Loving touches are again in reach
State care homes to open to visits
Doors slammed shut in March by the coronavirus pandemic begin to reopen Wednesday, allowing family and friends to embrace loved ones living in nursing homes or other long-term care places — as long as all follow new rules.
That’s welcome news to people such as Debbie Williams, who visits her 80-yearold father through a front window at StoneBridge Senior Living in Russellville.
On a recent sunny day, as birds chirped in the background, Williams dragged a metal chair closer to the outside wall.
Inching forward, she smiled warmly and placed the fingertips of her right hand to the pane in front of her.
“I love you,” she said. On the other side of the glass was her father, Alan Ford, wearing a blue plaid shirt, with a full head of white hair and wire-
rimmed glasses. At 1:30 p.m. every day for the past nearly four months, facility employees have wheeled Ford to the window — always the fourth one to the right — to visit with Williams until nap time beckons.
Ford smiled, reached his fingertips to meet his daughter’s and said, “I love you,” which elicited a laugh and an “I love you most” from Williams.
“He knows who I am this time,” Williams said, adding that her father was a pastor at First Presbyterian Church in Newport for 36 years. “When he gets tired from the visit, he will tell me, ‘I’ll have to get back to the people now.’ I can move away from the window, even for a second, and he’ll think I’m my mom or someone from church.”
Ford was diagnosed with Alzheimer’s eight years ago and was placed in the assisted-living facility at the beginning of 2018.
PANDEMIC STRIKES
In mid-March, the coronavirus pandemic arrived in Arkansas and the state shut down. Schools, stores, restaurants closed their doors. People quarantined at home. Most people weren’t allowed to be with their loved ones in hospitals or other care facilities.
Visits to nursing homes, assisted-living facilities and other long-term care facilities came to an abrupt halt, leaving residents confused and families distraught. As the coronavirus raged through some care facilities, residents died without family members by their sides and funerals were indefinitely postponed.
“The last time I was able to see him was Saturday, March 14,” Williams said. “This day I was completely caught off guard and just beside myself. I had arrived to visit him when I got the news.”
Gov. Asa Hutchinson announced June 17 that residential care facilities will reopen to visitors starting July 1, which is Wednesday.
“I do not have any family members in an assisted-living facility, but it was the letters I received from family members who were so concerned about the mental health of their loved one in a nursing home that motivated the decision,” Hutchinson said.
Visitation, other than to provide services, to facilities was blocked to reduce exposure to the virus by a vulnerable population. Of 259 deaths as of Saturday, 71% were at least 65 years old and 95 were in nursing homes.
Opening the long-term care facilities to visitors while trying to stave off a pandemic takes guidelines, strict requirements and monitoring, according to the Arkansas Department of Health.
The first step was to test every resident and staff member at such facilities. That testing must be completed before allowing visitors, according to the Health Department.
As of Friday morning, 33,700 residents and staff members had been tested, resulting in 217 positives for the virus, according to Health Department spokesman Gavin Lesnick.
“There are still some tests pending, and some retesting that will happen, so those numbers will change,” Lesnick said.
The step was recommended by the federal Centers for Medicare and Medicaid Services before the state relaxed any restrictions.
According to guidelines by the Health Department, the visits must be scheduled in advance and are limited to two visitors for each resident during select hours.
Facility staff members must screen every visitor, vendor and employee and collect a questionnaire with contact information and a declaration page regarding symptoms, exposure to the virus and any previous testing.
Visitors must wear masks at all times and residents will wear masks if they are able. Social distancing of 6 feet must be maintained and visitation areas will be wiped down between visits.
Visitors must sanitize hands with an alcohol-based solution or by washing with soap and water.
The rules also will allow facilities to resume communal dining and reopen beauty salons.
The facility staff is responsible for monitoring guests and ensuring that masks are used and visitation policies are followed.
The Health Department is encouraging outdoor family visitation when possible.
“Visitation is recognized as an important part of a resident’s health and well-being. We also know how important it is for families to see and spend time with their loved ones, and we understand how difficult it has been with nursing homes and other care facilities closed to visitors in recent months,” Lesnick said. “Through statewide testing at these facilities and our new guidelines that set strict safety rules including pre-visit screenings and use of face coverings, we believe we can safely restore this important in-person interaction.”
Williams said the new protocol will be difficult for the residents, like her dad, to understand.
“When this first began, I would cry often because he would try to push the door open to let me in and he wouldn’t and still doesn’t understand. I went from seeing him every day for two years to nothing,” she said. “I have thoughts that run through my head wondering what he is thinking.”
The covid-19 testing requirement concerns her.
“I worry about him not understanding the testing procedure and him being scared they will hurt him,” Williams said. “Dementia patients just do not understand.”
Samantha Johnston of Ozark hasn’t been in the same room with her aunt, Debbie Johnston, 66, since mid-December. Debbie Johnston, who has cerebral palsy, is a resident at Pocahontas Nursing Home and Rehabilitation.
Their visits have been through the glass of a window at the front of the nursing home.
“I will never cry in front of her because it makes it harder on her so once I got back to the car I had to sit for a minute and cry,” Samantha Johnston said, referring to a Mother’s Day visit through the glass. “I am an only child so I’m extremely close to my aunt. It’s hard already only seeing her once a month but now it’s harder emotionally not even getting to physically touch her.”
Samantha Johnston said she’s excited about the in-person visitations beginning again.
“But I’m extremely nervous,” Samantha Johnston said. “I don’t want anything happening to my aunt or her friends. With exposure to the outside, it could cause a huge incline in cases and, as it has been stated before, older people — especially those that are already immune compromised — it’s harder or deadlier on them and that terrifies me.”
DYING ALONE
Those who die at the facilities — whether it’s from covid-19 or other causes — are often alone, without family by their sides, because of the virus restrictions.
The last time that Karen Hicks of Little Rock saw her mother, Dorothy King, alive was on March 10 at the Good Shepherd Community assisted-living facility.
“After that, things started happening pretty rapidly,” Hicks said. “I just had this sinking intuition that I wasn’t going to see her again.”
King had severe dementia, Hicks said.
“I know she didn’t know what was going on,” she said.
Her mother’s health declined — the cause was something other than covid-19 — and she was taken to Baptist Health Medical Center in Little Rock on March 17.
On March 30, Hicks got a call saying her mother was not doing well.
“They called me back 15 minutes later and said she had passed away,” Hicks said. “She did not die of covid-19, but she was an ancillary victim of covid-19.”
King was buried April 4 in the Arkansas State Veterans Cemetery, but the facility was closed to the public and the family couldn’t attend.
“Four months later, and we still don’t feel comfortable having a funeral,” Hicks said. “Social distancing in a funeral home is almost impossible. I feel for these other people that have covid patients in the hospital. It’s just horrible. I’m not the only one whose family member had to die alone. And there’s going to be more. My mother is in a better place. It’s just hard on the family. They are the ones that are grieving. The loved ones who passed are not suffering any more.”
Some facilities, however, allowed loved ones to be with the residents as they passed, as long as safety protocols were followed.
John Goff and his wife, Amanda, moved his father, James Goff, to Heartland Rehabilitation and Care Center in Benton in March, right before the pandemic closed all nursing homes to visitors.
“Because of where his room was located, we were not even permitted to go to his window to see him because his window was near the smoking area and had patients in that area,” Amanda Goff said. “We could not Facetime because he had difficulty with technology. He had a flip phone and refused to accept a new one.”
On June 19, the day before John and Amanda’s wedding, they got the call that James’ vitals were declining and they needed to go to the center. He had diabetes, chronic obstructive pulmonary disease and end-stage kidney disease.
The nursing home allowed them to be by his side as he passed, but with masks on and only after taking their temperature and asking health screening questions.
“We ended up canceling the wedding, but we did meet with our officiant and a witness on Saturday and got married,” John Goff said. “We felt we needed to do so to honor Dad since we had told him that we were getting married that day. He was very happy that we were getting married.”
NOT YET AT PHASE 3
Arkansas has not yet advanced to Phase 3 of the pandemic reopening guidelines. The White House and federal Centers for Medicare and Medicaid Services say nursing homes and other longterm care facilities should not reopen until a state enters its third phase.
“If there are cases that develop, then we will deal with those nursing home by nursing home,” Hutchinson said, when asked what would happen if coronavirus cases increase in the facilities after opening up visitation.
The Health Department provided a chart to the Arkansas Democrat-Gazette that outlines the scenario if virus cases begin to rise in the individual facilities.
If only one or two residents test positive, visitation for that resident will be restricted and the resident will be quarantined. As the number of positive tests or exposure rises, the testing and restrictions adjust accordingly.
When more than one person tests positive, all residents and staff members at the facility will be retested. Visitation will be suspended for at least 28 days and cannot be reinstated without a release letter from the Health Department.
“The guidelines we have released that facilities must follow are designed to make the visitation process as safe as possible,” Lesnick said. “In addition to the requirements a facility must meet before expanding visitation and the strict rules for how a visit can proceed, the guidelines also establish important steps for limiting the spread of the virus if new cases are reported. This includes levels of retesting and potential suspension of visitation for a set period.”
Amanda Goff said the thought of nursing homes and other long-term facilities opening back up to visitors is “terrifying.”
“We fear for the residents at nursing homes,” she said. “Covid has not gone away. It makes no sense to us to open up to visits now when there are more cases now than when they closed the nursing homes when there were only a few cases.”
Hicks said she wants Hutchinson and health officials to rethink the reopening.
“There’s going to be a spike,” she said. “I can see why you need to have someone in there with loved ones, but in a community-based setting like that, it’s already proven to be rampant.”