After 45 years of marriage, the cruel twists of fate now leave Jean Ross and her seriously ailing husband, Phil, sadly hoping for a best-case scenario, under which they would be able to see each other without waiting for weeks, months or even longer.
It would be the best case because it could potentially be deadly if Phil, 69, were to catch the coronavirus in his current condition.
Phil is convalescing at a rehab facility in Alexandria, Virginia, following a series of six surgeries to amputate his right arm and right leg, necessitated by a serious allergic reaction to medications after an illness around Christmas. Jean has been barred from visiting him since the facility began following the Centers for Medicare & Medicaid Services’ (CMS) tough new coronavirus-related restrictions on visitors to nursing homes, hospitals and convalescent facilities.
“He's weak as a kitten due to three months in bed and very little rehab,” says Jean, who also turns 70 this year and had been completing plans with Phil to retire and move from Vienna, Virginia, to live closer to their daughter in suburban Philadelphia, before he became ill. “I'm looking at a new reality. It was wrenching last night to say on the phone, ‘I don't know when I'll see you again.’ “
At least Phil and Jean believe there's a road to recovery after his surgeries. But at nursing facilities nationwide, the new restrictions have left relatives of many elderly patients — particularly those who are dying — wondering if or when they will be able to see each other to say goodbye. That's because, under the new guidelines, issued in mid-March, visitations are strictly limited to patients in certain compassionate-care situations, such as end of life. Even then, there can be differences of opinion between a family and facility staff about whether a loved one is indeed dying.
Defining end of life
The CMS has no hard and fast definition. When asked during a press conference to define “end of life” or “imminent death,” CMS Administrator Seema Verma deferred to a colleague, who said the agency does not specifically define “end of life” — that should be left up to the facility and the family to decide together.
In other words, even in the midst of this terrible crisis, there is no simple answer.
“This is a very difficult question,” admits Manuel Eskildsen, a physician and clinician-educator in the division of geriatrics at UCLA School of Medicine. “A great amount of literature has been written on this, and even doctors can't always tell when patients are dying. It's really hard to tell. It's human nature that we're all optimistic, and we tend toward overstating how long someone has to live."