Cautious care homes lock residents away

Despite easing, facilities keep to tight rules

Gloria DeSoto (right), 92, visits with her family in their car from a window of the Hebrew Home at Riverdale, where she lives, in New York in this June 11, 2020, file photo. Strict rules on visits to nursing homes and long-term care facilities were imposed at the beginning of the coronavirus pandemic in March 2020. (AP/Seth Wenig)
Gloria DeSoto (right), 92, visits with her family in their car from a window of the Hebrew Home at Riverdale, where she lives, in New York in this June 11, 2020, file photo. Strict rules on visits to nursing homes and long-term care facilities were imposed at the beginning of the coronavirus pandemic in March 2020. (AP/Seth Wenig)

Pandemic restrictions are falling away almost everywhere -- except in many of America's nursing homes.

Rules designed to protect the nation's most vulnerable from the coronavirus are still being enforced even though 75% of nursing-home residents are now vaccinated and infections and deaths have plummeted.

Frustration has set in as families around the country visit their moms and, this Father's Day weekend, their dads. Hugs and kisses are still discouraged or banned in some nursing homes. Residents are dining in relative isolation and playing bingo and doing crafts at a distance. Visits are limited and must be kept short, and are cut off entirely if someone tests positive for the virus.

Family members and advocates question the need for such restrictions at this stage of the pandemic, when the risk is comparatively low. They say the measures are now just prolonging older people's isolation and accelerating their mental and physical decline.

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Barbara and Christine Colucci long to remove their masks and kiss their 102-year-old mother, who has dementia and is in a nursing home in Rochester, N.Y. They would love to have more than two people in her room at a time so that other relatives can be there, too.

"We don't know how much longer she's going to be alive," Christine Colucci said, "so it's like, please, give us this last chance with her in her final months on this earth to have that interaction."

"They have protected them to death," said Denise Gracely, whose 80-year-old mother, Marian Rauenzahn, lives in a nursing home in Topton, Pa.

Rauenzahn had covid-19 and then lost part of a leg to gangrene, but Gracely said what she struggled with the most was enforced solitude, going from visits six days a week to none at all.

Rauenzahn's daughters eventually won the right to see her once a week, and the nursing home now says it plans to relax the rules on visits for all residents in late June. But it has not been enough as far as Gracely is concerned.

"I believe it's progressed her dementia," Gracely said. "She's very lonely. She wants out of there so bad."

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Pennsylvania's long-term-care ombudsman has received hundreds of complaints about visiting rules this year. Kim Shetler, a data specialist in the ombudman's office, said some nursing homes' restrictions go beyond what state and federal guidelines require. Administrators have been doing what they feel is necessary to keep people safe, she said, but families are understandably upset.

"We've done our darnedest to advocate for folks to get those visitation rights," she said. "It's their home. They should have that right to come and go and have the visitors that they choose."

A recent survey by National Consumer Voice for Quality Long-Term Care found time limits on visits remain commonplace, ranging from 15 minutes to two hours. Some facilities limit visiting hours to weekdays, making it difficult for people who work during the day, or restrict visits to once or twice a week.

Federal authorities should "restore full visitation rights to nursing home residents without delay," Consumer Voice and several other advocacy groups said in a June 11 letter to the Centers for Medicare & Medicaid Services. Residents are "continuing to suffer from isolation and decline because of the limited visitation permitted in the current guidance," the letter said.

Advocates also take issue with federal guidance on how nursing homes deal with new covid-19 cases. The guidance says most visits should be suspended for at least 14 days. Some family members, administrators and advocates complain that the recommendation has led to frequent lockdowns because of one or two cases.

"We've never had a real long, lengthy period of time where we're able to have visitors," said Jason Santiago, chief operating officer at The Manor at Seneca Hill in Oswego, N.Y. He said continued isolation is inflicting a heavy toll. "We've got to do things that make more sense for these residents, make more sense for these families."

While the federal government recently eased restrictions for vaccinated nursing-home residents, New York state has not gone along. Those who eat together in communal spaces must remain socially distanced, for example, and they have to be masked and 6 feet apart during activities, no matter their vaccination status.

That makes crafts, bingo, music -- "a lot of what nursing home life is about" -- more difficult, said Elizabeth Weingast, vice president for clinical excellence at The New Jewish Home, which runs elder-care facilities in and around New York City.

"We prioritized vaccinating nursing home residents, and that's wonderful, but they're not getting the same liberties that you or I have now," said Weingast, who recently published an opinion piece calling for a loosening of restrictions.

Her co-author, Karen Lipson of LeadingAge New York, which represents nonprofit nursing homes, said the rules "force this kind of policing of love that is really, really challenging."

With the virus infecting more than 650,000 long-term-care residents and killing more than 130,000 across the U.S., nursing homes had a duty to take precautions when the pandemic was out of control, said Nancy Kass, a public-health expert at Johns Hopkins University. But she said she is baffled by the continued heavy emphasis on safety at the expense of residents' quality of life, given that "we're not in that state of affairs anymore."

In Ohio, Bob Greve was desperate for a change of scenery after being cooped up in his Cincinnati-area nursing home for most of the past year. But the administrator wouldn't permit a visit to his son's house -- even though both men are fully vaccinated.

The policy led Greve to a "breaking point," said his son, Mike Greve, who said his 89-year-old father called six, eight, even 10 times a day out of boredom and frustration and talked constantly about getting out.

Mike Greve said he pressed the home administrator for outside forays, only to be told: "If I let you take your father out, I have to let everybody else." Greve said the administrator was worried about residents carrying covid-19 back with them.

The administrator did not return phone and email messages from The Associated Press. A day later, Greve said, the administrator called him into the office, offered to allow his father out for a visit and said the policy would be changed for everyone else, too.

Father and son spent a glorious afternoon soaking in the sunshine at Greve's house, where his dad spotted a deer.

"He said, 'Hallelujah' I don't know how many times," Greve said. "He said, 'I don't know how you got me out, but I'm so happy I could cry.'"

TEXAS' CONTRAST

In Texas, covid-19 hospitalizations are at their lowest point in more than a year as the state surpasses more than half of eligible residents vaccinated, a promising sign months after Gov. Greg Abbott lifted his statewide mask order and moved to open businesses at 100% capacity.

Abbott has touted the state's vaccination numbers and declining covid-19 cases, but parts of Texas still are reporting low vaccination rates. Interest in vaccinations has waned and health experts warn that the virus could continue spreading unless local and state health officials find a way to inoculate more of the state.

Roughly 200 of Texas' 254 counties have yet to reach 50% of eligible residents having received at least one dose of a vaccine, a benchmark set by the Texas Department of State Health Services. That number declines further when including children younger than 12, who aren't yet authorized to receive shots but can still spread the virus.

Even the state health agency's goal of 50% is significantly lower than experts' estimates of the percent of the population that must be protected from the virus to reach herd immunity, the point at which each infected person transmits the disease to an average of fewer than one other person, and it starts to die out.

President Joe Biden has set a national vaccination goal of 70% of adults by July 4, a threshold Texas is not close to reaching, even as several states have surpassed that mark and others are poised to meet it. In neighboring New Mexico, nearly two-thirds of adults are fully vaccinated and three-quarters of adults have received at least one shot.

The risk for areas with low vaccination rates is a resurgence of the disease, especially as new variants spread, Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, has warned.

"We have pockets of this country that have lower rates of vaccination," Walensky said. "I worry that this virus is an opportunist and that where we have low rates of vaccination are where we may see it again. And so really the issue now is to make sure we get to those communities as well."

State health officials are strategizing on how to improve the numbers in much of the state. Imelda Garcia, the state health agency's associate commissioner for laboratory and infectious-disease services, said officials regularly monitor vaccination data to determine where to focus outreach efforts.

The rate in eastern Texas is among the lowest in the state, with fewer than 40% of eligible residents in most counties there having received a dose. In comparison, vaccination rates in the state's urban counties and the Rio Grande Valley are above 60%.

"We know there are still a lot of Texas counties that are below that threshold," Garcia said. "We're really trying to think outside of the box. How do we capture more willing individuals in a way that's really simple for them?"

State health officials have shifted efforts to target eastern Texas, using roving health officials and military teams to go directly to residents. The Texas Department of Transportation has offered vaccination clinics at some rest stops and will expand the program in the coming weeks, Garcia said.

The state health agency also made a $1.5 million investment to encourage Texans to get vaccinated as demand declines. The agency debuted TV and radio ads and offered 22 pop-up events in Walmart parking lots.

SINGLE-DOSE SHOT LINGERS

Meanwhile, more than 800,000 Johnson & Johnson vaccines in Pennsylvania, New Jersey and Delaware could go to waste this summer as states grapple with millions of time-sensitive doses of the less-popular vaccine.

Thanks to an FDA determination last week that extended the vaccine's shelf life, states now have until early August to use doses that would have expired in late June, a date by which most of the vials in this region would almost certainly have gone unused.

But some states are still struggling to find enough takers for the vaccine, a task that falls to them in the absence of a federal plan to collect and redistribute extra doses.

Vaccine providers continue facing low domestic demand for the Johnson & Johnson shot, which has been unpopular since the FDA halted its use for 11 days in April to investigate potential side effects that turned out to be exceedingly rare.

And providers simply can't donate the doses to countries that need vaccines; the Centers for Disease Control and Prevention told states that they can't be distributed internationally.

The prospect of throwing away millions of shots is a staggering turnaround for the "one and done" vaccine, which was hailed at the height of U.S. demand as a key tool for speeding up immunization efforts and reaching vulnerable, isolated or disadvantaged populations.

Instead, public perception of the vaccine never recovered after the pause.

Meanwhile, more than 153 million Americans, including more than 6 million Pennsylvanians, remain unvaccinated. The Biden administration has asked states to find ways to get unvaccinated residents to take the shots.

"What the state should be doing is maximizing output," said Kevin Munoz, a White House spokesperson. "It's all of our responsibility to work together to maximize the doses that [the states] ordered getting into arms."

The administration is working with states to help them use the doses they have through efforts like targeted clinics and mobile vaccination units.

Such efforts are important, particularly for immunizing harder-to-reach people, said Lawrence Ward, president of the Pennsylvania chapter of the American College of Physicians. He said taking the shots to doctor's offices, offering them to patients in hospitals, and incentivizing vaccine providers to seek out vulnerable populations are all strategies that could be ramped up to increase use of the Johnson & Johnson doses.

"We definitely have opportunity here at home" to use the vaccine before August, he said.

Information for this article was contributed by Michael Rubinkam and Marina Villeneuve of The Associated Press; by Nicole Cobler of the Austin American-Statesman (TNS); and by Justine McDaniel, Erin McCarthy and Jason Laughlin of The Philadelphia Inquirer (TNS).

Angela Ermold, right, and her sister, Denise Gracely, hold a photo of their mother, Marian Rauenzahn, Thursday, June 17, 2021, in Fleetwood, Pa. Pandemic restrictions are falling away almost everywhere — except inside many of America’s nursing homes. “They have protected them to death,” said Gracely. (AP Photo/Matt Slocum)
Angela Ermold, right, and her sister, Denise Gracely, hold a photo of their mother, Marian Rauenzahn, Thursday, June 17, 2021, in Fleetwood, Pa. Pandemic restrictions are falling away almost everywhere — except inside many of America’s nursing homes. “They have protected them to death,” said Gracely. (AP Photo/Matt Slocum)
Angela Ermold, right, and her sister, Denise Gracely, hold a photo of their mother, Marian Rauenzahn, Thursday, June 17, 2021, in Fleetwood, Pa. Pandemic restrictions are falling away almost everywhere — except inside many of America’s nursing homes. “They have protected them to death,” said Gracely. (AP Photo/Matt Slocum)
Angela Ermold, right, and her sister, Denise Gracely, hold a photo of their mother, Marian Rauenzahn, Thursday, June 17, 2021, in Fleetwood, Pa. Pandemic restrictions are falling away almost everywhere — except inside many of America’s nursing homes. “They have protected them to death,” said Gracely. (AP Photo/Matt Slocum)

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