“Older folks don’t have the reserve to handle illnesses,” explains the president of the American Board of Internal Medicine, where he is a geriatrician. “They really are fragile, and their clinical status can change very quickly.”
As the country begins to deal with the novel coronavirus and COVID-19, some of the hardest hit are those in nursing homes and assisted living facilities.
Consider the case of the Life Care Center in Kirkland, Washington. At least 31 residents have tested positive for COVID-19 and at least 18 people have died. By comparison, in an average month only about 7 residents would be expected to die.
COVID-19 has all the elements necessary to become a serious contagion. It seems to be easy to catch and only vigorous hand-washing and social distancing seems to be effective at preventing it. Once someone has the virus, they may become seriously ill. On the other hand, however, they may only get a mild infection, which they may not even realize is COVID-19. That may keep some people from self-quarantining once they’re sick and further spread the virus.
Due to the situation at the Life Care Center and other facilities in Washington, Governor Jay Inslee announced recently that children will be banned from nursing homes temporarily and that adults must remain in a resident room to avoid spreading the virus.
If you have a loved one in a nursing home, consider giving them a phone call instead of heading over for a visit.
Are nursing home visits being curtailed?
The American Health Care Association, the National Center for Assisted Living and the Centers for Medicare & Medicaid Services have all now issued guidance for nursing homes on how to limit residents’ exposure to COVID-19. The guidance suggests actively screening visitors and restricting visits by any who meet one of these criteria:
- Has symptoms of a respiratory infection, such as sore throat, cough, shortness of breath or fever
- Has been in contact with someone within the last 14 days who had a confirmed diagnosis of COVID-19
- Traveled within the last 14 days to a country with sustained community transmission
- Resides in a community where community-based spread of COVID-19 is occurring
If you meet one of those criteria, you should avoid visiting a nursing home or assisted living facility except in very limited circumstances, such as for end-of-life visits or because the visitation is necessary for the patient’s emotional wellbeing.
Regardless of whether you meet those criteria, the facility may ask you to wear personal protective equipment, such as a gown or mask, which can help prevent transmission from you to the residents. They may also set up “clean rooms” near the entrance to the facility that are easily sterilized.
Overall, the Centers for Medicare & Medicaid Services’ guidance is for nursing homes to discourage visitation in most circumstances. When visitation is allowed, facilities are encouraged to limit visitation to certain areas, such as the patient’s room, and limit contact with other residents. Visits by people who meet the above criteria should be restricted with no exceptions.
Practice appropriate hand hygiene and social distancing during your visit. For example, consider refraining from hugging your loved one during the outbreak. Stand six feet away.
Finally, if you get any symptoms of a respiratory infection within 14 days of visiting the facility, report it to the facility so they can get the appropriate testing done.