Nursing home residents took the brunt of the COVID-19 pandemic. Now they’re being hit by a second threat – the effects of prolonged isolation.
Cut off from family visits and communal activities, many residents have been largely confined to their rooms for more than three months and cared for by staff wearing masks and other protective gear. Now the process of shielding them is taking a toll on the residents’ mental and physical health.
Strict limits on visitation recommended by the Centers for Medicare and Medicaid Services and followed by North Carolina made sense in the pandemic’s early stages, but as the lockdown drags on the limits are sometimes doing more harm than good. Residents feel abandoned. Some lose the will to live.
The federal guidelines for resuming visits include: A decline in cases in the surrounding community, no new cases in the home for 28 days, weekly testing of all staff, adequate supplies of protective equipment and no staff shortages. It will take months for most of the state’s 427 Medicaid/Medicare-approved nursing homes to meet all those benchmarks. Given the pressing need, flexibility is in order.
William Lamb, the board chairman of Friends of Residents in Long-Term Care, described the case of a friend’s mother who entered an assisted living section of a nursing home in fairly good health before the COVID-19 lockdown. Since then she’s grown agitated, has stopped eating and has been moved to a nursing home bed.
“Her mom’s going to die and it’s not going to be from COVID,” he said. “Something is going to have to give as far as being creative in finding ways to promote interaction between families and residents.”
New Jersey health officials recently announced that nursing homes there can allow in-person visits outside with restrictions. On Tuesday, Colorado followed suit. North Carolina should join them as soon as its COVID-19 numbers allow. Until then, it should find ways to step up virtual and window visits.
Last week, the Department of Health and Human Services offered new guidelines supporting outdoor visits at assisted-living and residential treatment facilities. The changes do not apply to skilled nursing facilities, including combination skilled nursing/adult care assisted living facilities.
As its COVID-19 numbers improve, North Carolina nursing homes should be allowed to do something similar to other states where family members can visit outdoors with masks and social distancing restrictions. Additional precautions might need to be taken, such as visitors bringing evidence of a recent negative COVID test.
Improving the care of nursing home residents is especially needed given North Carolina’s poor record so far. Of the state’s more than 1,300 COVID-19 deaths, 50 percent have been nursing home residents, a rate above the national rate of 40 percent. Prolonging isolation could widen that gap by weakening more residents.
Meanwhile, the state is still not testing all nursing home workers on a regular basis. As a result, family members can’t meet outside with residents while infected but asymptomatic staffers may spend long hours inside nursing homes.
Catherine Sevier, a nurse and president of North Carolina AARP, said more needs to be done to help residents. “We need to protect people,” she said, “but at the same time not have them die of loneliness and the stress of being locked in place without being able to see family.”
Gov. Roy Cooper and Department of Health and Human Services Secretary Dr. Mandy Cohen have done fine work in responding to the pandemic by being vigilant and cautious. But nursing homes appear to be an area where too much caution creates another risk. They should find a safe way to ease the isolation of those most in need of the warmth of family.