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Visits to loved ones may be permitted at senior care facilities

STORY BY MICHELLE GENZ (Week of August 20, 2020)

Visitors may soon be returning to nursing homes and assisted living facilities as a task force appointed by Gov. Ron DeSantis moves forward with a plan to lift a five-month lockdown.

A Zoom meeting scheduled for Tuesday was expected to finalize a list of recommendations on how to safely allow face-to-face visits – or at least, mask-to-mask – in a matter of weeks. That strategy should soon be on the governor’s desk, task force leaders said Friday at their first meeting.

That online roundtable session was led by Mary Mayhew, head of the state’s Agency for Health Care Administration, and included Dr. Scott Rivkee, Florida’s surgeon general and leader of the state Department of Health, as well as representatives from long-term care trade associations.

The most compelling voice was that of Mary Daniel, the wife of a 66-year-old man with Alzheimer’s disease. Daniel, who runs a business helping people sort through problematic medical bills, took a job as a dishwasher in her husband’s memory care center just so she could visit him.

“I am begging for urgency,” Daniel told the group. “We are desperate. People are dying today of failure to thrive. Alzheimer deaths are way up, and it’s not due to COVID.”

Daniel, who was profiled in the Washington Post for her lockdown work-around, has started a Facebook page, Caregivers for Compromise, which now claims 8,000 members.

While their stories are deeply moving, there is also fear about what might happen if COVID-19 were to work its way into elder care facilities along with long-missing familiar faces.

“I’d love to see them reopen. We miss our loved ones. But they need strict regulations,” said Melissa Schwanke, who since March hasn’t seen her mother except through the window of her room at Sea Breeze Rehab and Nursing Center. Even without visitors, her mother contracted COVID-19 in late July. 

Arthur Broadhurst, a resident in independent living at Indian River Estates, questions the wisdom of reopening and said the CMS rules that locked down facilities made no sense in the first place.

“We have quite a few instances where one spouse was in the nursing facility, the other in independent living or the assisted living unit,” said Broadhurst. “Even though both spouses were inside a security protected facility that prohibited outside visitors, they were unable to visit each other.”

At the same time, he said, staff living outside the facility came and went each day.

“The CMS rules applicable to this facility were not compassionate. They were not helpful to patients and family. They did nothing to prevent infection from getting into the facility.”

Broadhurst said he worries that the new rules “are likely to create more and different obstacles” and may disregard the circumstances of different facilities.

He fears they “will focus more on optics than on substance, and will ignore the science while catering to the politics of an administration that shows it cares more for profits and investors than it does for people and health.”

As it stands, policies vary widely among facilities. A handful of facilities have shut out friends and family even by phone.

Prior to the lockdown, one couple had visited a woman who was a tenant in a property they owned who had no known family. She had been discharged to Sea Breeze by the hospital after collapsing in their condo.

When visitation was suspended, they could not reach the woman to ask what she wanted them to do with her possessions. There was also the matter of her automatic rent payments that were no longer due but that the couple couldn’t stop. And they didn’t know what the tenant wanted to do with the car she left behind.

After repeated attempts to reach her by calling the front desk, including two conversations with the Sea Breeze social worker, the couple, who did not want to be named to protect the privacy of their tenant, finally learned the phone in the woman’s room wasn’t working. Finally, they found a caregiver who set them up on a FaceTime call. By then the woman seemed to have lost all hope.

“I told her we had boxes and boxes of her stuff, and I asked her, what do you want us to do with it? She just said, ‘Burn it,’” the woman said.

Whether a stranger’s compassion would qualify her to visit under the new rules is anyone’s guess. Last week’s roundtable discussion mentioned “essential caregivers” needing documentation of prior visits to provide help with daily activities like eating and dressing.

There were also some nerve-jangling screening questions, including whether the visitor has been exposed to a COVID-19 positive person “within 6 feet for more than 15 minutes over the past 14 days.”

That set of parameters is used for contact tracing by the Health Department. But it’s doubtful the family of a vulnerable senior would be comfortable with 14 minutes of COVID-19 contact, or a half-hour at 6 1/2 feet.

There may also be a requirement that any visitor who develops COVID-19 symptoms within 48 hours of visiting report that to the facility. That presumes all visitors have the same degree of candor and concern.

Screening questions also include asking the visitors if they are experiencing any of the most common symptoms of COVID: fever, cough, loss of sense of taste or smell, fatigue, sore throat, congestion.

Other states that allow visitors are limiting the number to two people per visit, Rivkees said. Some are keeping all visitation outside, where transmission is known to be lower, but that would prove problematic in Florida’s sweltering heat.

 And there would likely be strict limitations on physical contact. The hugs and kisses families are craving may be reduced to gestures, socially distanced or from behind a Plexiglas screen, and under the supervision of a trained facility staff member.

Even more challenging, as the coronavirus continues to penetrate facilities around the state, the guidelines would likely include a rule that the facility be COVID-free for 28 days prior to allowing visitors. In recent weeks, there have typically been infections in half to two-thirds of the county’s 25 long-term care facilities, which house a total of 1,700 residents.

In all, the county has seen a total of 301 cases of COVID-19 among long-term care residents and staff.

Statewide, an estimated 2 percent of long-term care residents and 3 percent of staff currently have COVID-19 infections, according to Emmett Reed, president of the Florida Health Care Association, which represents 600 senior care facilities.

Speaking at last week’s roundtable discussion, Reed said a poll of his members showed two overarching but opposing concerns regarding reopening – the decline in the mental and physical well-being of residents due to lack of visitation and their fears of an outbreak.

“They’re terrified of letting COVID in the building,” he said.

Don Wright, a Vero resident who owns or has invested in three local long-term care facilities, has gone through a major COVID-19 outbreak in one of them, Rosewood Manor. He knows first-hand the fallout of the state not being adequately prepared for outbreaks, after widespread testing in all the state’s care homes seemed to overload labs and delayed results by up to a month – which in the case of Rosewood Manor allowed the virus to circulate silently in asymptomatic residents.

Wright factors in another big risk: the timing of the reopening, just as kids head back to school.

“Not having visitation has been horrible for our residents. They miss those family visits and I so badly want to open our doors to them,” Wright said. “However, I am still nervous, especially now that schools are reopening. I would prefer we wait another four weeks or so to make sure our community doesn’t have a spike in cases because of the schools opening.”

The wisdom of reopening schools just before reopening long-term care was not addressed in last week’s roundtable, though a drop in the rate of COVID-19 in the community at large has been one of the CMS guidelines for deciding to allow visits to nursing homes. CMS also suggests states consider whether there is adequate capacity in local hospitals in the event of a serious outbreak.

One key issue at last week’s meeting was whether all long-term facilities should reopen in unison, or if the decision should be left to individual facilities. Daniel, who went to such lengths to see her husband, expressed concern that given the choice, facilities would refuse to open just because of the added costs.

Reed agreed there were financial considerations, and he asked for more state money to help fund the effort. He called the cost of preparations for COVID-19 “astronomical.”

“Our members are barely keeping their heads above water financially. And when we do move [to reopening], additional costs will be incurred from PPE and cleaning supplies, to additional staff to supplies and tents for building a visitor area.”