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| Fears of COVID-19 have shut down visitation in long-term care facilities
across Michigan — even, at times, in hospice. (Shutterstock image) |
by Robin Erb
Late-stage Alzheimer’s disease has switched off nearly all of her mother’s memories — that’s cruel enough. Darlyn Townsend is now learning to accept that her mother is in hospice, too.
But the fact that Townsend can’t hold her 86-year-old mother’s hand, comb her hair, pick out a favorite pink nail polish, or play her favorite Perry Como tunes — that’s simply unforgivable, she says.
Like many nursing homes around Michigan, MediLodge at The Shore in Grand Haven has banned visitors because of COVID-19 concerns.
“I asked them about visitation,” Townsend told Bridge. “They aren’t going to do it. Not inside, not outside, not anything.
“I can’t even crack her window.”
Some
32,000 Michiganders in long-term care facilities will soon enter their
sixth month of being cut off from friends and families who, for the most
part, are unable to visit them due to statewide coronavirus
restrictions. While some facilities allow limited visits, others
continue to ban visits altogether, regardless of whether the resident
has the virus. It’s a painful but necessary precaution, they say, to
protect residents and staff from COVID-19.
Perhaps
no families are more desperate than those whose loved ones are living
out their final days. Representatives of the hospice industry and the Michigan Long Term Care Ombudsman Program say some families have been turned away from nursing home doors, even as family members were dying.
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Darlyn Townsend stands outside the
nursing home looking at her mother,
Ann Yanna, whom she has been unable
to visit in person, even though
Yanna is
in hospice. The nursing home, like
others around the state,
have banned
visitors as a way to guard against
COVID-19 infections.
(Photo courtesy
of Darlyn Townsend) |
Early in the pandemic, a few nursing homes briefly refused entry even to hospice nurses, according to Barry Cargill, executive director of Michigan HomeCare & Hospice Association.
“The next concern was to get family and loved ones in so they could be with that person,” he said. “It has been really hard … In many cases, families are not allowed to see their [relative]. Sometimes, they can’t even go to a window” to see them.
“We’ve had family members who can’t visit their spouse,” said John Person, executive director of Hospice of Lansing, which runs an eight-person hospice residence and also provides care at long-term facilities. “This might be anecdotal, but my sense is that it is relatively common.”
Some facilities have begun allowing visits, empowered by the discretion offered in guidance from the Michigan Department of Health and Human Services on June 30, said Alison Hirschel, director of the
Michigan Elder Justice Initiative.
In
it, MDHHS director Robert Gordon clarified that facilities “may” — but
are not required to — allow visitation in certain circumstances, such as
for residents in hospice, but only if it is scheduled and social
distancing and other safety measures are followed.
In March, when the new coronavirus began to devastate Michigan, a total lockdown on nursing homes made sense, Hirschel said.
“We’d
never seen anything like COVID before and it was so terrifying and so
devastating that it makes sense” that senior facilities focused
exclusively on stopping the virus, she said.
But five months later, “we realized that the meaning of life is much fuller than just protection against infection.”
Federal guidance
during the pandemic — reinforced by state orders — have left decisions
up to facilities, said Lori Smetanka, executive director of the
Washington-based National Consumer Voice for Quality Long-Term Care, a
national nonprofit that represents residents and consumers of long-term
care and services.
Across
the country, she said, there are reports of residents dying alone while
families are barred from facilities. Some families are allowed in — but
kept on time limits or limited to a single visit.
“The
facilities are given all the discretion about whether [visitors] can
come in, when they can come in, how long they can stay, and whether they
can come back … A lot of it is almost inhumane. It’s arbitrary,”
Smetanka said.
“That’s no way to establish policy and person-centered care.”
In
Michigan, the MDHHS order allows — but does not require — visits when a
resident is in “serious or critical condition or in hospice care.”
As a result, facilities have varied policies on what kinds of visits they will allow, she and Cargill said.
“It’s
heartbreaking to me when someone can’t see their spouse at the end of
life. That’s immoral to me,” said Person of Hospice of Lansing.
In
his facility, families are asked to designate a representative for
regular visits, and those visitors must abide by screening requirements,
he said. Others may visit in the final days of life, he said.
There
are 158 hospice programs in Michigan that provide services at homes,
skilled nursing facilities and hospitals. Hospice of Lansing is among 17
such programs that also operate a stand-alone hospice facility,
according to data provided by Michigan’s Department of Licensing and
Regulatory Affairs.
Early
in the pandemic, Person said his agency was “more aggressive” in trying
to get families into third-party facilities, “but we weren’t getting
anywhere.” Confrontation simply led to more tension and less
cooperation.
‘Actively dying.’
Advocates
for residents in long-term care facilities say their concern goes
beyond the feelings of isolation. A lack of visitors — relatives,
friends, specialists — means there are no extra eyes inside a facility
to make sure residents receive proper care, said Salli Pung of Michigan
Long Term Care Ombudsman, whose office also has received numerous
complaints.
“We
are hearing that many facilities are not allowing residents enrolled in
hospice to receive a visitor until they are actively dying,” she said.
Darlyn
Townsend said that’s what she was told about when she could visit her
mother: “like if her oxygen or blood pressure starts to change,” she
said she was told. But that’s beyond the point when visits would be most
helpful to her mother, said Townsend, 65, of Coopersville.
MediLodge officials declined to comment.
Townsend
said her bright-red bag — the one with the lotions and polishes and
hair brush that she usually took to care for her mother, Ann Yanna — has
sat unused for months.
On
July 31, she said she sat on the phone on the other side of her
mother’s MediLodge window, talking with the hospice nurse at her
mother’s bedside. Her mother was shaking and distraught, she said. The
hospice nurse put Townsend on speaker so she could sing her Como’s “Catch a Falling Star.”
Only then, Townsend said, her mother’s body stilled.
The
hospice nurse told Townsend her mother is still eating, so she wants to
take her mother another slice of her favorite: key lime pie.
“There may be so little left of her and the time she has,” Townsend said. “Can I not be part of that?”
Isolation vs. infection
Long-term
care facilities — as well as Michigan’s hospice residences — say they
must weigh the emotional and physical price of isolation against the
threat of infection that visitors pose to residents and staff.
HCR
Manorcare, a large national chain with facilities in Michigan,
continues to prohibit general visitation. Loved ones must schedule
visits with hospice patients and staff must supervise to ensure they
abide by six-foot social distancing. Visitors must wear “full airborne
[personal protective equipment] for one visitor after they have passed
the screening process. Visits last 15 minutes and there can be no
touching,” spokeswoman Kelly Kessler said in an email to Bridge
Michigan.
MDHHS
chief Gordon’s guidance in June giving facilities discretion in setting
visitation rules gives facilities leeway to consider many factors in
their decisions — the spread of COVID-19 in the community as well as
their own supplies of personal protective equipment and ability to
isolate an infected patient, said Cargill, at the state’s hospice
association.
“Gordon’s
orders do not ease restrictions, but simply provide the clarity to what
is allowable and how long-term care facilities should be managing the
excepted visits,” said Melissa Samuel, president of the Health Care
Association of Michigan, HCAM, which represents hundreds of long-term
care facilities.
Tom
Selznick of Livonia, a long-time family doctor who specializes in
geriatric medicine, said he can’t blame facilities that invoke strict
visitation rules.
Selznick
has spent much of his career working with patients in long-term care.
He often advises families to care for dying relatives at home when
possible. That’s even more important during a pandemic, he said.
 |
Caring for patients at home whenever
possible is even more important
during
a pandemic, said Tom Selznick,
a longtime family doctor and
specialist
in geriatric medicine. (Photo courtesy
of Beaumont Health) |
“Nursing
homes are always in the hot seat. They’re being scrutinized. Facilities
are concerned that all they need is one facility-acquired infection and
it’s all over the news … They don’t want lawsuits and the state to come
down on them.”
But social interaction is more important than even the best medicines in a person’s final days, Selznick said.
“When
you’re toward the end of life and even if you have dementia, you need
that family interaction. You don’t want to feel you’ve been abandoned,”
he said.
That
leaves industry trying to figure out what works and what doesn’t, as it
sorts through a barrage of guidance from the U.S. Centers for Disease
Control & Prevention, the Centers for Medicare & Medicaid
Services, and local and state health departments, said Person, at
Hospice of Lansing.
“Finding the best practices — we’re all struggling with that,” he said.
Representatives
of the hospice industry, including those from Harbor Hospice, which
cares for Townsend’s mother, say they often rely on virtual visits —
cellphones or computer tablets, for example — with family members when
the patient is in a nursing home which the family can’t enter.
Still, families are “desperate, … angry, upset and scared,” said the hospice association’s Cargill.
“They’re a whole lot of people out there struggling for answers.”
Full Article & Source:
Michigan families fight to see seniors amid COVID-19, even in hospice care
