Long-term care facility restrictions lifted - North Carolina Health News
Phil Wells and his siblings visited his 93-year-old mother every weekend.
Described as a “social butterfly” by her son, Rosalee Wells was a homemaker who raised five children. She lives in a Wake County nursing home and had a vibrant social life before the pandemic.
“We took her out for lunch. We took her shopping. We took her to dinner. We took her to Sunday school and church,” Wells said. “Her friends and neighbors took her out for outings. And that was part of her life.”
Then the COVID-19 pandemic hit.
“Well, suddenly, my sister took her back to the facility one day, and they said, ‘You can’t go back into her room with her.’ And when my mother walked back in the door that day, thus began the COVID lockdown.”
Family members had been able to visit with Rosalee outdoors on a screened-in porch or talk with her on the phone.
But Rosalee, who has dementia, didn’t understand why her family couldn’t hug her or why they were wearing masks.
“The main thing I want to do is to hug my mother’s neck again. That’s what I want,” Wells said early last week. On Friday, he got his wish.
Earlier this month the state rescinded a health order that restricted visits to residents in long-term care facilities like nursing homes after new federal guidance indicated in-person visits in nursing homes and other care settings could resume.
“Facilities should allow responsible indoor visitation at all times and for all residents,” the Centers for Medicare & Medicaid Services said a little more than a week ago, regardless of vaccination status of the visitor or resident.
In North Carolina, some nursing home residents started getting vaccinated in December. More than 80% of residents have had their first dose of one of the COVID-19 vaccines, said Jennifer MacFarquhar, an epidemiologist with the N.C. Department of Health and Human Services.
Coronavirus cases and outbreaks have also dropped in the past couple of months.
“One of the other positives that we’ve seen is the length of time that an outbreak is ongoing in facilities, that length of time has also been decreasing,” MacFarquhar said. Early in the pandemic, some outbreaks lasted longer than six weeks.
Though visits are now allowed, MacFarquhar said she recommends people continue to wear masks, wash their hands and stay physically distant.
“There is a caveat in there that if, particularly if both parties are vaccinated, if they choose to have that close physical contact, they can do so,” MacFarquhar said, as long as both parties wear well-fitting face masks.
A person is fully vaccinated two weeks after receiving the second dose of either the Pfizer or Moderna vaccine or two weeks after receiving the single-dose Johnson & Johnson vaccine, MacFarquhar said.
A different way of living
For Phil Wells, plans that would otherwise be mundane have new meaning.
“This Friday, I’m taking her to the dentist. It will be the first time,” he paused for several moments before continuing, “in over a year that I’ve gotten to do that. That I’ve been able to take her out and be with her.”
Throughout the past year, they celebrated milestones at a distance, such as a car parade on Mother’s Day, which coincided with Rosalee Wells’ 93rd birthday.
He hopes her 94th birthday this May can be celebrated differently.
In the past year, they’ve had phone conversations and attempted using video technology, but a window visit did not go well.
“Early on, we went and sat outside her window. She could not understand why we wouldn’t come in. She’d say, ‘Why aren’t you coming in to see me?’” he said. “For people with dementia, there’s this whole added element of confusion and uncertainty and difficulty.”
After the first couple of times trying a window visit, they stopped, he said.
“That was worse than not seeing her at all,” Wells said. “You’d see all of these pictures in the newspaper of these cutesy window visits. Well, they weren’t so cute to us, because they confused my mother even more.”
The past year has been “catastrophic” for people in long-term care, who have mostly been socially isolated, said Lauren Zingraff, executive director for the nonprofit Friends of Residents in Long-Term Care.
“In many cases, they have essentially been in their rooms by themselves. The only contact they’ve had has been with staff members who have been wearing PPE and masks to bring them meal trays three times a day,” Zingraff said, referring to personal protective equipment.
A few months into the pandemic, Zingraff said, people started noticing changes in their loved ones, such as increases in depression or anxiety. Some residents stopped eating and drinking.
“They would verbally share, ‘Why am I even alive?’” Zingraff said.
While the new guidance is giving hope to family members weary of the separation, there are some limitations.
Facilities should limit visitation if the county’s positivity rate is higher than 10% and fewer than 70% of residents are fully vaccinated, if any residents have a confirmed COVID-19 infection, or if the resident is in quarantine, according to federal guidance from the Centers of Medicare and Medicaid Services and the Centers for Disease Control and Prevention.
Before trying to visit a loved one, people need to call the facility first, said Adam Sholar, president and CEO of the N.C Health Care Facilities Association, which represents nearly 400 skilled nursing centers.
As community spread of the virus escalated and then peaked two or three months ago, Sholar said, “those restrictions were important to try to minimize the impact that community spread had on that nursing facility.”
Though cases are on the decline, nursing homes and other facilities are still fighting the coronavirus.
“We are still in the midst of this pandemic,” Sholar said. “This is still an extremely deadly virus. There is still not an insignificant amount of COVID circulating in the community. The direction is still to adhere to the core principles of infection control, which include masks and social distancing… This is not a return to pre-COVID visitation.”
While it wasn’t exactly like their pre-pandemic visits, Wells’ visit with his mother exceeded his expectations.
Despite concerns about awkward or hesitant moments, “it was wonderful,” Wells said. “Absolutely wonderful. We had a great time. It’s hard to imagine that a trip to the dentist could be so much fun.
“I was on the phone with my sister telling her about it. What was most striking was the sense of normalcy. I dropped her off at the facility a year ago and picked her up today, and we started right where we left off.”