 10
residents and 26 staffers at Broadway House have learned they had COVID-19. One
resident has died since the outbreak began.
“Are we worried about
visitors bringing the virus? Yes, but I think we can manage that,” Gonzalez
said. “We’re going to have to take this day by day.”
“Are we worried about visitors
bringing the virus? Yes, but I think we can manage that. We’re going to have to
take this day by day.” –James Gonzalez Health Care Association of New Jersey
On Father’s Day, Raul
Lugo arrived at Broadway House to visit his grandmother, Rosa Perez, 89, who
raised him after his mother died when he was an infant. He had not seen Perez,
who had contracted COVID-19 and spent two months in the hospital, since the end
of March. Because Perez is frail and it was extremely hot, they met in the
facility’s vestibule.
“She told me she
missed me and that she loves me. I told her I love her back,” said Lugo, a
truck driver. “It was 1,000 times better seeing her in person than talking to
her on the phone. You can’t compare it. It was awesome.”
Complete Care
Management, which operates 16 nursing homes in New Jersey, opened all its
facilities to visitors within a week of the announcement of the state’s new
policy.
Complete Care asks
visitors to sign consent forms indicating they understand the risks and will
let staffers know if they become ill. No one is allowed to bring food or enter
the buildings, even to use the restrooms. For the time being, get-togethers are
short — no more than 15 minutes and no more than two visitors at a time.
“Really, the only
burdensome part of it is having staff available to bring residents outside,
wait with them and bring them back in,” said Efraim Siegfried, Complete Care’s
chief executive officer. “If we do everything right, I don’t see a negative
outcome. And to see how excited people are, how happy they are, it’s a
beautiful thing.”
Before the pandemic,
Patricia Tietjen, 72, visited her husband of 52 years, Robert, who has
dementia, every day at Complete Care at Green Acres in Toms River, New Jersey.
Though staffers tried to arrange FaceTime visits when the home closed to
visitors, “it was hard because he was never awake — he started sleeping all the
time — and he can’t speak anymore,” Tietjen said.
Robert became ill
with COVID-19 in April. Although he survived that, he recently entered hospice
care and Tietjen has twice been let into the facility because he is near the
end of his life. “It was extremely emotional,” she said, breaking into tears.
Although federal
guidance says visitors should be permitted inside long-term care facilities at
the end of life, this is not happening as often as it should, said Lori
Smetanka, executive director of the National Consumer Voice for Quality
Long-Term Care, an advocacy group.
She wants family
visitation policies to be mandatory, not optional. As it stands, facility
administrators retain considerable discretion over when and whether to offer
visits because states are issuing recommendations only.
Smetanka’s
organization has also begun a campaign, Visitation
Saves Lives, calling for one “essential support person” to be named
for every nursing home or assisted living resident, not just those who are
dying. This person should have the right to go into the facility as long as he
or she wears personal protective equipment, follows infection control protocols
and interacts only with his or her loved one.
Not doing so is
“inhumane and cruel” punishment for more than 2 million people — most of them
older adults — living in “solitary confinement conditions,” said Tony Chicotel,
a staff attorney at California Advocates for Nursing Home Reform, a campaign
partner.
Kaiser Health News is
a nonprofit news service covering health issues. It is an editorially
independent program of the Kaiser Family Foundation, which is not affiliated
with Kaiser Permanente.
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