BY LINDA BERGTHOLD AND NANCY HEALEY
One of the most devastating outcomes of the Stay at Home mandates around the country is the isolation happening in nursing homes and elder facilities and communities. In an effort to control the spread of Covid-19, almost all facilities, large and small, have limited or totally eliminated outside visitors. This means family and friends, and even Ombudsman visitors, are denied access to people living in the facility. Some places are not even allowing residents to leave their rooms without permission or visit with other residents. The loneliness and the isolation is causing depression and physical weakness among residents, and elders living by themselves at home in the community are at even greater risk because they may have no one to look in on them.
In the retirement community where I live in Los Angeles County, management has tried their best to ameliorate the isolation by sponsoring YouTube fitness classes and events, Zoom discussions, and balcony singalongs. But the result of restricting outside visitors has made our community work a lot harder to retain our physical as well as mental health. I saw one of our residents last week and asked how he was doing. He replied “I am getting weaker.” That broke my heart. He was always at all events and eating communally with other residents, and now he literally cannot afford to lose those activities for the sake of his health. My husband and I are also losing some of the strength we had gained through the in-person exercise classes too. Doing exercise to YouTube is just not as motivating as going to a class. As the weeks go on, we have to push ourselves hard to make even the minimum effort to get out and walk around.
Keeping our facility closed to outsiders, testing all of our staff regularly, ramping up infection control at all levels, requiring any home health aides to work only here and not in several other places — have all been measures designed to keep us from getting Covid-19. And so far, the results have been mainly good. Only one positive case among the residents. While the loneliness is stressing our residents, we are not the only ones experiencing this isolation.
In Ventura County right next to Linda in LA County, we have experienced a considerably lower than average rate of Covid-19 than our neighboring counties. When our Stay at Home orders started in mid March, Residential Care Facilities (RCFEs) began restricting visitors and requiring residents to remain in their rooms. The larger facilities ceased all congregate meals and residents’ meals were delivered to their rooms. One of the biggest reasons for choosing larger assisted living facilities is the varied activity schedule, including movies, bingo, Wii bowling, poker, bridge, entertainment and field trips for residents. All of these were stopped because of Covid-19. Some facilities were able to broadcast classes and entertainment through their in-house systems but facilities with this capability are not the norm.
Some facilities have been able to set up visitations occasionally for residents and friends and family through closed patio doors or windows where the resident is inside and the visitor outside. I visited a friend in a large assisted living home for a Mothers’/Family Day event. Visitors had appointments and were well separated on the large patio and were able to talk to the residents through large windows. It was very well run and was definitely positive for both the residents and their visitors.
Our County began to open up several weeks ago. Those of us who live independently were able to go out to stores other than grocery stores and pharmacies. We could get our hair cut and take our poor pets for much needed grooming. I could make the choice to eat dinner in a park with friends or to eat inside or outside in a local restaurant. I had very mixed thoughts about how the County would begin to lessen restrictions on RCFEs. While the isolation has been very detrimental to the residents, we have all seen what can happen when there is a lack of control over who comes and goes. Again we have been fortunate not to have had the large numbers of Covid cases and casualties in our care facilities that we have seen across the country. I believe that was due in large part to the quick action taken by our Public Health Department in making these very difficult decisions to restrict visitors and activity at the facilities in our County.
Ventura County guidelines released on June 3 have partially lifted the restrictions now allowing family and friends to visit residents of many long term care sites but still not allowing them to actually enter the facilities. They suggest visits through open doorways or in outdoor courtyards or in drive-up meetings where residents are taken to a curb to meet their visitors in their vehicles. For non-ambulatory residents, outside activities require being brought outside by a staff member to a safe area. The new guidelines do not allow for physical contact or the direct exchange of gifts during a visit. Staff needs to monitor visits where residents and visitors are not separated by a partition or some other barrier. They do require the use of masks for the visitors and the residents. Visitors should be screened and their temperatures taken. All chairs and benches have to be sanitized after each visit.
These guidelines, however, are not mandatory. Facilities can decide for themselves whether to allow visits and whether to require appointments. These guidelines were designed to carefully crack open a door to visitations that were stopped almost three months ago. The Ventura County Public Health Director Dr Robert Levin said he took this action because he felt that human contact is very important to our seniors. He said, “I felt this manner of proceeding could balance that necessity for human contact with safety from Covid.” Dr. Levin has also been impacted personally by the restrictions because his 98 year old mother resides in a Ventura County facility. These guidelines are not recommended for all skilled nursing homes but only those that have met certain Medicare parameters for reopening, including no Covid cases in 28 days, no staffing shortages, access to testing and adequate personal protective equipment.
While the new guidelines still present difficulties in being close to loved ones, they have been very welcomed by my friends who reside in congregate facilities. One friend said it was like heaven the first time she was able to meet her family outside on a beautiful afternoon and simply sit (socially distanced, of course) and talk with them in person. Zoom has been a big help but is not a substitute for in-person conversations. How long our visits to friends and family will be regulated by these guidelines is anyone’s guess. With cases rising in some areas, the Governor of California issued mandatory masks outside the home in most settings, so it is not clear whether or not other restrictions may once more be implemented in the weeks to come.
Linda and Nancy urge you to reach out to anyone you know in a congregate setting to find out how they are doing. And if you want to visit someone in one of these settings, it is best to contact their facility in advance to determine their specific procedures in order to make your visit the best it can be.