Nursing homes become solitary confinement
Nearly every day, Michelle Dettlaff sits outside the glass door of an Altamonte Springs assisted living facility to see her 81-year-old mother, who sits on the other side.
Sometimes Dettlaff will reach out and press her hand against the glass. It’s as close as the mother and daughter are permitted to be.
“It sucks,” said Dettlaff, 52, whose mother suffers from dementia, “because I want to be there with her.”
Since March 15, when state officials banned nearly all visitors from entering long-term care facilities to slow the spread of the coronavirus pandemic, thousands of Florida families have struggled to monitor the well-being of their loved ones and let them know they’re not forgotten.
“I’m worried that I won’t even know if there’s a problem,” said Cecilia Meeks of Winter Park, who used to visit her 88-year-old mother at a local nursing home several times a week. “I worry she’s over-medicated. When I try to call her, she just sounds drugged.”
Officials on Tuesday reported 72 cases of COVID-19, the highly contagious disease
caused by the virus, among the state’s long-term care facilities. The total included two cases in Orange County and a cluster of 20 patients and one employee at Atria Willow Wood, an assisted living center in Fort Lauderdale, where six residents have died of the illness.
The Florida State Emergency Operations Center has announced it won’t identify the other institutions that have positive cases — only the counties in which they’re located — claiming that doing so is banned by privacy laws. Elder-care advocates contend it’s not.
“They’re not exposing personal health information about any of the residents individually,” said Brian Lee, executive director of the national nursing home watchdog agency Families for Better Care and a former Florida ombudsman for long-term care facilities.
“They’re talking about an outbreak in a home,” he added. “And I would remind them that if they just do a quick Google search — looking at the [state Agency for Health Care Administration] website or Nursing Home Compare [run by Medicare administrators] — it’s chock-full of inspection information for nursing homes and assisted living facilities that is public.”
On Monday, AARP Florida sent a letter to AHCA Secretary Mary Mayhew asking her to cite any federal guidance the state is using to withhold the names of the facilities, saying families are “desperate” to know.
Given the number of Florida facilities — 691 nursing homes and 3,080 assisted living centers — the total of reported cases remains relatively low, but Lee and others say testing has been extremely limited so far, and all agree the stakes are high. The elderly, and particularly those with chronic health problems and living in close quarters, are most at risk of becoming infected and dying from the disease.
To prevent an escalation, the state Agency for Health Care Administration, which oversees the industry, initially called for all long-term care facilities to require the universal use of face masks as well as gloves for all workers doing direct patient care. It turned out, the facilities didn’t have them.
“The unfortunate reality is that these centers are experiencing supply shortages at a crisis level,” Emmett Reed, executive director of the Florida Health Care Association, the statewide alliance for the nursing home industry, said on March 18. “Long-term care providers are already taking extraordinary actions to conserve masks, gloves and gowns wherever and however possible. Despite these significant and meaningful efforts, there is great concern that many nursing homes and assisted living facilities are already at the point of exhausting their supplies.”
A day later, Florida officials announced they would not penalize facilities unable to follow the directive because of supply shortages. But supplies aren’t the only problem.
To allow for the required 6-foot separation in longterm care facilities, administrators have been ordered to cancel congregate meals and the daily group activities intended to keep patients from growing depressed. Since March 15, staffs have had to deliver meals to residents individually, and they’re scrambling to find ways of engaging the residents without taking them out of their rooms.
“Our facilities have been trying to be creative,” said
Kristen Knapp, communications director for the Florida Health Care Association. “We’ve got places where the residents move no farther than their doorways and they’re playing bingo with everyone [nearby]. Or the staff is playing music and line dancing down the hallway. And, of course, they’re helping the residents use Skype and Zoom and FaceTime when they can.”
But that creates extra demands on staffers at a time when they also have extra cleaning duties and have to have their own temperatures checked daily to be permitted to work.
“On the staffing side, this will be costly for us,” said Jim Jennings, chief operating officer of Strive Senior Living, an assisted living and memory-care facility. “It’s definitely something like I’ve never seen in my lifetime. It’s very stressful for us, and it’s especially stressful for the families.”
By law, the state’s longterm care facilities can only hire workers who have been fingerprinted and passed a state and national background screening — a process that has slowed with the closure of some major screening companies during the pandemic. So bringing more workers on board quickly is unlikely.
Lee, of the national watchdog group, said longterm care facilities as a whole are handling the challenge “as admirably as they can.”
His nonprofit launched a fundraising campaign 10 days ago to donate Amazon Echo Show devices to lowincome nursing home residents to connect with their loved ones. The devices sit on the patients’ nightstands to allow video chats.
“We’ll have 800 of those devices right off the bat,” Lee said. “But there are 1.5 million people who live in nursing homes around the country. And we don’t know how long this lockdown could go on.”
And for elderly patients and residents who suffer confusion and dementia, teaching them to use the devices can be a bridge too far.
Dettlaff, for instance, at first tried talking with her mother through video conferencing. The staff at Bridgeport Senior Living in Altamonte Springs, where her mother is a resident, accommodated her by setting up a laptop computer in front of the older woman.
“But it wasn’t the same,” Dettlaff said. “She has a lot of mannerisms in person that you miss on video.”
Instead she began “visiting” from the other side of the glass door. She calls the staff beforehand so her mother can be positioned to see her.
Other families have taken to “dining” with their loved ones by setting up a picnic outside their windows, then connecting by phone. Some yell toward balcony rooms from parking lots.
In Winter Park, Linda Warren has been communicating with her father, Bill, from behind a glass first-floor window for nearly two weeks now. The World War II veteran, who lives in Westminster Winter Park, a continuing care community, will turn 99 in August.
“I can’t physically touch him,” Warren, 64, said. “And I miss that.”
In the beginning, he would try to wave her to come inside, but he no longer does.
“Sometimes I can see that he cries, but other times he seems to accept that this is happening,” she said. “I have days where I sob. I just worry about him.”