Grandma’s digs may not look the same once nursing homes and assisted-living places get the all-clear to welcome visitors.
Plexiglass dividers on dining tables, electrostatic sprayers in public areas and air purifiers in ventilation systems are among the changes some long-term care facilities are introducing in preparation for receiving guests for the first time since New York State barred visitors on March 13.
“The focus now is absolutely on visitation and making that happen,” said Stephen Hanse, head of the New York State Health Facilities Association and New York State Center for Assisted Living, which represents 450 of more than 1,150 nursing and adult-care facilities throughout the state.
“We’ve all had to adapt to Skype and Zoom, but nothing beats in-person visits,” he added. “It’s time.”
The preparations come as Gov. Andrew Cuomo and the state Department of Health mull options for lifting visitation bans, as they did last week for hospitals and group homes for developmentally disabled adults.
“As Gov. Cuomo has said, the Department of Health is studying this issue and working on guidance to resume visitation in nursing homes and adult care facilities, which will be announced soon,” said Jill Montag, a DOH spokesperson.
When asked about a timeline for lifting the ban at a briefing earlier this month, Cuomo replied, “The closedown is a pain in the neck, but my continued answer is, it’s better than death.”
‘My Mom is Locked Away’
Meanwhile, the lockdown can’t end fast enough for family members distraught over being separated from ailing loved ones for months.
“It’s killing me that my mom is locked away and it’s just gone on way too long,” said Lisa Vasquez, whose mother Esther Cohen, 82, has been at the Bensonhurst Center for Rehabilitation & Healthcare in Brooklyn for three years.
Deirdre Garrett-Scott, director of the New York City area’s state long term care ombudsman program, a federally funded consumer advocacy group for nursing home residents, said she has lost trust in the state DOH’s handling of the COVID crisis. Hundreds have died at facilities that were given clean bills of health for controlling the spread of infection.
She recognized the need for in-person visitation, but urged the state to proceed with caution.
“If nursing homes are still short-staffed, I don’t care how much they’re spending on fancy new technology for disinfection, residents are going to suffer,” she said. “They need to hire more staff and they need more mental health services. That should be the priority.”
Prepping for Summer Visits
While long-term care officials await the state’s decision, they say they are implementing disinfection and social-distancing protocols to mitigate the spread of the coronavirus among a highly vulnerable population. They’re also reviewing a host of technological options to make their communities safer.
Hanse noted Cuomo’s June 10 extension of the executive order mandating COVID-19 testing of nursing home staff and residents expires on July 9.
“Once we get past July 9, I suspect in-person visits would follow within a week or two,” he said. “Visitation in the five boroughs needs to — and will — happen this summer.”
“We can’t have a one-size-fits-all approach, so different facilities are looking at different options,” he added, noting upgrades that include plexiglass barriers, additional hand-washing stations and new air-filtration systems.
“But it all comes down to adequate staffing, adequate PPE [personal protective equipment] and sufficient testing.”
Maryellen McKeon, senior vice president of operations for Ultimate Care Assisted Living Management, which operates senior living communities across the tri-state area, wrote in a recent email to residents and representatives, “We are all optimistic that regulations will start to ease.”
Among the changes at Ultimate Care facilities, McKeon pointed out, would be the installation of “electrostatic sprayers” and “iWave-R ionization units” in all communities.
“As the air flows past the iWave-R, positive and negative ions actively purify the supply air, killing mold, bacteria and viruses in the coil and living space,” she wrote.
Nu-Calgon, the manufacturer of the iWave-R, said in a press release, however, “It is important to note that we make no medical claims.”
David V. Pomeranz, chief operating officer for RiverSpring Health, a nonprofit senior healthcare organization that includes the Hebrew Home at Riverdale in The Bronx, said his organization was focusing on proven methods of slowing the spread, such as “blitzing through buildings with deep-cleaning.”
“Right now, there’s a lot of stuff out there, but not all of it is tried and true or proven to be reliable,” he said. “One article might say UV [ultraviolet] lighting is the way to go, another says something else. Being that we’re not scientists, we’re doing what we know works. Unfortunately, this virus is going to be with us for a long time, and I don’t believe the science has caught up.”
Pomeranz said his organization is watching the “Disneys of the world” to see how they are screening customers. RiverSpring is looking into “booth thermometers,” for instance, which take temperatures faster and don’t require staff.
“Realistically, I think outdoor, controlled visiting may be on the horizon,” he said, “but real visiting is not.”
Mounting Death Toll
As of June 18, a total of 6,387 residents have died of Covid-19 in 450 long-term care facilities throughout New York state, accounting for 21% of all COVID-19 fatalities in the state, according to Kaiser Family Foundation.
In New York City, 3,268 COVID-19 deaths have occurred in nursing homes and adult-care facilities as of June 15. Nationwide, nursing homes account for more than a quarter of all COVID-19 deaths, according to an Associated Press analysis.
The federal Centers for Medicaid and Medicare Services (CMS) notes on its website that “because nursing home residents are especially vulnerable,” it does not recommend opening facilities to visitors “except for compassionate care situations” until they have met a series of benchmarks.
Those include having no new cases for 28 days; adequate staff, personal protective equipment and disinfection supplies; access to sufficient COVID-19 testing; and available beds in referral hospitals.
‘Dying of Broken Hearts’
Pandemic health concerns for nursing home residents, though, go beyond COVID-19.
“I don’t say this lightly, but residents are literally dying of broken hearts, a failure to thrive due to loneliness and isolation,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a Manhattan-based residents’ advocacy group.
“A nursing home is not a MASH unit in a war zone, it’s peoples’ home,” Mollot told THE CITY. “It’s completely outrageous that the federal and state governments have allowed the industry to operate for months on end with limited oversight while essentially cutting off residents from family. It’s unacceptable and inhumane.”
The coalition recently issued a “blueprint for restoring residents’ rights to visitation and care” that called for each resident to have at least one designated in-person visitor to provide on-site emotional support.
Additional recommendations boil down to five S’s: schedule and structure visits to allow for social distancing, supply masks and other personal protection equipment, screen guests and residents for fever and other COVID-19 symptoms, and sanitize surfaces.
“These are common-sense suggestions that are long overdue,” Mollot said.
Mollot stressed that the long-term care industry has sufficient funds to make the safety upgrades, given recent injections of federal aid.
The Department of Health and Human Services (HHS) announced last month that skilled nursing facilities were eligible for $50,000 each in stimulus funds, plus an additional $2,500 per bed, as part of the CARES act. In addition, the coronavirus relief legislation created a 20% premium, or add-on, for COVID-19 Medicare patients.
Some care facilities are already figuring out socially distanced visits. In The Bronx, The Hebrew Home introduced drive-in visits earlier this month.
Families and friends enter the main gate in their own vehicle, answer a series of questions and have their temperatures taken. They then proceed to a circular driveway and up to an enclosed vestibule, where a staffer and COVID-free resident await.
Each car is given a sanitized wireless speaker to enable them to converse with the resident, who has the other speaker. A visit lasts for 10 minutes, with five-minute breaks in between to allow for disinfection of the speakers.
“There have been such joyous reunions,” said Wendy Steinberg, a Hebrew Home spokesperson.
Among the happier visits, she recalled, was one in which resident Zelda Fassler “met” her great-grandson Henry for the first time.
“What is critical to note here is that this was all done with the approval of the Department of Health,” Steinberg added. “No one gets out of the car and nothing may be dropped off or picked up.”
‘A Prisoner in Half a Room’
For family members of residents, like Lisa Vasquez, the three months of lockdown have been filled with anxiety and stress.
“My mother’s got dementia, and so she’s regressed and gained weight,” said Vasquez, 53. “She’s basically been a prisoner in half a room for months.”
The Bensonhurst home has logged nine confirmed and 27 presumed COVID-19 deaths as of June 18, according to Department of Health records. Vasquez said the home was chronically short-staffed, but faced additional pandemic strains due to staff illnesses and departures.
The facility did not return calls for comment.
“My mom called me in tears at one point because she needed to be changed and needed fresh linens and she kept ringing for help but nobody was answering the calls,” said Vasquez.
“Back when we were allowed to go in to visit, I did her laundry and we were able to get her things we could see that she needed. Now we don’t know what’s going on inside.”