By Mary Clarkin, The Active Age
When Mary Malone turned 61, family members couldn’t come closer than the other side of a nursing home window.
Malone, a nanny and housekeeper described as the “glue” of her family, lay in a bed at Watercrest at Victoria Falls in Andover, a skilled nursing home and rehabilitation center that had been locked down because of the coronavirus pandemic. Her family erected a yard art scene outside her window.
“So this is what we have come to,” Malone’s niece, Jannette Malone Page, wrote about the experience at the time.
But the worst was yet to come. Malone, whose birthday was in March, had gone into the home in July 2019 to recover from the amputation of her leg due to cancer. She died on April 25 after a cancerous tumor was found on her arm, in circumstances made more painful by coronavirus pandemic-related restrictions.
Page said her aunt suffered panic attacks before her family was finally allowed to visit her in her final days. Hospice care had been permitted, but Malone “had to be like literally declining” before family members were allowed in.
Page, a certified medical assistant, said she understands the importance of COVID-19 restrictions, but believes long-term care facilities must consider each situation individually. Nobody should have to alone during their last days, she said, even if her aunt’s devout Catholic faith comforted her.
“She was scared, but she wasn’t.”
The case illustrates the challenges that long-term care facilities, residents and their family members face during the pandemic, which reached Kansas six months ago. In Sedgwick County, at least 37 of the first 50 deaths from COVID-18 were linked to long-term care facilities. The county’s total death count rose to 55 on Thursday. It wasn’t yet clear if any of the five latest deaths were linked to long-term care facilities.
The federal government’s primary strategy to limit COVID-19 from entering long-term care facilities is to restrict outside visitors. The U.S. Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services issued that guidance March 13.
The restrictions carved out an exception to the no-visitors strategy for “compassionate” cases, allowing visitors outfitted in personal protective equipment to visit a resident in a specific room.
Angie Hoffman, director of operations, said Victoria Falls policy follows federal guidance. Hospice nurses were allowed in the facility with proper screenings and personal protective equipment and saw Malone frequently, Hoffman said. Victoria Falls tried to accommodate as much visitation as possible while following guidelines and policies, she said.
“This pandemic has been extremely difficult on all of our residents and staff and our top priority was and continues to be to ensure that every resident at Victoria Falls remains safe and healthy,” Hoffman said in a statement.
As for regular indoor visits with residents who aren’t in end-of-life situations, that’s not yet common in long-term care facilities in Kansas, according to Kansas Long-Term Care Ombudsman Barbara Hickert. A couple facilities in rural parts of the state have started to allow visits inside, she said.
A facility that in July “implemented the most liberal visitation policy I’ve been aware of, has already stopped all visits because of an increase of cases in the county,” Hickert wrote in an email to The Active Age.
Hickert knew of another facility allowing an “essential family caregiver” for each resident to come inside the facility.
Some facilities are allowing outdoor visits between residents and guests, provided participants wear masks and observe social distancing.
The five Meadowlark Adult Care Homes in west Wichita are examples of facilities that are not doing that. Meadowlark Adult Care Homes have been completely COVID-free since the start of the lockdown, said Susan Hatcher, operator of the facilities.
“Our residents are doing wonderfully,” Hatcher said. Once-a-week theme days, contests with staff, and communications with families are part of their routine. Residents also are able to go out on the patio, she said.
Rules for reopening
On May 18, the Centers for Medicare and Medicaid Services released recommendations for the phased reopening of nursing homes.
In the three-phase process, visitation in nursing homes would remain generally prohibited until Phase 3. To reach Phase 3, the CMS outlined that there should be no rebound in community cases of COVID-19 and that there should have been no new onset COVID-19 cases in the nursing home for 28 days. The nursing home also should not be experiencing staff shortages, but it should have an adequate supply of personal protective equipment, disinfectant and cleaning supplies and adequate access to testing. Also, there should be hospital capacity to handle patients with the virus. Even in Phase 3, visitors to nursing homes would be required to wear facemasks for the duration of their visit, under CMS recommendations.
A nursing home progressing toward Phase 3 would have to start over if a new case of COVID-19 was diagnosed.
The CMS said all nursing home staff and residents should be tested for COVID-19 but did not mandate it. The state of Kansas isn’t requiring baseline testing for residents and staff in nursing homes or in adult care homes, which include assisted living, residential health care, and home plus facilities.
CMS also recommended nursing home staff continue to be tested once a week as part of the reopening plan, but Kansas isn’t requiring that.
The federal government encouraged state and local health departments to collaborate in deciding how to implement or adjust the recommendations. The Kansas Department for Aging and Disability Services issued in turn its recommendations and requirements. Like the federal government, the state leans toward giving the decision-making to the local health authorities and to the facility operator.
No rush locally
Before reopening, facilities in Kansas are required to create plans to help prevent the virus from entering their buildings and detail how they would respond if someone tested positive. Plans for reopening must include consultation with the local health officer, under the guidelines and requirements issued by KDADS. Most facilities in this area are not at that point.
“Some of the long-term care facilities have consulted with me and sent copies of their plans,” Butler County’s Local Health Officer and Health Department Administrator Jamie Downs wrote in an email.
“As far as I know, no facilities have reopened” to regular visitation, Downs added.
Several facilities are allowing outdoor visitation with everyone staying at least six feet apart. If a facility that has reopened would have a COVID-19 case, it would need to close, Downs said.
“Locally, there is no requirement to test all staff and residents in order to reopen, but they must have a plan in place for testing in case there is a positive resident or staff member,” Downs said.
The health departments in Sedgwick and Harvey counties are also not requiring testing of residents and staff before reopening.
No facilities have reopened in Sedgwick County, according to Kate Flavin, public information officer for the county. “When facilities do get to the place where they can begin to relax restrictions, it will be gradual,” Flavin wrote.
Harvey County Health Department Director Lynnette Redington said in an email that some facilities “had conducted outside visits, while others have not.” She was not aware of any indoor visits.
Despite measures in place since March to prevent the virus from entering and spreading in long-term care facilities, as of Thursday, 233 of Kansas’ 458 deaths from COVID-19 were linked to long-term care facilities.
Those fatalities and the limitation on visitors point to staff members as being “one mode of transmission” for bringing the disease into facilities, according to Kristi Zears, director of communications for the Kansas Department of Health and Environment.
In Sedgwick County, the facilities accounting for the 37 deaths are: Clearwater Nursing and Rehabilitation Center 12; Chisholm Place 7; Diversicare of Haysville 5; Avita Assisted Living and Memory Care at Rolling Hills 3; Park West Plaza’s The Manor Nursing Home 3; Legacy on College Hill 2; New Life Home Plus 2; Homestead of Wichita 1; Sedgwick Plaza 1; and Wichita Center 1.