En español | Federal officials are urging nursing home and long-term care residents, staff and their loved ones to “exercise extreme caution” during the holiday season. COVID-19 continues to sweep through the facilities, which are home to 40 percent of U.S. coronavirus deaths.
But with the U.S. more than nine months into a pandemic that has reshaped how and when long-term care residents can spend time with loved ones, many families are weighing the risk of spreading COVID-19 against a desire to spend an hour or a day with a resident who has been isolated for months. “I know the risk,” says 57-year-old Mary Daniel of Jacksonville, whose husband, Steve, lives in a nearby memory care facility. “But I also believe that I, as a responsible adult, can bring my husband home to a safe environment to spend possibly his last Christmas with me and his children."
The Centers for Medicare & Medicaid Services (CMS) recently warned that in-person holiday gatherings pose a risk to the health of long-term care residents and staff. The Centers for Disease Control and Prevention (CDC) has similarly warned Americans against celebrating the holidays with people outside their own homes. “For those who have been visiting a loved one in a long-term care facility for holidays every so often, it's not going to be like it's been in the past,” says Bob Stephen, vice president of caregiving and health at AARP.
Complicating in-person holiday visits this year is the fact that visitors, even if they wear masks and practice social distancing, risk spreading COVID-19 to other residents and staff members. It takes just one coronavirus-positive resident or staff member to threaten an entire facility. “We are pleading with a lot of our families to try not to visit,” says Deke Cateau, CEO of the Atlanta-based A.G. Rhodes Health & Rehab, a nonprofit long-term care facility.
An exclusive AARP analysis of federal nursing home data found that the rate of nursing home resident deaths doubled from Nov. 16 to Dec. 6, from 0.78 per four weeks per 100 residents to 1.53. Rates of resident and staff cases have increased by nearly two-thirds over the same period.
But family and friends of nursing home residents and others in long-term care still have options to connect with them this holiday season. Most states are allowing in-person visits at facilities that aren't experiencing active COVID-19 outbreaks. And facilities are now required to make phone and video calls available to residents who are unable to meet face-to-face with their loved ones.
Here's how to safely spend time with a loved one in a long-term care facility this holiday season:
Rhode Island recently closed its nursing homes to visitors, as resident cases spiked, but almost every other state is allowing scheduled visits. There are lots of caveats. Outdoor visits may be limited right now in cold-weather states. And even though many states signed off on indoor visits after CMS officials updated their visitor guidelines, facilities usually have discretion to implement their own policies, with protocol varying from one county to the next based on how COVID-19 is spreading.
Even if indoor visits are allowed, facilities may not be able to welcome all their residents’ loved ones on Thanksgiving or Christmas or New Year's Day, says Lori Smetanka, executive director of the National Consumer Voice advocacy group: “There might be more demand than availability for facilities to be able to help everyone have a visit on a specific day."
You'll probably have more luck getting into a nursing home by scheduling your visit for a day leading up to or following a holiday, rather than on the day itself. “Try to be flexible and think of this as a holiday season,” Smetanka says. She recommends reaching out to the nursing home administrator to see how the facility is handling the holidays before making concrete plans.
Nursing home and long-term care staff are already stretched thin, and most facilities have a fixed number of communal phones and tablets to go around. So residents and family members may need to be flexible in scheduling virtual visits. “Chances are, facilities aren't going to be able to accommodate multiple virtual visits [for each resident],” Stephen says. “So get everyone on the same call, have someone take the lead and get everyone on the same page."
Cateau says he and his colleagues at A.G. Rhodes Health & Rehab are working to “increase our FaceTime and our Skype calls.” They're also encouraging loved ones to send cards and letters to let residents know they're missed. “We're still going to do everything that we can to make this an enjoyable holiday,” Cateau says. “But we know it will not be the same.”
Health experts are recommending that long-term care facilities forgo large, communal holiday dinners this year. But some facilities are still celebrating. Stephen notes that some nursing homes and care facilities are organizing car parades, window visits and other events that allow residents to see and interact with loved ones, even if they can't visit in person. “Find out how you can participate in that,” Stephen says. “That's a real mood-booster — for the families and their loved ones.”)
Taking a Resident Out of a Facility
Parades, video calls and controlled in-person visits are a far cry from normal holiday festivities. Some may be tempted to take residents out of their facilities to enjoy a home-cooked meal.
The CMS holiday guidance notes that nursing home residents are legally allowed to leave facilities but warns that doing so may raise their chances of contracting COVID-19. CMS Administrator Seema Verma said she doesn't recommend residents leave over the holidays, citing coronavirus concerns.
The CDC recommends — and many states enforce — 14-day quarantines for residents who choose to leave their facility upon their return. The CDC also recommends family members quarantine for two weeks leading up to any kind of holiday gathering with people from outside the home, regardless of whether it involves a loved one living in a nursing home. Guests are also advised to wear masks — both indoors and outdoors — when not actively eating or drinking. “For Thanksgiving and the approaching holidays, we really need to quadruple down on the CDC guidance,” says John Sauer, president and CEO of the Wisconsin branch of LeadingAge, an advocacy group representing nonprofit long-term care facilities. “Everyone knows what [the rules] are, but for God's sake, we have to follow them for society."