Oct 13, 2020
Nursing Homes and Families During COVID
“If the nursing home would allow one advocate, one compassionate care person, and let them visit their family members, that would be very helpful to them.”— Nettie Batchelor
Skilled nursing homes are currently facing unique challenges with coronavirus. Previously, we talked about the role of social workers in nursing homes and mental health. In this week's episode, we're going to have a heart-to-heart conversation with my Mom, Nettie Batchelor. We're going to share her story about the impact of the visitation restrictions she’s faced with my grandmother, Grandma Trudie, who lives in a nursing home.
Part One of ‘Nursing Homes and Families During COVID’
When Grandma Trudie went to the nursing facility, it was hard for her to leave her home and accept the fact that she needed 24/7 care; care that had to be provided in a skilled nursing home. Thankfully, the staff who work in her facility treat her very well. She began to even think of it as home. My Mom used to see her two or three times a week. The last time my Mom saw her face-t0-face was March 4th, 2020 - that was the last time she was able to sit beside her for a visit or give her a hug.
Visitation guidelines issued by CMS and its federal partners have issued directives and guidance regarding visitation during the pandemic in multiple documents that have made it challenging for nursing homes to meet (and CMS to enforce) federal expectations or leverage evolving flexibility with states re-opening at different paces.
“The longer this pandemic takes, the more bad outcomes we're going to see.” — Melissa Batchelor, PhD, RN, FNP, FAAN
Visitation Restrictions may have partially helped protect resident’s physical health, residents are experiencing loneliness, anxiety, and depression because they have been separated from family and friends longer than any other group of people in the United States during COVID.
My Mom appreciates everyone in the facility doing their best to help her remain socially connected through video calls, but honestly, when you’re 91 years old, time is even important than it’s ever been. In September of 2020,
the Governor of North Carolina moved the state to Phase 2.5 - allowing outdoor visitation with nursing home residents. So after 202 days, my mother’s brother was allowed to visit my grandmother two and a half weeks after that Phase 2.5 announcement. It did not go well. Grandma Trudi completely lost it; because of the social distancing rules, she wasn’t allowed to hug or even touch my Uncle so she started crying and begging to go home. She kept saying, "That's my son, that's my son!" She got so upset, the staff had to ask my Uncle and his wife to leave. You can imagine how hard it is to finally be able to see each other again, but you can’t hug or even touch the other person after SEVEN MONTHS.
Part Two of ‘Nursing Homes and Families During COVID’
If you're curious about what else is going on with older adults inside the nursing homes, all of their activities have been shut down and she’s in her room alone for the majority of the day. Unable to even move around in her wheelchair led her to become very deconditioned. Through her Medicare benefit, they finally allowed physical therapists back in the facility to work with the residents. She will get two months of physical therapy to get her moving again.
“There definitely needs to be answers and solutions for family members to be able to go in to visit.” — Melissa Batchelor, PhD, RN, FNP, FAAN
Some residents quit eating; others started to eat more. My grandmother is eating more. She's gained 10 pounds. You think she's doing fine, but the reality is she's eating out of loneliness and unhappiness. She's not the kind of person who cries a lot or easily gets upset about her situation. She tries to make the best of it. My Mom is doing the best she can to keep in touch through FaceTime and is always encouraging my Grandma Trudie that this will be over soon.
While better than no contact at all, FaceTime or other types of virtual visits are not a sufficient substitute to meet resident or family needs and are often harder when residents have a hard time hearing or have memory problems.
COVID protocols for in-person visitation need to be adjusted to include family members as Essential Care Partners. CMS needs to allow nursing homes to reinstate the resident’s rights to visitation. This can be done with weekly testing of Essential Care Partners that follow the same guidelines in place now for nursing home staff and many other industries.
Residents rely on visits with loved ones for care and critical emotional support. Family caregivers also provide outside support for the nursing home staff, who have been under-prioritized during COVID. Nursing home staff have faced increased pressure to meet the needs of residents - without adequate training or equipment – and nursing home workforce shortages have been amplified during this public health crisis.
Even if nursing homes allowed at least one family member to visit, that would be very helpful. They should allow some type of visitation that doesn't require having to be six feet apart. I hope this little story of ours somehow made you feel that we're all in this together; you're not alone….but we don’t have time to waste. We need to fix this now and figure out a way to allow these residents the ability to visit their families. The staff come and go every day and are not quarantined in their homes after work. Finally, the staff have been provided the resources to have weekly COVID testing. These protocols should be extended to include Essential Care Partners - to allow visitation for residents, provide support for the staff, and give 1.4 million Americans the dignity and quality of life they deserve.
About Melissa
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.