Ginny Jeffries laughs when she recounts the craving that her mother-in-law, Jean, developed after recovering from a weeks-long bout with the coronavirus just before her 94th birthday.
"She wanted a Manhattan,” says Jeffries, who, along with her husband, James, was able to bring Jean the cocktail and a cake last month. Jean's Pennsylvania nursing home, closed to visitors for three months as part of the federal ban on such visits during the pandemic, allowed her an outdoor, socially distanced birthday party with a few close family members. “She was so happy seeing us,” Jeffries says. “That was the first time she'd seen anybody since February."
It was nothing like a pre-pandemic visit to the Parkhouse Nursing and Rehabilitation Center, an hour's drive northeast of Philadelphia. And it offers a glimpse into the new normal for nursing homes seeking to reunite residents with loved ones while mitigating the risk of infection.
Jean was placed in a three-sided outdoor plexiglass enclosure while family members, clad in face masks, gathered around. After nearly succumbing to the virus, which landed her in the facility's isolation ward, Jean was “just so happy” to have company again, Jeffries says.
"She wishes we could come up and hug her," Jeffries says, reliving the moment. "We all say that. ‘We wish we could come up and hug you.’ "
Nursing homes and other long-term care facilities that have started offering visits are still the exceptions. More than a month after the federal government began relaxing guidelines that had closed long-term care facilities to most visitors since mid-March, fewer than 20 states have allowed visits, and then mostly outdoors. At the time of Jean's birthday celebration, Pennsylvania had not explicitly signed off on outdoor visits. It wasn't until late June that Gov. Tom Wolf unveiled a multistep, multi-week process paving the way for nursing homes and long-term care facilities to receive visitors.
Even in states where outdoor visits have been approved, implementation varies widely from one facility to the next, depending in part on how much outdoor space is available and on management's risk tolerance. Opening these facilities to visitors, even those who remain outdoors, increases the chances that residents are exposed to the virus.
"The risks of COVID well exceed the risks … of the social isolation. But, having said that, it is certainly a quality-of-life issue,” says David Nace, president of the nonprofit Society for Post-Acute and Long-Term Care Medicine and chief medical officer at the University of Pittsburgh's Senior Communities assisted living and skilled nursing operations.
Nace cautions that these visits are “not ideal” and not quite like “sitting next to somebody, holding their hand.” The federal Centers for Medicare & Medicaid Services is advising that masks be worn at all times during outdoor visits and instructing visitors and residents to stay 6 feet apart. Still, Nace calls outdoor visits “the appropriate thing to do” in communities that have brought the spread of the virus under control.
"Safety is the utmost priority,” says Elaine Ryan, vice president for state advocacy and strategy at AARP, which has pushed for more transparency from nursing homes during the pandemic, along with more personal protective equipment, testing and support for virtual visits. “It is critical all nursing home and assisted living facilities meet CDC guidelines, including no COVID-19 cases for 28 days, adequate staffing, testing of all residents and staff, and adequate personal protective equipment for staff."