In January, Teresa Williams moved her 90-year-old father to an assisted living center about five miles from her house in Snellville to make it easier for regular visits.
At first, it went swimmingly. Williams saw her father, Maurice Collier, at least three times a week. She helped him shave, keep his two-room suite tidy, and communicate his wants and needs, including his preferred bedtime at about 9 p.m.
All the while, Williams was by his her father’s side, keeping him company, and keeping his spirits up.
“My dad’s a real talker,” Williams said.
But the visits at Sunrise of Webb Gin abruptly stopped just days after Collier’s 91st birthday in March as the coronavirus started spreading in Georgia, and nursing homes and assisted living centers, particularly vulnerable to the pandemic, went into lockdown. At first, barring all visitors seemed sensible and a necessary step to protect residents.
As the COVID-19 pandemic stretches into the fifth month with no end in sight, some families in Georgia are vigorously challenging visitor bans, saying the restrictions are unhealthy.
“I feel like I’m in prison,” said Collier by phone.
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Meanwhile, Williams fought back tears as she talked about a noticeable mental decline, saying her father seems confused and anxious.
Some families strongly support keeping senior care homes in lockdown, given how vulnerable residents are if they exposed to the coronavirus. More than 1,600 long-term care residents in Georgia have died with COVID-19, about 45 percent of the state’s total deaths.
But many other families are passionately advocating for long-term care homes to resume face-to-face interactions, even if strict measures remain in place. Several states including New Hampshire, New Jersey, and Indiana are relaxing visitation rules.
“I feel like I'm in prison."
Families are calling and writing letters to Gov. Brian Kemp urging him to ease restrictions. They’ve organized a Georgia chapter of a Facebook group called, “Caregivers for Compromise because Isolation Kills Too.”
Even in nursing homes without COVID-19 cases, communal dining, and group activities have been restricted, which deepens the social isolation and feelings of loneliness.
There is strong evidence older adults who are socially isolated face significantly higher rates of heart disease and stroke and a 50 percent increased risk of dementia, according to a recent report by The National Academies of Sciences, Engineering and Medicine.
“We are social animals. It is part of our species and it’s almost built into our DNA, and when you take away that critical part of our environment, that changes our bodies,” said Dr. Dan Blazer, the committee chair and a psychiatrist at the Duke University School of Medicine.
Kemp has reopened much of Georgia, but he has repeatedly extended his emergency order that placed restrictions on long-term care settings because COVID-19 can be so deadly for seniors, especially those with health issues. Along with prohibiting visitors, the order says senior care homes should provide in-room dining and cancel all group activities.
Federal guidance for reopening nursing homes says infection rates should be low in the community and access to tests and hospital beds should be adequate. Georgia’s current trendlines for these standards argue against reopening.
The Georgia Health Care Association, which represents long-term care providers, had proposed some plans for reopening homes to visitors, said Tony Marshall, the association’s president and CEO.
But with the recent spike in cases both inside long-term care facilities and across Georgia, Marshall said, homes don’t want to reopen soon.
Marshall said the industry is working with the state to ease some of the isolation by allowing residents to have communal dining and group activities at some homes without outbreaks.
“We’re trying to find that fine line between protecting the residents from community spread and at the same time allowing them to have some enhanced interaction,” Marshall said,
He said long-term care providers believe families will accept ongoing limits on in-person visits if they are convinced that safety remains a priority and that the psycho-social needs are being addressed by lifting some of the restrictions within the centers.
Senior care homes have tried to get creative to combat isolation. Some bring special snacks and games from room to room. Others have offered concerts by musicians in their parking lots that residents can view from windows or balconies.
“All of our members have been concerned about the emotional well-being of the residents, and they want to help them hold safe visits with their family members,” said Ginny Helms, president and CEO of LeadingAge Georgia, which represents non-profit and mission-driven senior care organizations. “But we still have a major concern about the coronavirus in the community at large.”
Helms said her members want Kemp to mandate masks statewide to lower the spread of the virus. Members of LeadingAge are “starting to get frustrated that we don’t have a better plan in place.”
Blazer said he believes the time has come to try to find ways to allow some visits, whether it’s outdoors with physical distancing or with family members who get tested.
“We are not talking about totally opening up,” he said.
“We need to be seriously thinking about the consequences of loneliness and social isolation the way we have been thinking about COVID-19,” he said.
Skype and window visits
Jill Davis of Lawrenceville said while she understands homes’ desire to keep residents safe, she sees the continued restrictions as “inhumane.”
She now worries her mother, Edna Taylor, who is 92, may never leave her nursing home in Dahlonega.
“My mom is mentally with it and well aware of what’s going on,” said Davis. “We Facetime and she tells me she’s so bored.”
Davis said her mom also desperately misses social dinner get-togethers with her friends at the nursing home, and other little life pleasures.
“She wants to get her hair done and a Wendy’s Frosty,” Davis said.
Meanwhile, Maxine Williams (no relation to Teresa Williams) has felt a particular sting because her mom, who is in a nursing home in southeastern Georgia, ended up getting infected with the coronavirus – several weeks after visitations stopped. Williams, who lives in Woodbine, a small southeastern town in Georgia, said her mother was transferred to a nearby hospital and is mostly recovered.
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Williams is advocating for carefully planned visits with a designated visitor and recommends they start with at least weekly visits, with the visitor required to wear PPE. She has also asked for a point of contact in the administration for concerned family members.
She longs for the days she could bring her mom her favorite foods, including fried okra and homemade cornbread, and curl her mother’s hair before bingo games. Williams, who is a registered nurse, also made a point to be with her mom on Fridays during weekly appointments with a physician. She could help answer questions, review medications and help put her at ease.
Meanwhile, Teresa Williams said she regularly drops off essential items such as toothpaste along with cookies and popcorn in a box outside the Sunrise facility.
“But sometimes, my dad will call me and say, ‘Why didn’t you come see me?’ "
