IssuesKeeping the Elderly in Nursing Homes Amid Coronavirus Concerns May Bring Other Health Risks

Guidelines have been issued to protect residents of assisted care facilities from coronavirus concerns, but the restrictions bring other challenges as well. 
April 7, 2020
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Last month, Governor Abbott directed the Texas Department of Health and Human Services to issue guidelines to protect approximately 94,000 residents of assisted care/nursing facilities in Texas. These restrictions are meant to protect some of the most vulnerable Texans who may succumb to COVID-19, but they bring other challenges as well. 

According to the Centers for Disease Control, patients over 65 account for 8 out of 10 deaths from coronavirus reported in the United States, and anywhere from 31 to 70 percent of adults 85 years old and older who are confirmed to have COVID-19 require hospitalization.

Restrictions include limiting entrance to only medically necessary personnel, screening staff and medical professionals for fever or symptoms, requiring staff to wear face masks, and suspending group gatherings within the facility.

With residents’ exposure to the outside very limited, the transmission is most likely coming from caregivers and staff, some of whom work at multiple facilities.

A nursing home in Texas City reported 83 cases of COVID-19 last week and in San Antonio, 67 out of 84 residents of one nursing facility had tested positive for the virus. Two residents have died. 

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“We need to move nursing homes up the priority list for testing, at least for caregivers,” advocates Brian Lee, director of Families for Better Care, a non-profit eldercare advocacy group in Austin. 

“Folks need to contact Governor Abbott to get tests in the hands of nursing homes to test workers,” he added.

While endeavoring to protect nursing home residents from contracting COVID-19, the isolation may be contributing to other health problems.

Texas nursing homes are ranked the lowest of all 50 states on Families for Better Care report card, which takes factors like staff ratios, staff training and supervision, and infection control deficiencies into account.  

“I’m very afraid of what’s happening behind closed doors,” Lee pointed out.

Visitation by families has been prohibited for the protection of the residents, however, family members often provide accountability for their loved ones’ care and advocacy on their behalf.  

The state has also ended visits by licensing regulators, investigators, and ombudsman advocates who are often on the front lines to make sure regulations are followed and residents are protected.

Additionally, the loneliness and isolation will impact residents negatively, Lee said. Many of the residents have cognitive impairments, he added and will have a hard time understanding why their families are no longer visiting.  

“Some studies suggest that the impact of isolation and loneliness on health and mortality are of the same order of magnitude as such risk factors as high blood pressure, obesity, and smoking,” wrote Dr. Clifford Singer in an article published in the Journal of Aging Life Care.  

During this difficult time when nursing homes are closed to visitors, Lee encourages families to stay in contact with the nursing home administration.  

“Have a point person for direct communication with the nursing home. Nursing homes are obligated to communicate with the legal representative for the resident,” Lee advised.  

He also encouraged families to try to communicate with residents as much as possible. Families for Better Care has started a campaign to provide Amazon Echo Show devices to residents so families can check in on their loved ones regularly. 

Nursing homes are encouraged to provide means of communication such as FaceTime, Skype, or other video or audio systems so that residents can stay in contact with family and friends.

“We understand how difficult these new restrictions will be for residents and their families and loved ones,” David Kostroun, HHS deputy executive commissioner for Regulatory Services said in a press release. 

When asked if families should move their loved ones home during the pandemic, Lee hesitated to give blanket advice. 

“It depends on the situation. Not all families can take care of them at home. I would certainly ponder the possibility.”

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Kim Roberts

Kim Roberts

Kim Roberts is a reporter for the Texan in the DFW metroplex area where she has lived for over twenty years. She has a Juris Doctor from Baylor University Law School and a Bachelor's in government from Angelo State University. In her free time, Kim home schools her daughter and coaches high school extemporaneous speaking and apologetics. She has been happily married to her husband for 23 years, has three wonderful children, and two dogs.