Families can resume nursing home visits in some states

Before the COVID-19 lockdown, care for untold thousands of nursing home residents across the country came as much from family members as from the aides on the floor. From Maine to Hawaii, relatives would drop in to feed residents of chronically short-staffed nursing homes, brush their teeth, check for bedsores, get them moving and keep them company.

Barred since March, many families have worried that no one has sufficiently taken up the slack.

Now, after tens of thousands of residents died as COVID-19 swept through one nursing home after another, more than a dozen states are cautiously setting rules for the return of a limited number of family visitors. They range from New Jersey, where officials believe the peak of the pandemic has passed, to New Hampshire, which has seen very few cases all spring, to Oklahoma, where, even as cases are spiking, criteria have been drawn up to allow family access.

Nursing homes vary considerably in their capacity to control infection. The pandemic is still raging, and some states — including New York, Pennsylvania, Ohio and Florida — have not budged.

June Cox had gone to see her mother, Dorothy Cox, three times a day at her nursing home in San Diego. “I tried to take care of her physically, emotionally, musically, spiritually, every way I could think of,” she said.

After March 13, she called as often as she could on FaceTime. “‘I’ll be there as soon as I can be, as soon as I’m allowed, Mama,’” she told her mother. “She’s not a prisoner. She hasn’t committed a crime. She’s not supposed to be living in solitary confinement.”

Dorothy began declining shortly after the lockdown began and died alone April 7, after a seizure. “My mother would still be alive, I’m pretty sure,” said June, if she had been able to keep looking after her.

On March 11, Leonard Beatty, of Ashland, Mo., seemed as robust as he had been in months. His appetite was back. His wife, Myrna, and daughter, Cindy Harper, had made plans to bring him home from The Bluffs nursing home in nearby Columbia by early April.

“Then COVID hit. The door slammed. What do you do?” Harper said.

They visited with

him through a window on March 31, his 84th birthday. He still seemed strong, but when they sang “Happy Birthday” he started sobbing.

The next time they saw him was a week later. “We were shocked,” Harper said. “He was just a shell of himself. We didn’t know what was going on.”

No one from the nursing home had told them he was failing.

Two days after that, a staff member called them and said he should be put in hospice care. He had bronchitis, they were told. He was not tested for COVID. Instead, with considerable difficulty, they arranged to bring him home, where he died 29 hours later.

Myrna Beatty believes that by being there, she had enabled him to survive a bout of pneumonia last October. She and Harper think their absence this spring was fatal to him, that he’d still be alive if they’d been able to bring him home on April 1 as they had planned.

“I have to accept,” Harper said. “This is the way it went down. We have to tell ourselves we did our best. It was out of our hands, that we weren’t there to help him. And that hurts. COVID ? It did us in. We’ll feel forever guilty.”

“He may not have died from COVID-19. But he definitely died because of it.”

The tension with renewed visits is between safety and compassion, said Susan Frampton, president of an advocacy group called Planetree International. Staff and residents alike shouldn’t be needlessly exposed to the virus. But neither should someone be cut off from all family contact. Frampton points out that family members can spot troubling signs in residents more quickly than staff members.

“Isolation has serious impacts on the health and wellbeing of the residents of these facilities,” said Daniel Rusyniak, the chief medical officer of Indiana’s Family and Social Services Administration.

Elaine Ryan, vice president of state advocacy and government affairs for AARP, said she is concerned that the states are moving too fast and too haphazardly.

“No state has the infection and death count under control in nursing homes and assisted living,” she said. “Nursing homes are struggling with just the basics. We have a long way to go to have the assurances that these kinds of visits can be done safely.”