By Stacey Malcolmson
1:30 AM on Dec 12, 2021 CST
In the spring of 2020, the life-threatening dangers of COVID-19 became evident, and Dallas County Judge Clay Jenkins advised families with elderly loved ones in nursing homes to bring them home.
His recommendation, while maybe unrealistic, was well-intentioned and based on facts. Senior care communities were dangerous places during the first year of the pandemic. Almost one-third of U.S. deaths from COVID-19 occurred among residents and staff in long-term care facilities.
Seniors living in these facilities make up about 1% of the population, yet they account for 40% of fatalities to date, according to a New York Times analysis.
But the reality was (and still is) that the average family cannot safely provide round-the-clock care at home that some elderly adults need. Our staff and volunteers at The Senior Source’s Long-Term Care Ombudsman Program walk countless families through the complex and emotional decision of choosing a long-term care setting for a loved one, and we’ve seen how the pandemic has made this decision more fraught with emotion and fear, even with the vaccine available.
Seventy percent of seniors will need residential care, from short-term rehab stay to lifetime care. Here are some new factors to consider when choosing a care facility in a post-COVID-19 world:
In the early months of the pandemic, personal protective equipment was hard to find, as were COVID-19 tests. Vaccines were not available. Caregivers and staff in long-term care facilities were exposed to risk themselves, and many are still traumatized by their experiences. Staffing shortages still persist in these communities, by the way.
Among the wide range of residential senior care, from unregulated independent living to state-regulated nursing homes and memory care to federally regulated skilled nursing facilities, the rates of COVID-19 deaths increased at each level of care. In one study by NORC of the University of Chicago, the mortality rates of independent senior living communities were comparable to those of other older adults living in the same geographic area. But mortality rates were higher in assisted living and memory care communities, and they were even higher in skilled nursing facilities.
So why were residents in nursing homes so vulnerable to COVID-19? At least partly due to the health status of seniors living in those settings, those with chronic medical conditions like heart disease or diabetes are more vulnerable to COVID-19. Memory care communities were particularly challenged as many residents were unable to comply with infection control precautions such as wearing masks.
So now, seniors and their families considering long-term care options must add questions about infection control to their long list of worries when shopping for a facility. What is this community doing for infection control? What are their procedures? Are there enough staff to ensure compliance of infection protocols?
Our ombudsman program staff and volunteers regularly visit nursing homes and assisted living communities in Dallas County. We monitor complaints related to infection control as well as cases of abuse or neglect. Sharing what we learned about the nature and frequency of complaints in any community helps families have as much information as possible to make a wise and life-giving decision.
When the vaccine became available, priority went to residents and staff in nursing homes and other senior living communities.
Our ombudsman staff were so relieved because they have lived through countless instances where entire facilities were locked down because a single staff member brought the virus into the community.
Seniors and their families are allowed to ask and deserve to know the vaccine status of staff and residents in a facility they are considering. The government now requires nursing homes to offer vaccines to all staff and residents and to publicly report their vaccination rates. You can access that information on Medicare.gov’s Care Compare website.
While care communities not federally regulated aren’t required to report vaccination status, some tout their vaccination rates in their marketing. If you don’t see any information on a community’s rates, you must ask.
Your right to visit
To protect residents from COVID-19, senior care communities shut their doors to visitors and suspended communal dining and other resident activities, both actions that had devastating effects.
Social connection is critical for seniors’ well-being. According to the Health Resources and Services Administration, loneliness poses a health hazard to older adults equivalent to smoking 15 cigarettes a day. For many seniors, meals in the communal dining area are the highlight of their day and activities provide the main source of physical exercise and social connection. Without those, the resulting isolation had very serious health impacts.
We heard from family members whose senior loved ones developed depression, signs of physical decline or emotional distress during the quarantine period. We heard heartbreaking stories from families who couldn’t visit with their senior loved one during their last hours.
Families, you have rights to visit your loved ones in long-term care facilities and our ombudsman program staff are here to advocate for those being refused visitation. Fortunately, on Nov. 2, a constitutional amendment passed to allow families to designate one “essential caregiver,” a family member or friend, who can visit a senior at any time, regardless of the resident’s COVID-19 status or any community emergency pandemic.
Of course, we recommend balancing the need for safety and infection control with the very real need for human contact. But as a grandmother or father lie dying, it is simply inhumane to refuse visitation to family.
To our Dallas seniors who have had the good fortune to live long enough to see William Shatner make it to space, and to their families with the responsibility of caring for them, know that you do not have to search for a safe and healthy living situation alone. If COVID-19 taught us anything, it’s that we get through things better, together.
Stacey Malcolmson is chief executive of The Senior Source. She wrote this column for The Dallas Morning News.