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Iowans In Nursing Homes Are Socially Isolated As Coronavirus-Related Visitor Restrictions Continue

Courtesy of Angela Doyle
As Iowa nursing homes remain locked down indefinitely to protect residents from COVID-19, some are finding new ways for residents to see their families. Here, Mary Anne watches her family wave from a distance at the Friendship Haven retirement community in Fort Dodge in earlier this month.

Every day, Myron Green stands outside the closed window of his mother’s nursing home in Johnston to check on her. But he’s only been able to actually talk with his 95-year-old mom once on the phone since the nursing home shut down in March.

“When we come up to the window, and we’re trying to kind of communicate the best we can to see if she can read our lips or something, she puts her hands up on her head, and she’s frustrated,” Green said. “And I know she misses her family and would like to talk to us, but it’s just not arranged that way.”

Before the pandemic hit, Green visited his mom every other day for a few hours, and brought home-cooked meals.

But it’s been more than six months since many Iowans living in nursing homes have been able to spend time with their spouse, children or grandchildren in person. And it’s been more than six months since they’ve been able to hold hands with a loved one. As nursing homes are staying locked down indefinitely to try to protect residents from COVID-19, social isolation is a growing concern.

While many long-term care facilities at least offer video chats with iPads, and some have outdoor socially-distanced visits, Green said the Bishop Drumm Retirement Center hasn’t provided those options.

So he delivers a letter to his mom each day, recounting happy stories from her life.

“It’s like I told my mom, it’s kind of the only way the two of us can love each other,” Green said. “I said, ‘You don’t get to write me or say anything to me. But at least you get to read my letters and relive all the good times that we’ve had all these years.’”

Green is concerned about the decline he’s seen in his mom’s care, and he’s asked for virtual visits with her. He said the nursing home hasn’t been responsive.

“It’s been a struggle to find out what’s going on, what’s happening to your loved ones, to make sure that they’ve got clean clothes on,” he said.

He said one day when he was at his mother’s window, a nurse held up a note that said, “Give me your cell phone number.”

“Well later on, that nurse called me,” Green said. “She said, ‘I don’t know if you know, but your mom’s got COVID-19.’ I said I hadn’t been told that yet. It was a couple of days later we were told that.”

Green’s mother survived. But the nurse told him several residents in that wing of the building died of COVID-19. The Bishop Drumm Retirement Center is now experiencing a second coronavirus outbreak.

It’s one of 41 long-term care facilities in Iowa with a current outbreak as of Tuesday. That number has gone up and down over time, and has been increasing recently. And 671 nursing home residents have died as of Tuesday morning, according to the state, making up more than half of the state’s total COVID-19 deaths.

“We have two simultaneous crises going on right now,” said Brad Anderson, the state director of AARP Iowa. “Number one is we have Iowans dying at an unacceptable rate in nursing homes. But secondly, we have residents and family members that are greatly suffering from social isolation. So we’re not going to be able to address that second issue of social isolation until we address the first issue of stopping the virus.”

Iowa’s rules for nursing homes

The Iowa Department of Public Health has phased reopening guidance for nursing homes that was first released in the beginning of June, and was last updated in early September. At the strictest level, the only visits allowed inside the facility are for end of life or psychosocial needs.

Even in those cases, it’s up to the nursing home leaders to make those decisions.

“I’ve had constituents call me and tell me they can’t get in for compassionate care visits,” said State Sen. Claire Celsi, who had her own struggle with trying to get into her father’s nursing home before he passed away.

Celsi said the state should be more forceful in directing nursing home leaders to allow end-of-life visits.

“If you’re careful, if you put protocols in place, there’s no reason you can’t let people spend a few more days with loved ones when they die,” Celsi said.

Under the state’s guidance, nursing homes can relax visitor restrictions based on how long it’s been since a staff member or resident tested positive, a downward trend in the county’s coronavirus infections, and the facility’s staffing and PPE levels.

Anderson said everyone wants nursing home residents to be able to have in-person visitors.

“However, because of the wave of outbreaks that have happened and the increase in the number of deaths that continue to happen today, we have not gotten to a place at all where we can have in-person visitation at nursing homes and assisted living facilities,” Anderson said. “And so then the question becomes, well how do we get there?”

Anderson said the state should mandate and support widespread testing in care facilities, help ensure access to adequate PPE and staffing, and require all nursing homes to provide virtual visitation. He wants the state to form a task force to work on these issues with the goal of safe in-person visits.

The federal government recently mandated routine staff testing, but nursing home leaders say they need more resources to sustain it. And the state says its public health lab doesn’t have the capacity to help, except when residents or staff are showing symptoms or had a known exposure to the virus.

The state has not been requiring or facilitating surveillance testing in nursing homes, according to Gov. Kim Reynolds’ office, even as the White House Coronavirus Task Force repeatedly recommended that for Iowa.

The IDPH guidance says long-term care facilities should provide virtual visits, but it’s not required.

Hari Sharma, an assistant professor with the University of Iowa’s health management and policy department, agrees nursing homes need more resources from state and federal governments to support testing, PPE, and even virtual visitation.

“We have evidence on the negative impact of social isolation and loneliness,” Sharma said. “And anything that facilities could do to help residents with this is going to be very helpful.”

He said that can include virtual visits, outdoor visits, and allowing more interaction among nursing home residents when there aren’t any coronavirus cases in the facility.

But Sharma said visitor policies can only be safely relaxed when the surrounding community has a low rate of coronavirus infections.

“And that’s going to be under control only when we have either a vaccine, or we are adequately doing the things that we should be doing, in terms of wearing a mask and maintaining distance,” Sharma said. “Those are some things we can do now.”

According to a recent White House Coronavirus Task Force report, Iowa had the third highest rate of new coronavirus infections in the country.

Iowans see decline in nursing home residents’ condition as restrictions continue

Still, some Iowans believe nursing home visitor restrictions can and should be safely relaxed.

“We’re doing the best we can,” said Julie Thorson, president and CEO of the Friendship Haven retirement community in Fort Dodge. “And we try to create spontaneous things for them to do, and we’ve been trying to do creative things. But bottom line, a lot of them want their loved ones. We have couples that the husband or wife came every single day. And they were with them here at Friendship Haven all day long. And now seven months in, they haven’t been able to hug or hold hands.”

Thorson said nursing homes should be provided more testing and PPE to support safe visits.

“We have seen steady declines in our residents physically, emotionally, cognitively,” “And I’m reminded on a daily basis by our caregivers; they’re really the ones that see it firsthand. There’s confusion. Residents have actually told caregivers and nurses they think they’re being punished.”

Courtesy of Angela Doyle
Angela Doyle's family waves to their mom from a distance to celebrate her 83rd birthday. Doyle's mother, Mary Anne, is at a nursing home in Fort Dodge and can only have very limited outdoor visits with family due to precautions to limit the spread of COVID-19.

Thorson’s facility hasn’t had a coronavirus outbreak, and they’ve been offering virtual and outdoor socially-distanced visits for family members.

Angela Doyle has been using those options to see her mother Mary Anne, who is a resident at Friendship Haven and has been diagnosed with Alzheimer’s.

“We have seen a huge decline in my mom,” Doyle said. “And while I understand that some requirements need to be in place, I also think that there must be a way that we can get these nursing homes opened up. I mean, to be blunt, my mom is a prisoner. And she has no rights. And we have no rights on her behalf.”

She said Friendship Haven has been responsive to her concerns about her mother’s care. But it’s not the same as having a family member eat dinner with her every day, giving cues to help Mary Anne feed herself, and to turn on the music she enjoys like they did before the pandemic.

Doyle holds out hope that a vaccine will be developed soon, and she’ll get more visits with her mom.

“She’s declined in front of our very eyes and the time will come where there won’t be much else that we can do,” Doyle said. “She’s got to have contact with her family.”