Indoor visits at long-term care facilities spotty despite new state guidelines

Oct. 25--For their 50th wedding anniversary last year, Monclova Township couple Darrell and Becky Hawley rented the top floor of Mancy's Steakhouse and hosted an elegant party with their family and friends. This year for their 51st, affections were shouted through a glass window.

Mr. Hawley, 73, isn't even sure if his 70-year-old wife, who has dementia and is living in the Parkcliffe Memory Care Community in Toledo, could hear him or understand what he said.

It's the reality many families and spouses have grappled with since the coronavirus pandemic sent nursing homes and assisted-care facilities into lockdown in March. Even with more visitation options available at such facilities now, families remain separated by masks, plastic, and six socially-distant feet, making communication difficult and physical affection impossible.

Some families say near-isolation over the last seven months has caused their loved ones to deteriorate faster, robbing them of what precious time they had left to be together. For residents with Alzheimer's disease or other dementia, like Mrs. Hawley, the strain can be even more pronounced.

"She has deteriorated tremendously since COVID started," Mr. Hawley said. "It's like I'm losing my wife twice."

Juanita Kontak, Mrs. Hawley's older sister, vehemently agrees. She used to visit weekly to take her sister on walks, to church, and out to dinner. But in coronavirus lockdown, recognition, physical ability, and conversation are now failing in the younger sibling.

"I'm firmly convinced that even though the disease [dementia] would progress, it would never have progressed this fast," Mrs. Kontak, 72, said. "We will lose her anyway, but we lost so much time."

State and local authorities have been factoring stories like the Hawleys' into the delicate balancing act between protecting residents who are most at risk of dying from the disease -- the state's coronavirus database shows at least 59 percent of Ohio coronavirus deaths have occurred in congregate-care facilities -- and helping them maintain their quality of life.

First, the state approved outdoor and window visits over the summer to provide some kind of contact. Then it added a "compassionate care" clause to visitation rules to prevent loved ones from dying alone.

Now the state is moving forward with indoor visitation, despite case counts being on the rise both in the Toledo region and across the state. Ohio set several daily records for new coronavirus cases just in the last week alone; while Lucas and Ottawa counties are now among 38 counties in the state marked "red" on the map health officials use to measure the pandemic's severity.

During one of Gov. Mike DeWine's daily briefings in September, his advisors explained the calculated risk of reopening nursing homes and other residential-care facilities.

"That human contact is so very important and so very essential, and yes we've tried to do that by computer and ultimately by outside visitation and it's been successful, but we know ... that that actual intimacy of being together matters so very much," said Jeffrey Davis, director of the Ohio Department of Developmental Disabilities.

That's why Ursel McElroy, director of the Ohio Department of Aging, said they've taken great care to help outline the detailed guidelines facilities must follow to minimize health risks associated with reopening.

Those guidelines include taking into consideration the level of virus spread in the community and in the facility. The guidelines also discuss adequate staffing, equipment and testing capacity, as well as local hospitals' capacity should there be an outbreak.

"The balance is making sure that we have the right guidance in place, but also being very clear that we are encouraging -- strongly urging -- that the connections that families want and need to have with their loved ones in the facilities and [for] themselves, that we're working toward that," Ms. McElroy said.

She sees the guidance as an instruction to open facilities, so long as they can meet all safety standards. But some facilities consider it a choice when or whether to open for indoor visitation.

Two new dashboards added to the state's coronavirus webpage -- meant to help families navigate visitation -- show that not all facilities are willing to take the risk.

Across Ohio, the dashboard shows only 63 percent of 1,230 facilities currently reporting to the state are open for indoor visitation.

In Lucas County, which was recently elevated to the second-highest threat level in the state's health advisory system, only 21 of the 43 reporting facilities offer indoor visits. In Wood County, which remains "orange" on the state's threat map, nine of the 16 reporting facilities do.

Four facilities in Lucas County said they offer no visitation at all.

Toledo-Lucas County Health Commissioner Eric Zgodzinski said he thinks it's right to leave it up to individual facilities to decide based on their staffing and space restrictions. He also recognizes that during an unpredictable pandemic, there may come a time where the amount of infection in the community or state could "drive additional decisions," which could include curtailing all visits again.

"The issue that we have right now is, what is the cost benefit?" Mr. Zgodzinski said, acknowledging the hardship the lack of visitation has had on families, residents, and congregate-care staff.

"Whether we're going to the store or going to school or going to work, there's always an increased chance of coming down with COVID-19 as we do more things outside of our home. Same thing here with long-term care facilities," he continued.

Some facilities are taking advantage of the opportunity now.

Genacross Lutheran Services-Wolf Creek Campus in Holland has not opened for indoor visitation in its nursing home building due to active coronavirus cases there, including four new infections reported this week on the state's dashboard. But it has allowed indoor visitation in the chapel for its assisted-living residents.

Because visits are held in rooms separate from residential care areas and the facility is following all of Ohio's prevention guidelines, Lorinda Schalk, senior vice president of finance and operations, said Genacross felt it was important to resume visitation as soon as the state allowed.

"We understand that family interaction and contact such as visitation is absolutely pertinent to our residents overall well-being," Ms. Schalk said. "We will begin nursing care visits as soon as we can after the positive cases fully recover."

At The Arbors of Oregon, Administrator Wendy Hartman-Hasselbach said her facility moved forward with indoor visitation because it was able to meet all of the state's guidelines.

However, John Stone, administrator at Merit House off Lewis Avenue in Toledo, said he will not voluntarily offer any indoor visits outside of compassionate care until a vaccine becomes available. In his mind, his facility doesn't have any active cases of the virus because it doesn't allow visits, and he worries that the facility will be blamed if visitors are allowed inside and an outbreak follows.

"Taking a chance with that stuff is scary," Mr. Stone said. "I just kind of want to hunker down and ride it out and have everyone trust us, that we're going to make the right decisions."

Mrs. Hawley's family understands the dilemma.

They miss their visits, and it hurts them to see the once-fit woman they love struggle to adjust to her new sedentary lifestyle. Because of the dementia, Mrs. Hawley doesn't understand why her loved ones are now separated by glass -- "She would be waving at me and she'd start to cry because I couldn't come in," Mr. Hawley recalled.

But they also understand Mrs. Hawley isn't the only resident that separation is meant to protect, so they "reluctantly" agree with the governor's shutdown order and the subsequent slow reopening. They just hope it doesn't rob them of the chance to hug her again.

"I don't want to kill somebody else's family member," Mrs. Hawley's sister, Mrs. Kontak said. "I don't know the solution to it."

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