'Do it now': Assisted Living and Nursing Facilities Work to Protect Residents

It may be difficult or impossible to visit a loved one in a long-term care facility in the coming weeks due to precautions taken statewide to slow the spread of COVID-19, but families and residents can ensure communication channels and plans are in place now.

"Talk to your facility about what the communications plan is with families," Patricia Hunter, Washington state long-term care ombudsperson, said.

Gov. Jay Inslee this week ordered visitor restrictions for nursing homes and assisted living facilities in Washington this week, allowing one adult visitor per resident per day, with prior screening. A person with symptoms of COVID-19 or who has had contact with a confirmed case of the disease is not allowed inside such facilities. The restrictions came amidst a growing number of cases, particularly in those connected to long-term care facilities in the Seattle area.

People over the age of 60, as well as those with underlying health conditions, are at a greater risk of getting severe illness if they are exposed to COVID-19. In Washington, the majority of deaths in people with COVID-19 have been residents of long-term care facilities, and there are COVID-19 cases linked to nearly a dozen such homes in western Washington to date.

The epicenter of the COVID-19 outbreak at the Life Care Center in Kirkland has led to 25 deaths so far, with several other residents hospitalized. Of the 37 COVID-19 deaths reported statewide, 25 are associated with Life Care Center of Kirkland. The story of residents and their family members at Life Care, while tragic, can also provide lessons for other facilities.

Hunter said it is important to not stigmatize facilities like Life Care as the place where COVID-19 originates. While the King County Health Department has not finished its investigation of how the virus got into the facility, Hunter believes it is likely that an infected person came into the center. With that in mind, stringent visitation guidelines are on the horizon at most facilities -- if not already in place.

The Centers for Disease Control and Prevention recommendations for nursing homes tightened in recent days, and they suggest restricting all visitors except for end-of-life situations. They also recommend restricting volunteers and non-essential personnel in such facilities. Residents should be screened for symptoms, too.

Hunter said facilities and families of residents residing there should prepare now for how they would communicate with loved ones if they are shut out from visiting. She encouraged people to explore options for reaching residents through mobile phones, iPads or potentially using facility resources. Some nursing homes have Skype options or other virtual communication resources for residents. Families should also be aware of how the facility plans to communicate with them if they are shut out completely.

Hunter also recommends starting a family council, in order to create an email group or phone tree to keep residents' families informed. She said all it takes is one family member to call the facility and request this, asking for their contact information to be sent to other family members of residents staying there.

At Life Care Center in Kirkland, Hunter said a group listserv email accidentally emerged after an administrator sent out an email update to families without hiding all the email addresses. This proved beneficial for family members of Life Care residents who used this list to begin sharing updates with one another widely, Hunter said. This type of organization can be purposeful, however.

"Every facility and families can organize in that way, I would say do it now, all it takes is one family member to raise their hand and start a family council," Hunter said.

A person still has the right to visit a resident who is in their end-of-life situation. Families also have the right to bring a person home from a facility, and residents have the right to choose to discharge. Hunter cautioned such a choice could lead to isolation for family members if the resident is displaying symptoms of COVID-19.

There are regional long-term care ombudspersons throughout Washington, and Hunter made the decision to have them all work virtually and not go into facilities. Centers for Medicare and Medicaid Services officials announced this week that inspectors will focus on long-term care facilities' infection control protocols, and Washington State Department of Social and Health Services workers are conducting these inspections in facilities statewide.

Gov. Inslee prohibited gatherings of more than 250 people statewide on Friday, as well as closing schools and university campuses until April 24. These actions are intended to slow the spread of the virus statewide. Additionally, he loosened restrictions on long-term care workers in order for facilities to keep their staffing at levels they anticipate needing.

"I don't think it's an overreaction," Hunter said. "I think if you look at the science and what experts are saying that it's deadly for some people in society... to not take it seriously is to risk the lives of people who are the most vulnerable."

Skilled nursing facilities do not just serve elderly people, Hunter said, noting that people who get in an accident, need rehabilitation or developed more severe diseases in their 40s, 50s and 60s also live in these homes.

"I challenge people about their ideas of who is in long-term care, and whether or not they are deserving to have this proactive or preventive response," Hunter said. "I think they are deserving of our compassion."

Taking precautions early, while difficult for people wanting to spend time with their family members, is the best thing to do for the community, Hunter said:

"It might have made a difference for people who lost their lives or those that are in the hospitals."

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