As governor eases COVID-forced restrictions at nursing facilities, many ask: Is this safe?
The recent loosening of restrictions on visitation at Florida nursing homes and assisted-living facilities hard-hit by COVID-19 invites a simple yet complicated question:
Is this safe, especially for vulnerable older residents, as the coronavirus surges locally, across Florida and nationwide?
While Gov. Ron DeSantis announced Oct. 22 that any increased risk of infection will be outweighed by positive mental health benefits of increased social interaction, concerns continue to swirl.
Brevard’s positive COVID-19 tests have numbered more than 10% of its total tests two days in a row just this week. On Wednesday, the United States surpassed 100,000 new daily cases for the first time.
Less than 2% of Florida’s population lives in nursing homes, yet those residents account for 40% of COVID-19 deaths in the Sunshine State, said Dave Bruns, spokesman for AARP Florida.
More than 6,400 residents and staff members of long-term care facilities have died from COVID-19 in Florida, he said — overwhelmingly, residents.
The virus is “absolutely deadly” in elder care facilities, Bruns said, “if it manages to find a crack in one.”
“Lifting the restrictions is not terrible if your loved one is suffering from isolation,” he said.
“But we have to be clear-eyed about the risk... we’re hearing from many family members who are criticizing the lifting of restrictions, but also from those whose family members caught the virus from staff members.”
On Nov. 4, Department of Health reports showed 51 positive cases across eight nursing homes and assisted living facilities in Brevard County. Also as of Nov. 4, 384 deaths in Brevard have been confirmed by the state since the beginning of the pandemic, and 228 of those were staff or residents of long-term care facilities such as nursing homes.
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The relaxed guidelines follow DeSantis' Sept. 1 executive order authorizing visitation to resume and providing required guidelines for nursing facilities. They allow children's visitation; outdoor visitation regardless of any COVID-19 cases in a given facility; clarify that the state is not requiring social distancing for designated caregivers; and allow facilities to set their own visitation limits.
At least 35 of the reported deaths in Brevard County were related to Rockledge Health and Rehabilitation Center: 33 residents and two staff members.
In a statement, parent company Greystone Healthcare spokeswoman Karen Marotta said that Rockledge Health and Rehabilitation Center is following the DeSantis order, "to ensure proper visitation education is being provided to all residents, staff, and visitors to enhance the psychosocial well-being of our residents."
A national COVID-19 dashboard released earlier this month by AARP shows that the death rate of Florida nursing-home residents over a recent four-week period exceeded the national average. Florida's percentage of nursing homes with active cases of COVID-19 positive residents, at 47%, is higher than the national rate, 24%. On top of that, nearly 72% of Florida nursing homes charted staff infections from COVID-19, compared to about 48% nationwide.
Isolation's devastating effects
As for the negative effects of being shut off from family and friends, there's "absolutely no doubt" COVID-19-forced isolation has caused great stress — and, though they can't be quantified, even deaths, Bruns said.
Sebastian resident Kathleen Schwab-Wardell's 87-year-old father died June 12 — not from COVID-19, but after a battle with end-stage heart failure, and months of isolation, she told FLORIDA TODAY earlier this year.
He needed the support of his family, she said, and it broke her heart.
"I was able to move him on June 10 to hospice house so I could be with him," she said. "When I got there he had had a stroke. He was blind and did not recognize me. But I was able to stay with him for the last two days of his life."
An Indialantic woman who had a recent stay at West Melbourne Health and Rehabilitation Center watches COVID-19 reports with a wary eye.
Jocelyn Schuman spent several weeks recuperating after suffering a spiral break of the femur while having a routine hip replacement. Schuman, 65, entered the facility Aug. 24, leaving Oct. 7.
Over the course of those weeks, she was tested three times, with negative results.
COVID was a constant concern, Schuman said. Though state-mandated weekly testing went into effect during her stay, "they didn't tell us what they found or didn't find," she said.
While the state Department of Health reports say that 19 residents have been diagnosed and died at the West Melbourne center, parent company NHS Management disputes that.
Since March the facility has had 52 residents test positive, with 46 recovering, five deaths and one person still in isolation, said NHS spokesman Joe Perkins. During that same time, 64 employees tested positive, and all of those employees have recovered and are back at work, he said.
Of all those with positive tests in West Melbourne, more than 50% of them were asymptomatic, Perkins said, and in a nursing home setting, that makes "defeating the spread of this virus next to impossible."
But from March 13 on, "we’ve taken the position that cost was no object, that we were going to do everything humanly possible” to deter virus entry and spread at all NHS facilities, he said. That included creating an isolated, specialized wing, with biohazard walls and staff dedicated to that area, when COVID is detected in a unit.
And now, those precautions include updating families on visitation changes.
"We’re calling all the families of each our residents to brief them on the visitation protocol so they understand, and to allow them to make appointments for visitation," Perkins said.
Even though by the Sept. 1 order Schuman's husband could have been designated as an essential caregiver and had expanded rights, the two decided that "visitation through the glass would suffice."
"But I knew I was going home within weeks," Schuman said, adding that others who were there long-term "may not have been in the best shape to be assertive as me."
'Folly to underestimate the virus'
To illustrate the impact of COVID-19 deaths in long-term care facilities, AARP's Bruns points to a dozen deaths at a Hollywood, Florida, nursing home after Hurricane Irma in September 2017 that shocked the state and the nation and led to legislative action.
"This is the equivalent of Hollywood Hills every day for more than 400 days," he said. "And this is despite the best efforts of the industry, the government and the facility staff. It is folly to underestimate the virus... we're entering the most dangerous period of the pandemic, and we've already had 40% of the deaths."
The Fort Myers News-Press reported that DeSantis, asked if he'd consider rescinding the loosened restrictions should hospitalizations and deaths begin to spike again, said:
"We are not going to revoke any of this. These facilities, if they have situations, they can obviously make decisions that's in the best interest of the residents and the families. And we support them doing that."
Contact Kennerly at 321-242-3692 or firstname.lastname@example.org. Twitter: @bybrittkennerly Facebook: /bybrittkennerly
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