The reopening of long-term care facilities is “an absolute necessity for our well-being”


For nearly a year, rest homes and assisted living facilities have mostly been closed to visitors. Now is the time for them to reopen and relieve residents of crushing isolation, according to a growing chorus of long-term care experts, caregivers, consumer groups and doctors.

They are calling on federal health officials to ease visitation restrictions at long-term care facilities, replacing guidelines that have been in effect since September. And they want federal and state authorities to grant special status to “essential caregivers” — family members or friends who provide critically important practical care — so they have the opportunity to care for relatives in the need.

Richard Fornili, 84, who lives in a nursing home in St. Marys, Georgia, supports policy change. He hasn’t seen any of his family since last summer, when a granddaughter, her husband and two children stood outside his window and called him on the phone. “The depression and the feeling of loneliness that affect my fellow citizens is terrible,” he said. “Bringing our loved ones back to see us is an absolute necessity for our well-being.”

“At this point, residents are increasingly more likely to die from isolation and neglect than from covid,” said Jocelyn Bogdan, program and policy specialist at the National Consumer Voice for Quality Long-Term Care, citing from new data linking covid-19 vaccination to sharp drop in covid-related deaths. His organization has launched a petition calling for nursing homes to reopen safely and for essential carers to have unrestricted access to their loved ones.

Since late December when vaccinations began, covid cases among nursing home residents have plunged 83%, while deaths have fallen 66%, according to an analysis by KFF. As of Monday, 4.6 million residents and staff of nursing homes and other congregate settings had received at least one injection of the Pfizer-BioNTech or Moderna vaccine, including more than 2 million who had received a second dose.

Vaccines have “changed everything” and nursing homes are now among “the safest places you can be in your community in terms of covid,” said Ruth Katz, senior vice president of public policy at LeadingAge, an association representing more than 5,000 nonprofit nursing homes. , assisted living centers and senior housing providers.

Last week, LeadingAge called on federal authorities to expand visits in a letter to top officials at the White House, the Centers for Medicare & Medicaid Services, and the Centers for Disease Control and Prevention. In an email, the American Health Care Association, which represents more than 14,000 long-term care providers, also urged the CMS and CDC to review their visitation guidelines. AARP, the nation’s most powerful seniors’ lobby, stepped in with a letter noting “a critical need” for new recommendations.

Medical directors of long-term care facilities are also intervening while exercising caution in new guidelines around resuming joint activities and visits to long-term care facilities. With new variants of covid circulating and significant numbers of potential employees and visitors still unvaccinated, “we recommend a measured, step-by-step approach,” said Dr. Swati Gaur, chair of the infection advisory committee for AMDA – the Society for Post-Acute and Long-Term Care Medicine.

Establishments that reopen to family members should do so “carefully,” she said, scheduling visits, screening those visitors for symptoms and ideally requiring a negative covid test before entry; limit the number of visitors to a facility at any time; send them to sites reserved for visitors, and not to the rooms of residents; and requiring the use of masks and gloves, among other precautions.

No one wants to see covid outbreaks reappear in long-term care facilities, said Gaur – the site of nearly 173,000 covid-related deaths, or about 35% of the national total.

The CMS ordered nursing homes to close nearly a year ago, on March 13, as the coronavirus pandemic gathered pace and the CDC said no one except visiting relatives end of life, should only be allowed to enter. In September, new recommendations allowed outdoor visitation, as long as safety precautions such as physical distancing were in place and indoor visitation, as long as a facility was covid-free for 14 days and that the covid case positivity rate in the surrounding community was less than 10%.

Federal recommendations apply to nursing homes. States regulate assisted living facilities and other congregate care facilities, but tend to follow the CDC’s lead. In practice, long-term care facilities vary widely in how they implement recommended policies.

Additionally, federal authorities have recommended that loved ones can make “compassionate care” visits when a resident is emotionally distressed, mourning the loss of friends or family members, losing weight, or coping poorly. to the recent loss of family support. But many nursing homes continue to refuse such visits, and enforcement needs to be strengthened, AARP observed in its letter.

Melody Taylor Stark said her request for a compassionate visit with husband Bill Stark was denied in October when her congestive heart failure worsened. Bill, 84, a resident of Huntington Drive Health and Rehabilitation in Arcadia, Calif., for five years, was later hospitalized with pneumonia. Stark said she was only allowed one 15-minute visit with him on November 17 after he returned to Huntington – the last time she saw Bill before his death on November 22. The Huntington Drive administrator did not respond to a request. for comment.

The Essential Caregivers Coalition, of which Stark is a member, is calling for every long-term care resident to be able to designate one or two essential caregivers who can walk in and out of facilities regularly to provide convenient care for their loved ones, as they have done before. the pandemic. As the anniversary of the closures approached, the coalition organized email blasts and letter-writing campaigns to federal and state authorities, a traveling campaign of lawn signs in more than a dozen states and rallies in several state capitals. The campaign slogan: Isolation also kills.

Mikko Cook, 49, of Ventura, Calif., is one of the group’s co-founders. Her father, Ron Von Ronne, 77, has advanced Alzheimer’s disease and lives in a 200-bed nursing home in Albany, New York. Before the pandemic, Cook’s brother visited almost daily.

“The house was severely understaffed and when my family members came to look after him, my father’s sheets were soiled. He would not have showered. The bathroom was never clean. But they would deal with it,” Cook said.

After the confinement, Von Ronne went more than three months without seeing or speaking to members of his family. Over the past year, he has nearly stopped communicating, been assaulted by another resident and lost nearly all of his possessions, which were misplaced or stolen, Cook said. Von Ronne has since had two visits away from home with loved ones and three short visits to family members over Christmas and in January and February.

Mary Daniel’s husband, Steve, has early-stage Alzheimer’s disease. Since visits to Steve’s Jacksonville, Florida assisted living facility were limited, Mary got a part-time job there so she could see him.(Lisa Marshall)

Mary Daniel, 58, founded another activist group, Caregivers for Compromise, after getting a part-time job in July at her husband’s assisted living facility in Jacksonville, Florida – the only way she can to see him. Steve Daniel, 67, has early-stage Alzheimer’s disease and had gone there every night before the pandemic.

After stories about him went viral, Daniel created Facebook groups in every state for caregivers who wanted more access to their loved ones. Now Caregivers for Compromise chapters in Connecticut, Florida, Illinois, Kentucky, North Carolina, New York, Pennsylvania, Tennessee, Texas and West Virginia are actively participating in the Isolation Kills, Too campaign.

“We are getting impatient: the quality of life of our loved ones is deteriorating day by day. My husband has been vaccinated and he wants to go out and feel the sunlight on his face. It’s time to open up again and let him live his remaining time with freedom,” Daniel said. “You can’t protect people like him forever, from everything.”

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