Loneliness vs. safety: The dilemma of nursing homes during coronavirus lockdowns

Rosalyn Kane spends her days reading book after book in her apartment at The Palace at Coral Gables, an independent living facility. She hasn't had a face-to-face conversation with her daughters in two months, nor has she eaten a meal with her friends. She worries about getting the new coronavirus, but she wants a social life again.

"It's been hard," Kane said. "It's been two months but it seems a lot longer to us."

Over the weekend, Florida Gov. Ron DeSantis issued an executive order that extends the ban on visitors to long-term care facilities in the state for another 60 days and prohibits group activities, including communal dining. The extension came on the heels of a continually rising death toll, 703 as of Monday, in residents and staff of Florida's long term care facilities—16 of them were at Manor Pines Convalescent Center in Wilton Manors.

But administrators of the long-term care facilities are pushing back—claiming the isolation is taking too great a toll.

"Our residents are breaking down and crying," said Margaret Friend-Conti, administrator of Pelican Garden Assisted Living in Sebastian and Dixie Oak Manor in Vero Beach. "I wish the governor would visit so he could see what we see. It affects our staff so much because you see the decline in our residents."

Friend-Conti has sent a letter to DeSantis and launched a campaign to encourage other facility operators to write him, too. Following her lead, some are not only writing but calling. They want the Agency for Health Care Administration, which licenses and regulates long-term care centers, to allow group activities again, and even ease up on visitations.

"These residents have been isolated in their rooms for two months now. The depression is heart-wrenching. If we could at least have communal dining and activities, the fact that they cannot see family or friends might be a little easier to swallow," Friend-Conti wrote to DeSantis. "I believe if you took a poll, most ALFs (assisted-living facilities) would feel the same."

The Agency for Health Care Administration banned all visitors to long-term care centers early in the pandemic, before the state became aware of any hospitalizations or infections in the facilities. It also told operators to discourage residents from leaving and stop communal dining and group activities. In most centers, residents now spend almost their entire days in their rooms alone, with staff coming to bring them meals or take their temperatures. Caregivers in many of the centers have helped residents use FaceTime and Skype to communicate with their family members who have not been allowed face-to-face visits.

Pascal Bergeron, the operator of Northlake Retirement Home in Hollywood, said residents of assisted living facilities, who are more independent than those in nursing homes, are threatening to leave if they have to be isolated for another 60 days.

"They are saying they know we are doing all we can to make things better for them, but they can't live in this type of environment due to their mental health," Bergeron said.

Melissa Bongart, owner of The Ranch Assisted Living Facility in Bradenton, said she called the governor's office asking him to reconsider the continued restrictions.

"Our community has been isolated and we have not had residents leaving or coming back or getting visitors; why do they need to be isolated from each other?" she said. "They have already been in quarantine for two months."

When asked about the 60 additional days of no visitors and no group activities and whether there would be an easing of restrictions, Mary Mayhew, secretary for Florida's Agency for Health Care Administration, offered this email response:

"The Agency understands it has been incredibly difficult for residents who have had limited communication with their loved ones during this emergency. We have launched efforts to provide nursing homes access to ... funds to expand virtual visits and communication for residents. By providing tablets to facilities that can be used to allow residents to safely connect with their family and friends, we hope to strengthen and increase communication to reduce social isolation."

Amy Van Kleeck, executive director of Twin Creeks Assisted Living in Riverview, said she has emailed the governor asking him to create a task force to study the re-opening of long-term care facilities as he did other businesses.

"Why is our only option to lock our doors?" Van Kleeck said. "Why not stock us up on PPE and allow residents for the sake of their mental health to see other people very cautiously?"

Some facilities are allowing visits with families through windows, or through screened porches sitting more than 6 feet apart. Van Kleeck said such visits have been her facility's way of preventing more residents from requiring a transfer from independent living to memory care. She already has had to transfer a handful.

During recent news briefings, DeSantis has emphasized his efforts to ramp up testing for long-term care facilities, even as the state has withheld the names and numbers of cases in each facility.

Along with AHCA's order to extend the visitation ban, over the weekend, the agency also issued an executive order demanding that when the Florida Department of Health arrives to test staff and residents for COVID-19, everyone must submit to testing—regardless of whether staff wants to be tested—or the facility could face fines or have its license revoked.

The concern has been that caregivers without symptoms can transmit the highly infectious COVID-19 virus to vulnerable elderly residents without realizing it. Last week, DeSantis announced a mobile unit that would travel to long-term care facilities to test residents and staff and provide results in 45 minutes.

ALF administrators say family members could be cautious if welcomed back into facilities.

"No one wants to see the numbers creep up. But if we can do it the right way, requiring visitors to wear masks and keep a 6-foot distance that could work," Bergeron said. "We need to resume some normalcy."

©2020 Sun Sentinel (Fort Lauderdale, Fla.)
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