After a grueling year of COVID-induced loss and loneliness in America's nursing homes, many residents finally are reuniting with their loved ones for hugs, hand-holding and indoor visits, thanks to recently revised nursing home guidelines from the federal government.
"It feels like a new day,” says Glen Lewis, executive director of the Edgewater senior living community in West Des Moines, Iowa. He opened his skilled nursing section to visitors March 11, the day after the Centers for Medicare & Medicaid Services (CMS) released the new guidance.
"It's definitely been a bright spot for our residents,” he says. “There's nothing like that sense of community and communication and companionship that comes from their own families.”
While the revisions represent the most dramatic steps toward reuniting residents with their family and friends since guests were first shut out of nursing homes in March 2020, many infection prevention protocols remain in place. Visitors must wear masks, the number of simultaneous visitors is capped, and the amount of time they can stay is limited.
Those restrictions continue to be challenging for some residents, says Maureen Cadwell, chief executive officer of Weston County Manor, a nursing home in Newcastle, Wyoming. Although the recent relaxations are “extremely welcome,” there are still struggles, she admits. “And they're wearing on everybody” — residents, staff and loved ones included.
Welcoming back families
"Facilities should allow indoor visitation at all times and for all residents [regardless of vaccination status],” the CMS guidelines say, citing widespread nursing home vaccinations and drops in COVID-19 infections among residents and staff.
Exceptions include residents in quarantine or with COVID-19. Also, residents who are not vaccinated and are living in a nursing home where fewer than 70 percent of residents are fully vaccinated, and whose county's rate of COVID-19 infections is greater than 10 percent, are advised against allowing visitors.
The agency also moved to permit “close contact,” which it had previously discouraged, if a resident is fully vaccinated and both the resident and visitor wear a “well-fitting face mask” and wash or sanitize their hands before and after the visit.
"We acknowledge the toll that separation and isolation has taken,” CMS officials said. “We also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one."
America's 15,000-plus nursing homes, which are regulated by the CMS, can face penalties if they don't comply with certain requirements of the federal guidance, such as using face coverings or masks at all times during visits. Other sections of the guidance are less straightforward and may only be advisory, not required. For example, it says “facilities should consider scheduling visits for a specified length of time” to help ensure all residents are able to receive visitors. But no suggested time frame or penalty for not complying is mentioned.
Assisted living communities and other types of long-term care are not required to follow the CMS guidelines, as they are regulated by the state government rather than by the federal government. However, many states have reissued their long-term care guidance, closely following the recommendations put out by the CMS.
Birthday visit for 94-year-old husband
Thanks to the CMS’ changes, Sharon Peters-Bergen was able to visit her husband, Harold “Hal” Bergen, in person for his 94th birthday at the Selfhelp Home, a skilled nursing facility in Chicago. Last year she had to sing "Happy Birthday" to her husband through a window. This year she wasn't allowed to celebrate in the home's dining room with other residents — whom she brought birthday bagels and mini muffins for — but she still sees progress.
“Getting the news that I could really see him in person was incredible,” Peters-Bergen says. “It's one thing to talk on the phone, but it's another thing to be there."
And that first hug was “glorious,” she adds. “If you love somebody, you want to hug them, you want to touch them. So it was a very, very liberating feeling."
For Bergen, who suffered great bouts of isolation and loneliness during the pandemic's lockdowns, the feeling was mutual. Hundreds of thousands of nursing home residents across the country have endured that same heartache.
"Just being able to just touch your hand or your hair … makes such a difference,” he said to his wife of 45 years. “It's amazing."
Down the hallway at the Selfhelp Home, the reunion between a mother and daughter was just as sweet. “Better than ice cream, better than pizza, better than chocolate,” says Ellen Rosner, describing how it felt to hug her mom, Josefina “Finnie” Rosner, for the first time in more than a year.
For Finnie Rosner, that closeness represents a return to some normality in her life. “That feels very good,” she says.
Old friends in the same complex reunite
While the government's revisions focus on safely allowing more outside visitors inside nursing homes, the updates also are reuniting fellow residents who haven't been allowed to get together throughout the pandemic.
Shortly after the new directives were released, Edgewater had a dinner to bring together residents from different sections of the continuing-care community. Two lifelong friends, one from the skilled nursing area and the other from assisted living, hadn't seen each other since the pandemic began.
"These two ladies were literally holding each other's hands and just saying, ‘It's so good to see you. It's so good to see you,’ “ says Lewis, Edgewater's executive director. “They just kept holding each other. It was really emotional."
For many nursing home residents, being able to reconnect over communal meals, bingo, or arts and crafts is just as special as the regained access to family.
"My kids can come and see me, but they don't get to very often,” says Norma Reman, a resident of Weston County Manor. “And, of course, it's not like they can just walk in.” The community's current restrictions allow for only one one-hour visit or two 30-minute visits per resident per week.
"So the main thing that is so nice is to be able to go to the table and sit down to eat together, like we're supposed to,” she says.
Alice Cunningham, also at Weston County Manor, agrees: “Yeah, we really, really missed that.”
Sometimes challenges, confusion
While many nursing home residents around the country are enjoying the lifting of restrictions, some are not.
On a recent visit to Weston County Manor, Connie Reimer was excited to finally be able to sit beside her 99-year-old mother, Doris Voss, and help her flip through the pages of a photo album. But Voss, who has dementia, didn't want to wear a face mask.
"I couldn't hold her hand or give her a hug because she wouldn't wear the mask,” Reimer says. “She doesn't understand why that goes together.”
Many families are likely to face the same struggle. More than a third of nursing home residents have severe cognitive impairment, and around a quarter have moderate cognitive impairment, according to CMS’ “2015 Nursing Home Data Compendium.”
To keep seeing each other, Reimer and Voss had to move to one of the facility's visitation booths, which use clear plexiglass dividers to keep residents and visitors separated. In there, Voss didn't have to wear her mask, but hearing her daughter through the wall was difficult. Eventually, Reimer gave up on conversation and instead played her mother some soothing music through her phone.
"That was very frustrating,” says Reimer, who has witnessed her mom's physical and mental health decline during the lockdowns. “And we both are vaccinated now, so it'd be nice if we could just have a nice visit without all of this.”
Although the Centers for Disease Control and Prevention (CDC) recently released new guidelines for the general population, giving fully vaccinated people the go-ahead to unmask indoors around other fully vaccinated people, the CMS has not issued the same recommendation to nursing homes. Instead, it continues to list face coverings and masks as a core principle of COVID-19 infection prevention that “should be adhered to at all times."
'The virus is not gone'
Recovering from a pandemic takes time, particularly for communities such as nursing homes that have proven so vulnerable to severe outbreaks, says Jennifer Schrack, an associate professor in the epidemiology of aging at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
More than 180,000 long-term care residents and staff — at nursing homes, assisted living communities and other settings where older adults live in close quarters — have died from COVID-19, representing more than 30 percent of all coronavirus fatalities in the United States, according to the Kaiser Family Foundation. The majority of those deaths occurred among nursing home residents.
While declining nursing home cases and new data supporting the effectiveness of vaccines in preventing coronavirus infections and complications from it are all “great signs,” Schrack says, “the virus is not gone” and “there are still so many unknowns.”
"If we really, truly are making progress, we want to stay on that path, and ending anything prematurely is just going to set us back,” she says. “Everybody wants to get back to normal. We just have to keep that in mind and just hang in there for a few more months. And we hope that that will happen.”
Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.