| Nursing homes are entering the third week of sequestering their residents to protect them from the fast-spreading coronavirus, and family members physically cut off from their loved ones are increasingly worried about their care and mental health.
Since the first nursing home case in Kirkland, Washington, at least 150 skilled nursing facilities in more than half the states have at least one resident with COVID-19, according to data that the Centers for Medicare & Medicaid Services (CMS) released March 23 and has not updated.
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Two leading industry groups and the federal government said in early March that family and friends of residents of any type of senior living community should stay away because some people can have a COVID-19 infection without symptoms. Others may be contagious days before showing symptoms.
"We know that there is a risk that people who appear healthy will enter nursing homes and assisted living communities and still infect residents,” said Mark Parkinson, president and chief executive at the American Health Care Association and National Center for Assisted Living
Amy Johnson of Windom, Minnesota, was able to visit her husband, who has frontotemporal dementia, on March 11 but didn’t make her usual weekend trip a few days later and, like others whose friends and relatives are in lockdown, doesn’t know when she’ll be able to return.
“The timing is hard because I want to be there more frequently because of the decline of the disease,” she says, adding that her husband recently became incontinent. “It’s really scary to have this out there when you have someone who doesn’t know how to be sanitary.”
Other caregivers worry because it has been more about three weeks since they have been allowed to assist staff with the daily care of their loved ones. Wives feed husbands, husbands make sure that their spouses do their physical therapy, and social isolation and depression can be big worries.
"He won't let anybody clip his fingernails or shave him besides me,” Johnson says.
Emergency measures now in place
Both the health care and assisted living trade groups, based in Washington, D.C., had urged family and friends to stay away from senior living communities before the federal government restricted nursing home visits starting March 13 after President Donald Trump declared a national emergency amid the global pandemic.
The Department of Veterans Affairs began the isolation strategy March 10 by suspending most new admissions and barring outsiders from all of its 134 nursing homes and 24 spinal cord injury centers. The exception to the no-visitors rule: when a patient is expected to die soon, a guideline now in place at all nursing homes nationwide.
"The grim reality is that for the elderly, COVID-19 is almost a perfect killing machine,” Parkinson told CNN. “In our facilities the average age is 84, and everyone has underlying medical conditions. So when you combine those factors together, we are dealing with perhaps the greatest challenge that we ever have had."
The government also told nursing home officials to cancel all group activities and communal dining. Residents and staff are being "actively" screened for fever and respiratory problems, according to a CMS memo that did not define the frequency of actively.
Health officials made the same recommendation for assisted living facilities, where older people who have fewer nursing needs live in close quarters. Assisted living, independent living and continuing care communities are primarily under individual states’ oversight.
One prominent senior advocate said he worries that the government guidelines are depriving nursing home residents of important support.
"We are deeply concerned that residents are cut off from loved ones and vice versa," Richard J. Mollot, executive director of the Long Term Care Community Coalition in New York City, wrote in an email.
"We know that, in addition to providing company, love and a friendly face, families provide vital monitoring and often essential care," Mollot wrote. He urged those people concerned about the Centers for Medicare & Medicaid Services action to write their U.S. senators and representatives.
The nationwide coronavirus death toll has surpassed the official death toll — 2,403 — in the Dec. 7, 1941, Pearl Harbor attack and far above the 3,000 people who died initially in the terror attacks of Sept. 11, 2001.