By Lauren J. Mapp, San Diego Union-Tribune, October 4 2020
Family caregivers visiting loved ones in skilled nursing facilities offer much more than companionship. The time they spend together also ensures that their relative’s needs are being met.
Yet for more than six months, California skilled nursing homes have had strict lockdown rules against indoor visitors in hopes of preventing residents from contracting COVID-19. Since March, family members have only been allowed to see their loved ones in nursing homes for compassionate care or end-of-life visits, with some nursing homes orchestrating visits outdoors, through windows or by using video chat applications like Zoom and FaceTime.
Not having this extra supportive care from family members has been detrimental for some nursing home residents, said Robyn Grant, director of public policy and advocacy for the nonprofit National Consumer Voice for Quality Long-Term Care organization.
“Without the support of their family members, many residents have experienced or are at increased risk of physical, emotional, and mental decline,” Grant said via email. “We’ve heard from many family members that this isolation has had a terrible impact on their loved ones — from serious weight loss and dehydration (that has required hospitalization) to memory loss and emotional decline.
“We’ve heard that in some cases dementia has grown more severe, with increased confusion and agitation,” Grant said.
On Sept. 17, the Centers for Medicare & Medicaid Services sent a letter to nursing centers stating that “facilities should accommodate and support indoor visitation, including visits for reasons beyond compassionate care situations.” Per this letter, nursing homes must have no new COVID-19 cases for two weeks, and the length of visitations and total number of visitors in the facility at any given time should reflect the size of the building and space.
This week, the California Department of Public Health listed 62 nursing homes of San Diego County’s 86 total facilities that can resume indoor visits.
But caregivers throughout the county are still waiting to find out when they can once again see their parents, partners, children, friends and other relatives.
These months-long separations can be challenging for any family, but for Shannon Svensen and her 81-year-old mother, Modena Svensen, the time apart has been particularly difficult. The two women lived together in Chula Vista until Modena fell and broke her hip in late August.
After a partial hip replacement, Modena was transferred to Carmel Mountain Rehabilitation & Healthcare Center to recover. Once there, Shannon said her mother tested positive for COVID-19 and experienced a cardiovascular event on Sept. 4, the symptoms of which Modena told her daughter about the next day.
“She called me and said that she had a band of pain across her chest, difficulty breathing, low blood pressure and just nauseous, dizzy, queasy — all the classic heart attack signs,” Shannon said.
Shannon alleges that she called the facility to find out what was going on with her mom, who previously had heart issues, but ended up calling 911 to have her brought to the hospital. Medical bills reviewed by The San Diego Union-Tribune confirm that Modena was transported via ambulance on Sept. 5 and 6.
Carmel Mountain Rehabiliation has had 26 residents and 18 healthcare workers test positive for the novel coronavirus as of Sept. 30, according to the state database. Administrator Matt Rutter declined to comment on Svensen’s allegations via email, citing HIPAA and California confidentiality of medical information laws.
Shannon, who is a middle school teacher, said that not being able to be with or comfort her mother in recent months has been painful.
“It has been emotionally and physically draining because it’s like another full-time job,” Shannon said. “It’s like two full-time jobs trying to be her advocate and get her the medical care that she needs. Plus not being able to see her in person and be reassured in person — we know this from school that the digital just doesn’t cut it emotionally.”
Having family members in facilities helping with their loved ones’ care has been a positive contribution to the nursing care industry, which has long been plagued by staffing shortages, according to Michael Connors, a senior health advocate for the California Advocates for Nursing Home Reform.
“Being with those we care about us is a fundamental human need,” Connors said, via email. “Visitors give much needed companionship, comfort, emotional support and love to people who live in nursing homes.”
Grant, with National Consumer Voice for Quality Long-Term Care, said family members who visit their loved ones regularly can often track minor signs of a decline in health and advocate for better care.
“Prior to the pandemic, many family members aided their loved ones in nursing homes with eating and drinking, as well as personal care tasks,” Grant said via email. “There were some family members who visited every day and helped with daily tasks — ensuring their their loved ones were clean, dressed and had what they needed to get through the day, like their hearing aids and glasses.”
Of the nursing homes on the state’s list of facilities that can resume indoor visitations, some are currently working on plans to do so safely in the near future.
This includes Poway Healthcare Center, which is developing an operational policy and procedures to expand visitation, Administrator Thomas Daynes said via email.
“In the meantime, we will continue to assist family members wanting to connect with their loved ones by scheduling window and virtual visits,” Daynes wrote. “We know doing so is important to our residents as well as those who care for them. We will make every possible accommodation, but not waver from our commitment to keep everyone in our facility safe.”
Meanwhile other facilities on the list are not yet taking steps toward resuming indoor visits.
Salma Moore, chief executive officer of Arroyo Vista Nursing Center in City Heights, said that the facility, which has had zero COVID cases so far according to the state data, has not moved forward with a broad-based return to indoor visits.
She said that the center has continued to accommodate window visits and outdoor visits in a covered space set aside for that purpose. There does not seem to be, Moore added, much demand for bringing visitors back into residents’ rooms.
“So far, nobody has requested indoor visits,” Moore said.
Although there are clear benefits of family members visiting residents’ home environments, Moore said she believes it is important not to forget the risks.
“There is still a lot of risk involved with our fragile patients,” Moore said. “We are doing our best to create a balance that keeps them safe and happy.”
Use this map to see how many COVID-19 cases and deaths are attributed to each skilled nursing facility in San Diego County as of Sept. 30, 2020. Green dots represent facilities with no reported cases of COVID-19, orange dots are facilities with at least 1 case but less than 11 cases in every category, and red dots are facilities with 11 or more cases in at least one category. (Lauren J. Mapp / The San Diego Union-Tribune)
Sources: California Department of Public Health database, Reo Vista Healthcare
San Diego County reported Wednesday there have been 1,103 cases among skilled nursing residents, and 717 cases among healthcare workers, up from 1,037 and 671, respectively, on Sept. 23. No new deaths were reported among nursing home residents or staff for the second week in a row, so the total remains at 168.
Three new outbreaks in skilled nursing homes were reported by the county this week, bringing the total up to 83, but there are only 21 active outbreaks this week compared with the 22 reported the week before.
The only facilities in the county that haven’t recorded a single case among either residents or healthcare workers are Amaya Springs Health Care Center, Arroyo Vista Nursing Center, Monte Vista Lodge, Somerset Subacute and Care, and Valle Vista Convalescent Hospital.
Those looking for information about a specific skilled nursing facility can visit the online version of this story at https://bit.ly/3cRgu8K to search the full dataset.
The San Diego Union-Tribune is interested in speaking to family caregivers enduring the months-long separations from their loved ones living in senior nursing facilities. If you’d like to share your story, please email firstname.lastname@example.org.
Paul Sisson, Gary Warth, Lindsay Winkley and Jonathan Wosen contributed to this report.