By Jackie Fortiér, LAist, August 24 2020
Under near constant video surveillance, she’ll only talk on her cell phone when she’s sure no one can overhear. She eats her meals alone and spends most of her time in her room. She feels like she’s in prison, not a nursing home.
“In the beginning, all of the measures were supposed to be to help seniors,” said the woman, whom we’ll call Lucy. “And yet, we were basically locked away and they threw away the key. It’s like we don’t even exist.”
It has been more than five months since nursing homes locked down to try to protect their highly-vulnerable patients. But even with strict rules in place, more than 2,000 of L.A. County’s nursing home residents have died from COVID-19 since March.
Most of the county’s nursing homes have yet to reopen to visitors. Those new rules meant to keep out infection have also kept residents confined and isolated from their families and friends.
That’s taken a toll on people like Lucy, who spoke to us on condition that we not use her real name because she fears retribution from administrators. She reached out to us after reading our coverage of nursing homes.
We spoke with other nursing home residents who described conditions similar to Lucy’s, but they refused to speak publicly, terrified that they would be punished by staff or management.
The isolation has taken a mental and physical toll. Dozens of complaints are filed with county officials every week by nursing home residents desperate to leave their confined quarters but who fear even a walk outside could lead to eviction and homelessness.
DOOR CODES CHANGE TO KEEP RESIDENTS FROM RETURNING
Before the coronavirus, Lucy would sign out and leave the L.A. nursing home she’s lived at for two years to get her hair cut or go to the grocery store. That changed in March when the pandemic hit.
“There was never like a general announcement, it was just suddenly, we’re not allowed out,” she said, adding the door codes were changed, making it impossible to let yourself back in.
Lucy hasn’t left the facility since it was locked down in mid-March. The only outdoor access she has is a small employee parking lot encircled by a locked fence. She’s been told if she so much as walks around the block for some fresh air she’ll be evicted from the facility, the only home she has.
“We get complaints from the residents saying, ‘They’re holding us here against our will. They’re threatening to evict us if we leave,'” said Molly Davies, the nursing home and long term care ombudsman for L.A. County. She estimates her office receives between 25 and 35 complaints like Lucy’s every week. Residents report being barred from leaving even for doctor’s appointments, Davies said.
Her office investigates complaints and monitors the safety and well-being of residents but can’t enforce regulations — in L.A. that’s up to the County Department of Public Health.
A slew of employees come and go every day to work in nursing homes. In their free time, they go grocery shopping and run small errands. Davies said residents are entitled to the same freedoms, so long as they take appropriate precautions like wearing a mask and physically distancing.
“It’s a violation of the residents’ rights … we’re talking about nursing homes, we’re not talking about prisons,” she said.
The California Association of Health Facilities, a trade group that lobbies for 80% of the nursing homes in the state, doesn’t see it that way.
Competent residents have the right to leave, said DeAnn Walters, the association’s clinical affairs director. But she said the risk of asymptomatic spread could mean a resident is placed in a 14-day quarantine when they get back.
“There shouldn’t necessarily be this, ‘You’re not allowed to go anywhere,’ but there will be a lot of education around the risk of going out to themselves, to the others in the facilities,” Walters said.
She maintained that employees differ from residents because they have training in infection control. And Walters argued that because facility administrators want to reduce the number of people infected in the community surrounding their nursing home, they need the flexibility to respond to local COVID-19 conditions.
IS THREATENING EVICTION LEGAL?
Nursing home critics challenge the basis for some of these rules.
“In the absence of consistent and widespread testing of health care workers at these facilities, it is the height of hypocrisy to say that residents must not be readmitted in order to prevent transmission of the virus,” said Mike Dark, an attorney with the watchdog group California Advocates for Nursing Home Reform.
Instead of infection control, the motivation to keep residents from leaving boils down to money, he said.
“There have always been problems with nursing homes finding ways to kick residents — especially Medi-Cal residents — out so that they can make that bed available for a more lucrative Medicare patient,” Dark said.
Threatening eviction is a tactic that started long before the pandemic, he argued. Most nursing homes are for-profit, so they want shorter-term residents on Medicare, which provides a higher reimbursement rate. Usually, there are legal safeguards to prevent financially-motivated evictions.
“In normal times if a resident walked out and then was not permitted back in, that would be a plain violation of the law,” Dark said. “It would be called a wrongful refusal to readmit and a nursing home could face penalties [from the state health department] and even financial fines.”
But is it against the law now? Dark said it largely depends on how the policy is communicated to the resident. The new coronavirus regulations make that murky.
“If they have a policy of not readmitting people after they go out but it’s unwritten and people aren’t told about it so they can’t even know that that’s the consequence of leaving the facility, that could certainly get them in trouble with [the California Department of Public Health] and should be the subject of a complaint,” he said.
Calling it “a legal grey area,” Dark said if a resident has been informed beforehand in writing that the facility won’t allow re-entry due to fear of contagion, it may be much harder to get that resident reinstated.
“It puts them in a terribly dangerous situation, without a place to stay during a pandemic,” he said. “Many of those people, especially ones without families, will become homeless.”
HOW MUCH LONGER INSIDE?
Lucy isn’t ready to gamble on becoming homeless just for the sake of taking a walk. But she said there needs to be a better balance between protecting vulnerable people from the coronavirus and the mental and physical toll of strictly limiting their movements.
After more than five months locked inside a nursing home where she both contracted and recovered from COVID-19, Lucy just wants to get out, even for a couple of hours.
“I lost a lot before I came here,” she said. “I need to be somewhere I’m not being videotaped. Sometimes I just need to cry. I need to be away from here to do that. I just need to be free to think and feel.”