Opinion by Tom Elias, California Focus, June 8 2020
Nothing has contributed more to substandard treatment of older adults in nursing homes than a futile, failed rule imposed by state and federal governments at the advent of the COVID-19 crisis: Virtually no visits for anyone in any nursing home or skilled nursing facility.
The ban was intended to keep the coronavirus out of nursing homes, but patients there nevertheless account for more than one-fourth of the 110,000-plus COVID-19 deaths nationally and almost half of California’s fatalities. It’s clear the nearly four-month ouster of visiting relatives and friends has been worse than useless.
The rule has certainly not kept the virus away. But it produced scores of heart-wrenching newspaper stories and television news segments featuring some of the thousands of patients who died alone because nursing homes kept their loved ones away, be they friends or close relatives like sons and daughters, grandchildren, brothers and sisters, nieces and nephews. Some said permanent goodbyes to beloved elders through closed windows or via cellphones, making for dramatic videos.
The harm from this goes far beyond emotional damage. It has also led to new low standards of care in many facilities, charge some patients, their relatives, and doctors.
One accomplished, a mentally alert 76-year-old man who was forced to sell his house and move permanently into a nursing home when he became too disabled to transfer from bed to wheelchair by himself confided this: during one stretch in May he was kept in bed for periods of both five consecutive days and, later, four straight days. Telephone calls to a nurses’ station near his room revealed he is routinely put to bed at 4 p.m. daily, like it or not. In an email, he said this was new, done “for the convenience of the staff.”
Such treatment has become routine in an unknown, but large, number of nursing homes chiefly because of the virtual ban on visitation, mandated by overlapping federal and state rules. This is true despite assertions from the California Department of Public Health (DPH) that it has conducted numerous inspections and assessed many penalties during the pandemic.
“Nursing home management already disliked visitors before COVID-19,” said Michael Dark, staff attorney for California Advocates for Nursing Home Reform. “Visitors notice bedsores on people not being turned in their beds, they see when residents are not hydrated or not clean, they notice when sheets are not changed, things that are supposed to be routine.”
Management knows visitors can complain to state authorities. But because of the visitor ban, outsiders now don’t see these things or complain.
All this is in the name of shutting coronavirus out of the homes, something that clearly does not work. That is chiefly because nursing home staff, including many certified nursing assistants, is low paid, often getting minimum wages and thus forced to work more than one job to survive. If one nursing home is sanitary, but staffers also work in others that are not, they can carry the viral infestation from home to home. And there’s no requirement for regular testing.
One doctor who treats nursing home patients when they arrive in her hospital with COVID-19 wrote in the New York Times, “The elderly are more isolated and defenseless than ever.”
So it is long past time the DPH changes a keyword repeated often in its May 2 guidelines that help exclude almost all visitors from California nursing homes. Those rules repeatedly “recommend” homes admit visitors under specific, spelled-out conditions, including a recommendation that children in skilled nursing facilities each be allowed visits from one support person.
Said Dark, “The guidelines could mean there will be virtually no visitors for years to come because management interprets them to mean they don’t have to let anyone in. If the DPH changed its wording to ‘shall’ or ‘must,’ it could improve things a lot.”
But Heidi Steinecker, deputy director of DPH’s Center for Health Care Quality, declined to say whether she would consider such a change.
The bottom line here is that right now Gov. Gavin Newsom’s administration tolerates a situation that leads to disease and death for thousands of helpless elders and others in nursing homes.
Email Thomas Elias at firstname.lastname@example.org.