By Thomas Goldsmith
Like others around the globe who are battling the COVID-19 virus, residents and staffs of North Carolina’s long-term care centers are dealing with the threat of disease amid a shifting landscape of risks, guidelines, fears and hopes.
However, the mostly older long-term care residents are more susceptible than the general population to contracting the novel coronavirus — and more likely to die from it if they do.
Data from the Chinese outbreak show that the rate of death from coronavirus increases sharply with age, with those patients over 80 years having an almost 14 percent mortality rate.
For those reasons, long-term care visitors in North Carolina, some wearing facemasks, will be limited in number, quizzed on their own health and backgrounds, and, in some cases, discouraged from coming in. That disruption in routine could frighten a resident with dementia who doesn’t understand what’s taking place and why.
What would happen in a NC nursing home in the event of an outbreak of COVID-19? Is there the capacity to manage?
Bill Lamb, a long-time advocate for older people, and others, are keeping an eye on the situation of tens of thousands of North Carolinians in nursing homes, which are federally regulated and more medically intensive. They’re also monitoring what happens in adult care homes, also known as assisted living facilities, which are mostly regulated by state government.
“It’s a huge concern in the sense that you’ve got a lot of people in a congregate setting that are at risk,” Lamb said during a telephone interview. “It’s even more so with adult care homes. They are not health care facilities; they are not as tuned in to medical issues as a nursing home.”
Issues confronting residential care homes in the time of the novel coronavirus include illness and absenteeism in already overloaded staffs, shortages of essential supplies such as facemasks, heightened concern over the transmission of disease among staff and residents, and the possibility that visitors could introduce the virus. Residents with existing illnesses are more likely to contract the virus or other diseases, as well as less likely to have an immune system strong enough to resist it.
“You’re talking somebody with a respiratory illness in long-term care,” Lamb said. “People don’t go into these facilities when they are healthy.”
The federal Centers for Medicare and Medicaid Services (CMS), which regulates nursing homes, has been tightening rules for visitors by asking nursing homes to:
- Ask or require visitors to wear personal protective equipment or PPE, such as facemasks, while in the center.
- Turn away visitors if the protective gear isn’t available, asking that they return another time.
- Ask visitors to hold back on close contact with the person they are visiting, or others, in the center.
- Set up separate visiting areas or clean rooms near an entrance so that visitors and residents can get together in a place that will be disinfected after their meeting.
- Ensure that hand sanitizers and other disinfectants are available to visitors.
Adam Sholar, president of the North Carolina Health Facilities Association, a nursing home trade group, said visitors will expect these levels of precaution given an international environment of concern and trepidation.
“Those procedures are being put in place because nursing facilities want to do everything possible to keep the virus out,” Sholar said in an interview at the General Assembly.
CMS also wants facilities to interview visitors, potentially denying entry to those who have:
- Fever, a sore throat or cough, shortness of breath, or other symptoms indicating a respiratory infection;
- Recent contact, within two weeks, with someone who has COVID-19, is being monitored for its presence, or has a similar illness;
- Travel within two weeks to a country that is known to have experienced community transmission or transmission of the disease without a known link to a carrier;
- Lived in an area where community-based transmission is happening;
- Traveled within the past two weeks on a cruise ship or have spent time where large groups of people are confined together.
Jeff Horton, executive director of the North Carolina Senior Living Association, noted that assisted living centers have during the past 10 or 15 years become destinations for residents with more extensive health-care needs.
“In the ‘90s, you could go into an adult care home and see folks walking around, barely dependent,” Horton said. “And what’s happened over the years is our population has gotten older. This is a different population than it was 20 years ago.”
What should someone expect if they go to visit a nursing home in North Carolina during the time of social distancing to prevent the spread of coronavirus?
Today’s assisted living residents would at one time have been more routinely been found suitable for nursing homes. That means that the stricter regulations for nursing homes might be needed in today’s assisted living as well.
Horton’s group, representing assisted living centers, has asked the state Division of Health Service Regulation to match the more stringent federal or CMS guidelines on visitors and other factors affecting disease transmission. On Thursday afternoon, Horton said he was still waiting for a response.
“If I could get the state to adopt the requirements that CMS issued for [nursing homes] this past Monday, that would help because it puts more restrictions on who can enter a facility and that type of thing,” Horton said at the General Assembly.
Visitors play key roles in the lives of long-term care residents, providing companionship and solace as well as making sure that staff members are following basic and specific tenets of care for a vulnerable older person or individual with a disability. Depressing the number of visitors should be avoided, Lamb said.
Administrators ask that visitors weigh their valuable functions against the possibility of introducing infection into the facility, while suggesting that alternative means such as Skype be made available to potential in-person visitors.
“First and foremost we’re going to ask them to think about, is it most important to visit your loved one just now?” Sholar said.