Mar. 13—The COVID-19 vaccination rollout has become a light at the end of the tunnel and a cautious beacon of hope for nursing home residents and older adults — the population for whom the virus posed the biggest threat.
While much was unknown about the novel coronavirus in the early days of the pandemic, health officials identified those with underlying medical conditions and older adults as some of the most at-risk populations for developing severe COVID-19 symptoms. According to the Centers for Disease Control and Prevention, 8 out of 10 COVID-19 related deaths in the U.S. have been in adults 65 and older.
Long-term care facilities served as an almost ground zero for the virus, killing more than 150,000 residents and employees in the U.S. and accounting for more than a third of all virus deaths since last spring, according to a New York Times database. However, The Times reported that since vaccines arrived, new cases and deaths in nursing homes have fallen steeply.
These trends ultimately influenced the Centers for Medicare and Medicaid Services to release new nursing home visiting recommendations on Wednesday, allowing "responsible" indoor visitation at all times with a few suggested limitations.
"CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents and their families," Dr. Lee Fleisher, chief medical officer at the Centers for Medicare and Medicaid Services, said in a statement.
Laci Cornelison, an instructor at K-State's Center on Aging whose research in the PEAK 2.0 program focuses on implementing person-centered care in nursing homes across the state, said nursing homes have been challenged with balancing the safety of its residents while also trying to preserve their autonomy. First and foremost, she said, maintaining residents' physical health has remained a priority, though with easing restrictions and reopening visitation, it has allowed facilities to focus more on managing the mental health aspect of the pandemic.
"It's definitely more on the side of keeping them completely safe from COVID versus considering their mental health," Cornelison said. "The mental toll can be almost as big or greater than the physical toll, and obviously our mental health impacts our physical health, too. I think we're still exploring, in terms of research, what that looks like and what that impact is, but there's no denying there has to be one."
And for facilities that took a stricter isolation approach with its residents, that impact may be amplified, she added.
"There have definitely been increases in behaviors for people with dementia and even for people without, increases in anxiety and depression and isolation and all of those things are going up, for sure," Cornelison said.
Many people shifted to digital means of communication, like Zoom meetings and Facetime calls, as a way to remain connected with friends and family they were unable to see in person, but that wasn't necessarily a simple transition for elders, Cornelison said.
For example, she said, it can be difficult for dementia patients to recognize loved ones, and that's worse when the visit is through a screen or voice call.
"They no longer had direct access to their families and have that human connection, whether that's being able to have their family members, loved ones or friends come visit them or go out to see them, so that obviously takes a toll because physical contact is important," Cornelison said. "I think it has a different level of intimacy and connection than virtual connection through technology."
She said many nursing homes tried to meet that need by increasing residents' access to devices and having extra iPads on hand, upping buildings' capacities for internet connection, providing noise cancelling headphones for better hearing capabilities and more.
Jami Ramsey, director of the Riley County Seniors' Service Center, which hosts regular programming and events, said after the facility had to close in March because of the pandemic, they had some guests who also didn't want to bother with email communication. She said staff made sure to contact all their members, especially isolated folks, on a regular basis to see how they were doing and help provide resources when necessary.
Most of their initial efforts involved moving fitness classes online via streaming and pivoting their dine-in meal service to home delivery.
The center reopened its doors in October on a limited basis and at the time it still hadn't reopened its dining room, which was one of their more social events. It started out with small programs like guest speakers and reservable activities and social hours, and they'd also been doing outdoor events like concerts in the parking lot or coffee and donuts in the park. The center later reopened its dining room in January, which has slowly been growing in number, Ramsey said.
"We might have had four to eight (initially), and I would've thought it would have been the single men, but there were some married couples who came in," she said. "It wasn't who I expected to come in. We can start to see that fact they're getting their full vaccinations so that number is going up."
Ramsey said they've had some guests come in and say how lonely it had been to be isolated for months, and they felt the need to have some face-to-face interaction with others. There are still some who haven't come in as regularly or at all, but she said the center is working on providing a mixture of programs and events, whether virtual, in person or outdoor, as a means to reach out and at least offer those options.
"As everybody's kind of getting their vaccinations, I think it'll come back but not the way it was," Ramsey said. "I think that's the challenge, and it's an opportunity for us to say, 'OK, we haven't seen some of you, what is it you want from us now? Do you want a class online or do you want to come in, and what do you want to come in for?"
Ramsey said the center also recognizes the emotional and mental toll the pandemic has had and its staff hopes to work with Pawnee Mental Health to have someone speak about those effects and allow for open conversation about that experience.
"I'm cautious, but I can see where our programming also opens up and it gets nicer so that if you're still hesitant we can offer you coffee and donuts in the park ... or a parking lot concert," Ramsey said. "That's a way to kind of stay safe, come on out, do something you'll enjoy."
Cornelison echoed those statements, and said local nursing homes have responded in kind and started to return to allowing visitation and events. She said she believes that while it won't happen overnight, people are looking forward to one day being able to be around others without masks at all times and being able to have regular human connection and interaction in person. She credited care staff for the ongoing work they have been doing, as they also likely have experienced trauma from seeing the effects of the pandemic firsthand, and residents' families for their flexibility during the pandemic.
"I think each (facility) has responded in their own different ways and I think overall depending on where each one is with current COVID cases and staff and vaccinations, I've heard signs of hope that they want just as much as everybody else to get open and start being a part of the community again," Cornelison said. "But it will take time."