For a glimpse of why it's so worrisome to ease restrictions on family visits to nursing homes, look at a photo that appeared on the front page of the Star Tribune last Friday.
It shows a woman and her 99-year-old father, about to be reunited for the first time in months. They are following some of the guidelines issued last week by the Minnesota Health Department for resuming visits during the COVID-19 pandemic: Both wear masks. They are meeting outdoors. But both the woman and her dad have flung their arms wide for a hug, and they appear to be about 0.2 seconds away from contact.
And who could blame them? It's the most natural of gestures. Residents of nursing homes and other long-term care facilities have endured months of isolation. If they could see their loved ones at all, it was likely at a distance, through a window. The new guidelines ease that isolation, but they ask families to do something unnatural: Visit, but don't touch.
If not for the deadly serious consequences involved, that request would be not only unnatural but unreasonable. The numbers describe the risk: Of the 1,393 Minnesotans who have died of COVID-19 and its related conditions, 1,101 — or 79% — have been residents of nursing homes or assisted living facilities. Of the 21 deaths reported since Sunday, 16 were of people who had resided in such facilities. Considering the time it takes the virus to incubate and do its damage, these numbers are echoes of the danger that existed in long-term care facilities before the visitation rules were relaxed.
People in long-term care are likely to be particularly vulnerable to the worst effects of COVID-19. They tend to be older, with compromised health. "You only go to a nursing home if you need nursing-home level of care — if you're sick," said Patti Cullen, president and CEO of Care Providers of Minnesota.
Given the dangers of COVID-19 to this vulnerable population, it might make sense to keep the drawbridge raised and allow no visitors at all. But such a course would expose residents to a different hazard: the harm of continued isolation, with the attendant risk of depression and failure to thrive. "In our setting, there is a fairly high level of depression anyway," Cullen said last week. She described the easing of restrictions as "a good thing. … For psychosocial well-being, it's a great thing."
It's clear that, to balance the physical and emotional health of residents, some accommodation had to be made. Whether the rules announced last week are sufficient will become clear with time — but staff, families and the residents themselves will have to take responsibility for following them.
Among those rules: Stay 6 feet apart. Use hand sanitizer before and after every visit. Screen every visitor for contamination. Wear masks unless a medical condition makes it impossible. That last requirement is proving surprisingly hard to meet.
"We're getting a little pushback on the whole idea of masks," Cullen said. "The wearing of masks is almost a partisan issue. And we're not political. We don't care [about anyone's politics]. Wear a mask."
To Cullen and other professionals around the country, the goal is not to come up with ways of getting through a temporary crisis. As indications mount that COVID-19 is reasserting itself even before the so-called second wave arrives, they are thinking about long-term improvements in their safety procedures.
As Cullen succinctly put it: "We're not going back to normal until we have full vaccines." Even more succinctly: not anytime soon.
