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By Lauren J Mapp , The San Diego Union-Tribune, May 09 2021

Jen Potter grasps her mother Rita Bumbera’s hand as they meet at St. Paul’s Senior Services Nursing and Rehabilitation center on Friday, April 30. 
(Sam Hodgson / The San Diego Union-Tribune)

Long-time sweethearts Raymond E. and Valerie Hanks spent their Cinco de Mayo sitting side-by-side Wednesday outside of the adjoining senior living facilities in Bankers Hill they call home.

In normal years, it wouldn’t be strange for the married couple of 55 years to spend an afternoon in the shared courtyard of St. Paul’s Nursing and Rehabilitation Center and St. Paul’s Manor.

But after a year kept largely apart due to the COVID-19 pandemic, the afternoon felt special.

When Valerie, 76, first moved into St. Paul’s Nursing four years ago because of her worsening dementia and multiple sclerosis, it was difficult for Raymond, 82, as he adjusted to her absence. He soon moved into the adjoining Manor — an independent living facility — to be closer to her, and they would visit about six times a day either in his apartment, the courtyard or at the nursing home.

Folklorico dancer Paula Alemán performs for residents at a Cinco de Mayo celebration at St. Paul’s.
(Sam Hodgson / The San Diego Union-Tribune)

But when the COVID-19 pandemic hit, long-term care nursing facilities suspended visits to protect their vulnerable residents, and the Hanks’ visits came to a halt.

For most of the year, that meant no hugs, hand-holding or kisses on the cheek for the Hanks and the families of other residents.

“It’s been a tough year and a half, I’ll tell you,” Raymond said.

Skilled nursing facilities were some of the hardest hit areas in the county during the pandemic, with 4,464 novel coronavirus cases among residents and 3,038 staff cases reported between the beginning of the pandemic and May 6, county data shows.

As of Feb. 26, there were 5,911 living in skilled nursing facilities throughout the county, the California Department of Public Health reported.

Raymond E. Hanks and his wife Valerie Hanks hold hands as they take part in a Cinco de Mayo celebration.
(Sam Hodgson / The San Diego Union-Tribune)

But since vaccination efforts began in December, they’ve also been some of the earliest sectors of the community to see significant decreases in new cases and outbreaks.

New outbreaks in skilled nursing facilities steadily dropped each week starting in late January and have since stabilized, county data shows, as has the rate of new cases among nursing home residents and staff.

As of May 6, there were only 13 active outbreaks in skilled nursing facilities, compared to the high of 63 outbreaks in mid-January.

COVID-19 at county skilled nursing facilities

Cumulative total cases, deaths and outbreaks at all San Diego County facilities as of May 6.

With the widespread vaccination of skilled nursing residents and staff, as well as the regional decrease in cases allowing San Diego County to move to less restrictive tiers, visitations have been allowed for the majority of residents in nursing homes.

On April 11, CDPH updated its visitation guidance for skilled nursing facilities, but visitors of all vaccination statuses must still be screened for fever and other novel coronavirus symptoms, and wear appropriate personal protective equipment.

Although Valerie cannot visit Raymond in his apartment, they’re now both vaccinated and back to visiting each other at least twice a day.

While listening to a live mariachi band under strings of colorful papel picado decorations on Wednesday, Raymond was filled with joy as it was the second time he’d seen his wife that day. “I steal every moment I can get.”

“We couldn’t sit this close together six months ago, or even two months ago. We enjoy this,” he said.

For El Cajon resident Jennifer Potter, the reopening of facilities means not only being able to regularly visit her mother Rita Bumbera at St. Paul’s Nursing, she can now also bring her home to visit with the family for a few hours at a time.

Last year, 71-year-old Bumbera experienced a series of falls and worsening vascular dementia and fibromyalgia while living alone at her apartment in downtown San Diego.

Jen Potter grasps her mother Rita Bumbera’s hands as they meet at St. Paul’s Senior Services Nursing and Rehabilitation center.
(Sam Hodgson / The San Diego Union-Tribune)

On Christmas, she had a really hard fall while feeding her cat, but she didn’t want to be in the hospital during the height of the pandemic. She stayed with her daughter’s family for a few days before eventually being admitted to the hospital. Because Potter was born with a congenital heart disease that will someday lead to heart and liver transplants, she was unable to move her mother into her home, so Bumbera was released to St. Paul’s in January.

At first, Potter was unable to visit Bumbera at all, and when she eventually could, she was unable to hold her mother’s hand.

“The hardest part is that my mom cannot talk, so we would have to write things down,” Potter said. “It’s not really conversational with my mom. It’s more about me telling her what’s going on and then her reacting.”

With their family vaccinated, they’re now enjoying regular visits together at the facility, and Potter can also bring her home to visit with her daughter and husband for about four hours each weekend.

“It was obviously fantastic to physically hold her hand or give her a hug,” Potter said through tears. “Me being a sick child, she was just the one who took care of me always, so I just feel like our roles have completely reversed.”

Jen Potter takes part in a visit with her mother Rita Bumbera while Jorge Morton brushes her hair.
(Sam Hodgson / The San Diego Union-Tribune)

With skilled nursing residents and staff largely vaccinated against the lethal virus, and with California’s planned reopening date on June 15, what further changes may happen on June 15 are still up in the air, a CDPH spokesperson said in an email.

“Throughout this pandemic, CDPH’s primary goal has been focused on ensuring the health and safety of residents at skilled nursing facilities,” the spokesperson wrote. “Accordingly, we are looking into any policy updates that may be necessary and applicable at those facilities in relation to the state’s planned reopening.”

While visitations at skilled nursing facilities have once again been allowed by both the California Department of Public Health and the Centers for Medicare and Medicaid services, facilities have different policies depending on whether the residents and guests have been vaccinated.

Some facilities allow visitations by appointment for those who are not displaying COVID-19 symptoms, who have neither traveled nor been knowingly exposed to COVID-19 over the past two weeks. This includes La Fuente Post Acute in Vista, which has an online portal leading someone through a series of questions before allowing them to select days and times for potential visits.

There are also facilities that have different visitation criteria geared toward indoor versus outdoor visits. According to its website, Aviara Healthcare Center in Encinitas will allow two visitors at a time for half an hour outdoors, or one visitor a day for a half-hour visit indoors as long as the resident has not been exposed to COVID-19 or has recovered from the virus.

Other facilities, including Arbor Hills Nursing Center in La Mesa, are continuing to rely primarily on outdoor visitations to continue protecting residents.

St. Paul’s Senior Services CEO and President Cheryl Wilson said over the past few months, the fear factor of interactions between staff and residents has significantly decreased as all residents and 93 percent of staff across St. Paul’s facilities have now been vaccinated.

Vaccinated visitors are allowed to not only come into the facilities, but also to hug and hold hands with their loved ones.

“That has been just an amazing improvement in the quality of life for the people that we serve,” Wilson said. “And it’s an improvement for our staff, too, because they see the difference in our seniors, how much happier they are.”

Folklorico dancer Paula Alemán performs for residents wearing a KN95 mask at a Cinco de Mayo celebration.
(Sam Hodgson / The San Diego Union-Tribune)

Although some visits have been able to resume this year, she predicts the June 15 reopening and more widespread vaccination throughout the region will mean even unvaccinated guests will once again be allowed to see their loved ones. To keep residents safe, they will continue to require that unvaccinated visitors sanitize their hands, wear masks and submit to a COVID-19 screening upon arrival.

Come June 15, St. Paul’s may also be able to move away from the state’s color-coded system that moves residents into separate units based on whether they have left the facility and potentially interacted with someone who is infected with the virus.

In the current green, yellow and red unit system for nursing homes, facilities must have separate spaces and staff for people who are quarantined. These are used if someone may have interacted with a COVID-positive person during a hospital visit (yellow) or because they tested positive for the virus (red).

This separation is difficult for the staff, Wilson said, and it changes the care residents can receive.

“It’s very difficult for rehabilitation to provide the same level of rehabilitation to the yellow and red zones as they do to the green zone,” Wilson said.

As a registered nurse, Wilson said infection control has always been pretty tight at the St. Paul’s facilities. In the past, St. Paul’s staff who hadn’t received flu vaccinations were required to wear masks at work, which will likely continue going forward when it comes to anyone who isn’t vaccinated against COVID-19.

There are also some changes the facility has made over the past year that will continue indefinitely as extra precautions, such as using air purifiers and UV light sanitizing devices in addition to wiping down surfaces with sanitizing wipes.

Changes have also been made in local memory care facilities where older adults diagnosed with Alzheimer’s disease and other forms of dementia live.

At Stellar Care in the College Area, Executive Director Linda Cho said the facility now allows in-person visits and has expanded the activities they offer in-house. Residents can also have more dining options and can leave the facility to visit loved ones without quarantining upon their return, unless they encountered someone with COVID-19.

Resident Craciun Arlette eats lunch at St. Paul’s Senior Services Nursing and Rehabilitation center.
(Sam Hodgson / The San Diego Union-Tribune)

Looking ahead to June 15, Cho said in an email that the state’s reopening will allow more normalcy within the facility.

“Currently, we must still observe social distancing in our community, which is hard for residents,” Cho said. “Our residents desire closer contact with their friends in the building whether it be sitting closer or perhaps holding hands.

“Even though all the residents are fully vaccinated, because we are a long-term care community, our state licensing guidelines require that residents still maintain social distancing as much as possible.”

Although many California nursing homes have resumed visitations, California Advocates for Nursing Home Reform advocate Michael Connors said others still continue to restrict visitors.

With the majority of residents and staff vaccinated, Connors said restrictions on socialization and visits should already be scaled back.

“We have concerns of course that there should be more of a return to normalcy already in nursing homes for residents than is occurring,” Connors said. “Our sense is that a lot of nursing homes in California are paying little to no attention to the orders from both California and from the federal government to allow visitations in facilities.”

Loneliness caused by a lack of activities and visits can cause severe impacts on the physical and mental health of older adults, including nursing home residents.

Given the dangers of isolation, Connors said facilities should face consequences if they continue denying residents access to visitors.

“It’s outrageous that so many people living in nursing homes are still being separated from their loved ones,” he said. “Many nursing home residents remain completely isolated from their loved one because California and the federal government are not enforcing their directives to allow visitors.”