Nursing Homes, Assisted Living Centers Told to Bar Most Visitors

Concern is that asymptomatic guests will bring coronavirus to vulnerable residents

An environmental services employee cleans March 5, 2020, behind an infection control warning poster at the Palm Garden of Tampa Health and Rehabilitation Center in Tampa, Florida.

En español | Two leading industry groups and the federal government are telling family and friends to stay away from nursing homes and assisted living centers as the fast-spreading coronavirus continues to make inroads in the United States.

The worry: Though younger people can have a COVID-19 infection without symptoms, a visit to spread good cheer to a frail relative can become deadly among a more vulnerable population, according to Mark Parkinson, president and chief executive officer of the American Health Care Association and the National Center for Assisted Living. Both are based in Washington, D.C.

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“The grim reality is that for the elderly, COVID-19 is almost a perfect killing machine,” he told CNN on Tuesday. “In our facilities the average age is 84, and everyone has underlying medical conditions. So when you combine those factors together, we are dealing with perhaps the greatest challenge that we ever have had.”

As of Tuesday, 19 residents from a Kirkland, Washington, nursing home had died, about two-thirds of all COVID-19 deaths nationwide. More than 30 additional residents at Life Care Center in the Seattle suburb have tested positive, several dozen employees are showing signs of infection and nine other long-term care facilities in King County have residents or workers who have tested positive for the virus.


Keep in touch remotely

The new recommendation from industry officials is that nursing homes and assisted living facilities, where older people live in close quarters, should not allow outsiders — including contractors, government officials and even staff members — to enter unless their task is considered essential.

The Department of Veterans Affairs also suspended most new admissions and barred outsiders from all of its 134 nursing homes and 24 spinal cord injury centers. The exception to the no-visitors’ rule: when a patient is expected to die soon.

“Nursing homes may have more to fear from visitors and staff carrying the virus than vice versa, as their residents are highly susceptible to the virus,” Michael Dark, staff attorney at California Advocates for Nursing Home Reform (CANHR) in San Francisco, wrote in email.


How to reduce infection risk

Residents, staff and visitors all should follow the same basic steps to reduce risk of infection, experts said:

• Wash hands often with soap, for at least 20 seconds. The World Health Organization offers illustrated guidelines.

• Use alcohol-based (with at least 60 percent alcohol) sanitizer if soap is not available

• Avoid touching your eyes, nose and mouth

• Avoid close contact with those who are sick

• Stay at home if you’re sick

• Cover your cough or sneeze with tissue and throw the tissue in trash

• Clean and disinfect surfaces such as doorknobs and television remotes with alcohol or with bleach wipes


Don’t move patients

Advocates are urging family members not to panic and say it is unwise for them to bring loved ones home to try to avoid infection.

“Moving an older adult from a long-term care center is risky and could have long-lasting impacts,” geriatrician David Gifford, chief medical officer of the American Health Care Association and the National Center for Assisted Living, wrote in an email.

The federal Centers for Disease Control and Prevention (CDC) does not recommend such moves, he said.

Others echoed that recommendation, saying germs are likely to flow more freely outside these communities than inside. Plus, residents are in nursing homes because they need higher levels of care than generally can be provided at home.

“In most cases, it is probably not a good idea” to move residents, Fulmer wrote in email. Instead, residents can take an active role in monitoring their nursing homes and assisted living facilities.

“Remember, you can use your voice! It’s OK to remind facility staff to wash their hands and maintain good hygiene,” she wrote. “Ask your facility about their plans for staff, who should stay home if they become sick.”

Staff must sanitize shared surfaces

A Centers for Medicare & Medicaid Services memo issued to states last week advised nursing home and assisted living center staff to limit the sharing of medical equipment among residents. When sharing equipment is necessary, it should be properly cleaned and disinfected before it is moved to another patient.

Staff also should avoid sharing items such as pens and pads. When phones, internal communication devices or nursing stations are shared, they should be disinfected frequently, the memo said.

“All staff, including housekeeping staff, receive in-service COVID-19 infection control training in addition to online infection control training,” spokesman Larry Elveru of Kendal, a Kennett Square, Pennsylvania-based nonprofit that operates continuing-care communities in eight states, wrote in an email. Staff are required to demonstrate what they’ve learned.

Charlie Campbell takes his mom, Dorothy Campbell, 88, to see her husband through his room window on March 5, 2020, at the Life Care Center nursing home in Kirkland, Washington, where multiple cases of COVID-19 have been diagnosed and some patients have died.

Advocates for older people have long criticized many long-term care facilities for staff shortages and lack of infection care. Residents and their families can consult Medicare’s five-star rating system to learn about their nursing home’s record on infection control. But the same sort of records are not offered for assisted living facilities because they are primarily under state oversight.

Residents and family also can review CDC guidelines for health professionals. If they’re concerned that a facility is not following those standards, they can contact their area long-term care ombudsman, according to CANHR, the San Francisco-based advocacy group.

Workers finding gowns, masks in short supply

Be aware that a number of long-term care facilities are having trouble getting supplies made in China, hard hit by the coronavirus, Gifford said Friday. Most needed are basic surgical masks and gowns.

“Some suppliers are getting very low,” he said.

He also mentioned that his group is trying hard to get assisted living and skilled nursing facilities a high priority in coronavirus testing. Vice President Mike Pence, now in charge of the Trump administration’s coronavirus response, said last week that the number of test kits available now will not meet the anticipated demand going forward.

Long-term care companies and individual facilities are posting information online about how they’re guarding against the virus.

Brookdale Senior Living, a long-term care company based in Brentwood, Tennessee, is focusing on preventing the spread of the virus, spokeswoman Heather Hunter wrote in email.

Some facilities have posted notices on how to properly wash hands. Kendal residents also are referred to the CDC COVID-19 website, Elveru wrote.

If a facility has suspected cases of COVID-19, experts provide these recommendations:

• Staff should use gowns, gloves and face masks or goggles when treating ill patients.

• Residents suspected of having the virus should be placed in single rooms with closed doors.

• Dining rooms may be closed and meals delivered to all residents’ rooms.

Those who feel they must visit any group living situation for older residents should be prepared for detailed questions.

“We are asking visitors to sign in at our main centers and disclose their prior travel,” Lisa M. Marsilio, chief executive officer of Kendal-Crosslands Communities in Chester, Pennsylvania, wrote last week in a letter to members of the continuing-care community. Residents and staff at the community with 500 independent living homes and apartments in addition to more intensive care are being asked the same questions.

Facilities should stay in contact with their local health departments “to determine if their surrounding community is high risk,” Gifford wrote.

Editor’s note: This story, originally published March 6, has been updated to reflect new information. Contributing: veterans reporter Aaron Kassraie.