At Evergreen Community of Johnson County, everything has changed.
Visitors and volunteers are no longer allowed at the Olathe nursing home. Vendors are met at the front door and staff sterilize packages before they’re brought inside. Residents sit six feet apart at meal times, or eat in their rooms. Group activities are canceled and social workers now go room-to-room instead.
It’s all an effort to keep out the new coronavirus and the disease it causes, COVID-19, which is particularly lethal to seniors.
“We’re taking every precaution necessary to keep the residents safe,” Evergreen Community CEO Chris Osborn said. “I know that’s tough on family members and loved ones who want to come and visit, but the best thing we can do now is limit access to try to limit the transmission of coronavirus.”
In the general population, most cases of COVID-19 are relatively mild. But so far, 8 out of 10 COVID-19 deaths reported in the U.S. have been in adults 65 years old and older.
Peter Hotez, an infectious disease expert from the Baylor College of Medicine told Congress earlier this month that COVID-19 is like an “angel of death” for the elderly. The first death from the virus in Kansas was a man in his 70s who lived in an assisted living facility in Wyandotte County and a nursing home in the Seattle area that suffered at least 35 deaths due to COVID-19 has emerged as a cautionary tale.
With that grim backdrop, the Centers for Disease Control and Prevention (CDC), has instructed all nursing homes in the U.S. to take extreme precautions.
“We’ve just got to keep it out of our homes,” said Linda Mowbray, the president of the Kansas Health Care Association, a nursing home advocacy group. “So, we really are asking folks to comply with the no-visit (policy), and that also applies to our supply companies too. If you’re not essential, don’t come in.”
Nursing home supply shortages
Extra protective equipment like masks have been scarce lately, and so have more everyday supplies, Osborn said.
“The supply chain has been interrupted and supplies are hard to come by,” Osborn said. “It doesn’t help that people have gone out to all the stores and bought up everything from toilet paper to hand sanitizer to disinfectant wipes. Those are all supplies that we need in health care and the general public is going out and hoarding them.”
Osborn said his facility would gladly take donations of those items at the door, and disinfect them just like regular deliveries.
The supply chain for protective gear like masks relied heavily on China, where manufacturing was disrupted in recent months, Mowbray said.
The federal government has a national stockpile, she said, but her organization was told that if nursing homes have to dip into that, the supply will only last a few days. Her organization and others have been working with federal regulators for guidance on when nursing home staffers can wear the same mask to care for multiple residents out of necessity — which would raise the risk of spreading infection.
Nursing home residents: ‘We feel isolated’
There’s been little guidance given about what precautions should be taken at lower-level care facilities, like assisted living and senior apartments. Out of an abundance of caution (and because many of them are also connected to nursing homes), many have adopted the same strict restrictions as skilled nursing facilities.
As a result, people like Susan Schrepel — who are used to having more freedom — are also sequestered.
Schrepel, 84, lives at Pioneer Ridge Independent Living in Lawrence. She said the facility banned most outside visitors about two weeks ago. Then it also stopped communal dining and activities for residents.
“You do feel very isolated,” Schrepel said by phone. “Before these latest restrictions came down, we did not. We were isolated from the outside world, but those of us that lived here, we could do things together. They had activities for us to do. You did not feel so isolated.”
What you can do to help elder communities
- Call, email, video chat or send letters
- Donate surgical masks, gowns and hand sanitizer of 70% alcohol or more
- Ask a nursing home activities director whether there are any residents who would like a phone call or virtual visit
- Check in on elderly neighbors to see if they need groceries or medications (but try to stay at least six feet away from them)
She’s now basically confined to her apartment, aside from occasional trips to the Pioneer Ridge fitness center, which are staggered to ensure there aren’t too many residents there at once. But Schrepel said the administration has done a good job of communicating with residents about the changes and she feels safer because of them.
Mitzi McFatrich, the executive director of Kansas Advocates for Better Care, said she understands why the CDC’s recommendations are in place.
But McFatrich, whose group represents nursing home residents and their families, said some family members provide needed care for their loved ones during nursing home visits — helping them eat, get back and forth to the bathroom and get their laundry done.
Those visits are largely on hold now, and inspections have also been limited by order of the federal government. With fewer outside eyes on the inner workings of the facilities, McFatrich is worried.
“We know that facilities are short-staffed, and with the COVID(-19) virus, they’re likely to be more short-staffed,” she said. “I have real concerns about what that’s going to mean in terms of the wellbeing and the quality of life for residents, and some concerns about how long this might go on.”
“Everything else that could negatively impact a resident — falls, loss of continence, loss of mobility — all of the other things that we worry about — antipsychotic drug use — surveyors have been told basically don’t focus on that, focus on the infection control. And while I understand we’re in a crisis, I don’t know that that is the most appropriate way for inspections to occur when you’re talking about the level of vulnerability people have.”
Nursing homes trying to maintain contact
Nursing homes and families are getting creative: Some families are calling their loved ones and then talking to them while looking through windows. Others are turning to Skype and FaceTime. Some nursing homes are asking local school children to make cards and letters to mail to nursing home residents.
Debra Zehr, the president of LeadingAge Kansas, an advocacy group for nonprofit nursing homes, said some have been assigning each resident an “emotional support” staffer who comes by to visit them every day and just talk, in addition to their normal duties.
“That’s the one thing I’ve seen with this disaster that’s going on is that good,” Zehr said. “People are trying to band together to do good things.”
But with all the attention on nursing home residents, Zehr said communities shouldn’t forget about the much larger number of seniors who live on their own, people who are also at great risk if they’re exposed to coronavirus and don’t have paid staff looking after them and providing food and medicine.
“It’s important for communities to also think about those individuals and try to maintain contact with them as well.”