Long-term care sites have high vaccination rates, low COVID caseloads
By JULIE MINDA
On March 11, Meygan Martin received the long-awaited news that residents of the Ascension Living Sherbrooke Village assisted living facility in St. Louis could receive visitors. After 372 days of separation from her beloved grandmother, she wrote in a Facebook post, "I thank God every day for keeping her safe and could not be more grateful for this news. Less than 48 hours! She's going to kick me out for crying a river of happy tears in her room."
Donald Kirsch, administrator of Good Shepherd Nursing Home in Wheeling, West Virginia, checks on residents in their rooms in February. Amid falling COVID caseloads, the Catholic long-term care site recently eased many of its lockdown protocols. Kirsch, who has led the nursing home for nearly 40 years, describes the coronavirus pandemic as the greatest challenge of his career.
Amr Alfiky/The New York Times/Redux
COVID-19 rates had fallen to a level that would allow the resumption of indoor visits in long-term care and assisted living facilities, while following infection prevention protocols.
While Martin had been told she'd have to wait two days to visit, her grandmother, Eula Goff, insisted she come the following day. Martin says the March 12 reunion was a joyful occasion for the two.
Their long physical separation had been very difficult. Martin had grown up two doors down from Goff, and as an adult, she'd made it a point to visit her grandmother every couple of weeks. "Reunited and it feels sooooo good!!!," Martin wrote in a Facebook update. "Got to spend the afternoon chatting and laughing with my BFF. Couldn't have been a better day! The biggest blessing of 2021 thus far."
Alverno resident Mary Wendel wins a NASCAR-inspired "Race to the Finish." The Alverno is a Trinity Health Senior Communities-sponsored skilled nursing facility in Clinton, Iowa.
The family is among the many nationwide benefitting from resumed visitation at long-term care sites that had been closed to visitors as a precaution against the introduction or spread of COVID.
Meygan Martin, left, and her grandmother, Eula Goff, in a photo taken before the pandemic.
Setting the rules
And new guidance issued by the Centers for Medicare and Medicaid Services on March 10 holds the promise of even greater openness in the near future. CMS says nursing homes should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor. (At the time of her visit with her granddaughter, Goff was fully vaccinated and Martin had received the first of two shots.)
CMS says it is recommending easing visitation restrictions because vaccination rates are high in eldercare facilities and COVID-19 caseloads are decreasing sharply. The next steps are for state and local public health agencies to develop regulations based on CMS' guidance and for long-term care facilities to adjust their own policies and protocols to those regulations.
Shelley Bhola, a regional nurse specialist/infection prevention specialist for Duluth, Minnesota-based Benedictine, says she thinks that once the new policies take effect, "residents and their visitors will be able to hug and touch each other as long as they are wearing a well-fitted mask and have performed hand hygiene before and after." She anticipates eldercare facilities will continue using health screening questions with visitors and follow infection prevention protocols.
The new guidance is a big step on the hard road back to post-pandemic normality. Daniel Stricker, president of St. Louis-based Ascension Living, said, "We envision a day when we can celebrate Mass as a community in our chapels. We look forward to a day when our team members and residents can see each other smile and our residents can fully enjoy the many amenities and services we offer."
The new CMS guidance comes about a year after that agency issued a memorandum recommending that in order to prevent viral spread of COVID-19 among the frailest elderly, long-term care facilities should immediately restrict all visitors and nonessential staff from entering their buildings. Compassionate exceptions could be made for visits at the end of life.
Source: The American Health Care Association/National Center for Assisted Living
Nevertheless, COVID continued to ravage nursing homes and assisted living facilities, causing extraordinarily high fatality rates. The sudden ban on visitors and the social distancing and isolation required to control infection and safeguard residents put a heavy emotional burden on patients, their families and staff.
In May, the agency offered the prospect of a slight easing of restrictions on visitation tied to caseloads in the community and in an individual facility, staffing levels and the availability of COVID testing at the facility. In September, CMS encouraged eldercare sites to facilitate outdoor visitation and allow for tightly controlled visitation indoors.
The March 10 guidance says that "responsible" visitation at long-term care facilities can take place in resident rooms, in spaces set aside by the facility for visits and outdoors. The facilities should continue infection control measures, including physical distancing.
Visitation should be restricted among unvaccinated people if COVID cases rise above 10% in the county where the facility is located, according to CMS. Visitation also should be halted for residents who are COVID-positive or in quarantine following exposure.
The relaxed visitation guidelines follow a March 8 easing of social distancing guidelines for vaccinated adults by the Centers for Disease Control and Prevention. That agency said fully vaccinated people now can visit with other fully vaccinated people without wearing a mask and without social distancing and can visit unvaccinated people from one household with no mask and without distancing, provided the unvaccinated individuals are at low risk of serious COVID complications.
A sampling of ministry eldercare facility leaders reported in early March vaccination rates among residents were around or above 90%. At that time, vaccination uptake lagged among staff, with those rates falling between 50% and 70%.
Stacey Johnson is vice president of quality for Trinity Health Senior Communities, which has 33 eldercare facilities. Johnson says with widespread vaccination of residents accomplished, "there is a big sense of relief, joy and gratitude" among staff, residents and family members. People have been mentally preparing for seeing grandchildren and for celebrating when the time is right for large gatherings.
David Becker is vice president for post-acute care for Covenant Health of Tewksbury, Massachusetts, which has 12 long-term care facilities. He says many staff members view widespread inoculation "as a turning point, a first step toward a new normal."
"People are just anticipating the change when we can open up again, and happy days are here again," adds Jeri Reinhardt. She is vice president, clinical services and performance excellence for Benedictine, which has 32 eldercare sites.
Becker says throughout the pandemic Covenant facilities have been working hard to give residents safe opportunities to socialize. Over the past few months, the facilities' units have been treated as bubbles, with each bubble taking turns having socially distanced dining and activities in common spaces.
Limited visitation has been allowed. Residents and their families have been "respectful but impatient" about an easing of visitation restrictions as widespread vaccination is achieved both among residents and among their family members. The facilities are awaiting state updates to regulations before they lift restrictions.
Reinhardt notes that at Benedictine residents' deep longing for in-person contact with their loved ones and staff's desire to diminish the suffering caused by loneliness and isolation is balanced by caution. She says some staff feel "like momma bears. Because we've held our residents so close and worked so hard for a year now, while we want to relax, we still want to ensure our elders are safe."
She says with the promised easing of visitation prohibitions and the onset of warmer weather, there is a sense of rebirth and gratitude. "I think this will be an Easter like no other. We think of the resurrection of Christ, and our hope is so poignant."