By Ryan Sabalow and Dale Kasler, The Sacramento Bee, March 15 2020
California Gov. Gavin Newsom’s recommendation that hospitals and nursing homes severely restrict visitors threw hundreds of thousands of California families into disarray and heartache Sunday.
Newsom said his directive is an advisory, not an order, but he’s confident California hospitals, assisted-living facilities and others will follow the guidance to limit visitations in all cases except for “end-of-life” scenarios.
There are about 1,200 skilled nursing facilities in California; many of them had already started restricting visitors to cordon off their patients from possible exposure to coronavirus. San Francisco ordered hospitals a day earlier to restrict visitors.TOP ARTICLES Federal courthouses in Sacramento, Fresno, Modestoclosed to public due to coronavirus
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“We didn’t come up with it randomly; we’ve been working with the industry,” Newsom said of the recommendation. “They’ve been expecting it.”
Newsom also asked anyone over 65, as well as people with chronic diseases, to voluntarily isolate themselves in their homes, to prevent them from coming into contact with someone who might be infected with the coronavirus. The governor said the state was working on a system to get meals to home-bound seniors.
Even as Newsom called the steps necessary, he acknowledged the psychological toll they would take. “We realize social isolation for millions of Californians … is anxiety-producing,” the governor said.
Betsy Donovan, chief operating officer at Eskaton, a major chain of skilled nursing and assisted living centers in Sacramento, added: “Isolation is very, very difficult for older adults. Many believe it can be more detrimental than some physical ailments.”
Out of 40 million people in California, nearly 6 million are over 65 years old — more seniors than there are people in the state of Wisconsin.
The dramatic moves on Sunday create a whole host of questions hospitals must now address: Will partners be allowed to accompany expectant mothers during births? What about clergy? Will parents be allowed in for their children’s surgeries? What about family members who need to translate for a non-English-speaking loved one?
Jan Emerson-Shea, a spokeswoman for the California Hospital Association, said members were still discussing what the directive means for their operations.
“Our team is looking at all the details,” she said.
Donovan said the governor’s advisory creates another problem. About 200 of Eskaton’s 2,200 employees are 65 or over, which means the governor wants them to stay home from work. “That becomes another workforce challenge,” she said. Eskaton serves nearly 12,000 residents at 35 different centers in Northern California, mainly in greater Sacramento.
At Summerset Senior Living in Rancho Cordova, staffers are feeding residents in their apartments and bringing them books and games to keep them engaged, said executive director Tracy McLinn. “We can even Facetime their families for them,” she said.
McLinn said restrictions on visits aren’t unheard of; they pop up when major flu outbreaks and other illnesses occur. “We’re used to doing things like this … just not this drastic.”
HOW FAMILIES ARE REACTING
Andrea Pook, an Oakland woman whose 95-year-old mother is in a Walnut Creek nursing home, is already experiencing the difficulties of not seeing her. The nursing home cut off visitation rights Thursday, beating the governor by three days.
“I would see her three days a week,” Pook said. Without visits, the residents “end up just sitting there in their rooms asleep. They watch the TV. …Today, when I called her, she was still in bed at 2:30.”
Compounding matters, the nursing home closed its dining hall and is feeding the residents in their rooms. And because Pook’s mother doesn’t use a smartphone, they can’t see each other via Facetime.
“I feel sad there isn’t another alternative” to the isolation, she said.
Last week, a woman in her 90s who lived at an assisted living facility in Elk Grove died of complications related to the new coronavirus. Nobody else at the facility, which is not a nursing home, has tested positive. It appears to have been the first senior living facility death in California.
Over the weekend, the state’s nursing home association already had urged the state’s facilities to prohibit all visitors, said Deborah Pacyna, a spokeswoman for the California Association of Health Facilities, which represents about 800 of the state’s 1,230 skilled nursing facilities.
Pacyna said the facilities don’t want to have what happened at the Life Care Center in Kirkland, Wash. — the epicenter of the outbreak in the Pacific Northwest. As of Sunday, at least one in four of the patients inside had succumbed to the novel coronavirus.
Denise Plank’s 84-year-old father, Edward, is at a Fresno assisted living facility where he is being treated for a type of cancer. She said she was frustrated that she is no longer allowed to see him, since she is isolating herself and taking steps to prevent getting infected.
She worries that without her visits, the boredom and isolation may make things worse for his already precarious health, she said.
“What’s going to kill him?” Plank said. “Is it going to be the coronavirus or is it going to be cancer? … Or is it just going to be depression and loneliness?”
Others said they fully support the decision, but like Plank, they also worry about the isolation of their loved ones.
Marilee Flannery, whose 67-year-old husband, Steve, is at a Citrus Heights care facility for treatment of Alzheimer’s, said she doesn’t want the virus to enter the facility, but she’s “also really wishing I could see him or tele-see him or talk on the phone to him.”
“It is difficult for people with Alzheimer’s to communicate that way,” she said. “I miss him a lot.”
HOSPITALS, NURSING HOMES ALREADY ACTING
A spokesman for UC Davis Medical Center said officials had limited visitors to no more than two at a time earlier in the weekend but said he wasn’t able to answer policy questions about the governor’s directive.
“During this time, it is critical that we protect vulnerable patients in our hospitals, as well as our healthcare workers and providers,” Sutter Health spokeswoman Erin Shaw said in an email. “Therefore, we are restricting all visitors from our hospitals, effective immediately and until further notice. There are some exemptions, including laboring mothers, end-of-life visitation and visiting patients that are minors and supporting those patients with disabilities.”
John Nelson, a spokesman for Kaiser Permanente Northern California, said the hospital chain was still reviewing the governor’s suggestions Sunday evening.
Some counties and cities earlier in the week already had begun to act before the governor’s order.
San Francisco banned almost all hospital visitors Saturday, including family, clergy and in some cases the partners of expectant mothers, the San Francisco Chronicle reported.
On March 11, San Mateo County health authorities barred any visitors to the county’s nursing homes until early May. The ban extends to family members and non-essential personnel at skilled nursing homes. The San Francisco Department of Public Health also last week restricted visitors to the Laguna Honda skilling nursing and rehabilitation center.
“A lot of these people have heart disease or pulmonary diseases, which puts them at risk of developing complications,” said Dr. Michi Yukawa, a geriatrician and medical director of the Community Living Center at the San Francisco VA Medical Center told the San Francisco Chronicle. “Their immune system is not as robust as younger adults or even children to be able to fight off viral infections.”
Marin County also last week closed its 13 nursing homes, with about 1,000 beds, to non-essential visitors. Group activities were also canceled. “This is an example of the dynamic nature of this pandemic,” said Dr. Matt Willis, Marin County’s public health officer told the Marin Independent-Journal. “Things are happening so fast here.
Experts say healthy, younger people are much less likely to fall seriously ill and some may not even show symptoms if they contract the novel coronavirus. But the elderly and sick are at particular risk and have alarmingly high fatality rates.
Health officials say the coronavirus has an incubation period of anywhere from two days to 14 days before symptoms emerge, meaning seemingly healthy people who are now infected are likely spreading it as they move from place to place.
Those factors are why public health experts say the time to act is now to avoid a situation in the coming weeks similar to what Italy experienced as massive amounts of people with severe symptoms swamped hospitals.
Physicians told The Sacramento Bee that as this crisis progresses, it’s going to be important for loved ones to stay in touch however they can with their isolated elderly friends and family members.
Calls, texts, letters, emails, video chats are going to be vital, they said.
“The deterioration of mental health is an insidious thing,” said Dr. John Swartzberg, a professor emeritus at UC Berkeley School of Public Health. “We can put up with this for a week. We can put up with this for a month, but at some point, because we’re social animals, it’s going to take a terrible toll on our mental status. We need to start doing prophylactic things now for our mental health. The same way we’re doing prophylactic things now for our physical health.”
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