Dina Halperin had been cooped up alone for three weeks in her nursing home room after her two unvaccinated roommates were moved out at the onset of the omicron surge. Im frustrated, she said, and so many of the nursing staff are burned out or just plain tired.
The situation wasnt terrifying, as it was in September 2020, when disease swept through the Victorian Post Acute facility in San Francisco and Halperin, a 63-year-old former English as a Second Language teacher, became severely ill with covid. She spent 10 days in the hospital and required supplemental oxygen. Since the pandemic began, 14 residents of the nursing home have died of covid, .
Over time, Victorian Post Acute has gotten better at dealing with the virus, especially its milder omicron form, which accounted for 31 cases as of Jan. 27 but not a single illness serious enough to cause hospitalization, said Dan Kramer, a spokesperson for Victorian Post Acute. But the ongoing safety protocols at this and other nursing homes including visitor restrictions and frequent testing of staff and residents can be soul-killing. For the 1.4 million residents of the nations roughly 15,000 nursing homes, the rules have led to renewed isolation and separation.
Im feeling very restless, Halperin said. She has Cushings syndrome, an autoimmune disease that caused tumors and a spinal fracture that left her mostly wheelchair-bound and unable to live independently. Although she has residual covid symptoms, including headaches and balance problems, Halperin, who has lived in the nursing home for nine years, is usually quite sociable. She volunteers in the dining room, helps other residents with their activities, and shops and runs errands during her frequent forays outside the building.
But covid infections are again spiking at nursing homes around the country. In California, 792 new nursing home cases on Jan. 19, compared with fewer than 11 cases on Dec. 19, 2021. However, the death rates are not nearly as bad as they were during pre-vaccine covid surges. From Dec. 23, 2021, to Jan. 23, 2022, 217 nursing home residents died of covid in California. By contrast, in just the week from Christmas 2020 to New Years Day 2021, 555 people died at nursing homes in the state.
Those numbers, and others cited in this article, dont filter out patients who entered hospitals for treatment of other conditions but a common occurrence during the omicron wave.
To keep nursing home residents out of overwhelmed hospitals, California public health officials have mandated masking and imposed strict vaccination and testing requirements for visitors and staffers at the homes, said Dr. Zachary Rubin, a medical epidemiologist with the Los Angeles County Department of Public Health. Our approach is to prevent cases from coming into the facility, stop transmission once it gets into the facility, and to prevent serious outcomes, he said.
Rubin acknowledged that some of these policies may seem like theyre doing more harm than good but only temporarily, he hopes.
The omicron surge has created staffing shortages as nurses and aides call in sick, and the strict testing requirements have the effect of limiting visits by friends and relatives who provide crucial care and contact for some residents, bathing and grooming them, overseeing their diets and medications, and making sure theyre not being neglected.
Nationally, a requires all workers in federally funded facilities to be fully vaccinated by Feb. 28. The deadline was extended to March 15 for 24 states that challenged the requirement in court. Last month, California issued a similar order, which also requires nursing home staffers to receive .
However, while vaccination rates for staff members and residents are high in California (96% for staffers and 89% for residents), only 52% of nursing home workers and 68% of their residents in California have received boosters, according to . At Victorian Post Acute, 95% of staff and 92% of residents had been vaccinated with boosters as of Jan. 27, Kramer said.
Across the state, many unvaccinated staff members . Others say they cant get vaccinated at their workplaces and dont have time to get shots on their own, said Deborah Pacyna, a spokesperson for the California Association of Health Facilities, which represents the nursing home industry in Sacramento.
Were going to have to deal with that as the deadline approaches. If theyre not boosted, does that mean they cant work? she asked. That would be an extraordinary development.
The state hasnt indicated how it will enforce mandates, especially for boosters, said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform.
Most nursing home visitors, as of Jan. 7, must be fully vaccinated including boosters, if eligible . Guests also a negative covid test taken within one or two days, depending on the type of test. The federal government is sending four rapid tests to families that request them, and the state of California tests to nursing homes.
Thats better than nothing, said Pacyna, but it may not be enough for families that visit several times a week. Some experts think any policy that tends to restrict visitors sets the wrong priority.
Limiting visitation is bad psychologically, said , a professor emeritus in social and behavioral sciences at the University of California-San Francisco who has done extensive research on nursing homes. social isolation and loneliness can lead to depression, worsening dementia and cognitive decline, anxiety, a loss of the will to live and increased risk of mortality from other causes.
Besides, Harrington said, most are caused by infected staffers, who often work multiple jobs because of the low pay.
Maitely Weismann visits her 79-year-old mother, who has dementia and uses a wheelchair, at a Los Angeles residential facility several times a week. Her mother deteriorated considerably during the initial lockdown, and Weismann is doing her best to slow her mothers decline, she said.
Its much harder to do this during the pandemic because there are so many barriers to entry, said Weismann, co-founder of the advocacy group Essential Caregivers Coalition. Family caregivers cant actually tell if a loved one is doing OK through a screen, or a window, or a phone call.
Responding to the critical health care staff shortages, the CDC issued emergency guidelines in December California followed suit in January that who have been exposed to or test positive for covid to return to work if they are asymptomatic.
It’s a short-term, last-resort measure, Rubin said. Its just not possible to adequately take care of people and do the daily activities of living if you dont have a nurse or caregivers. You just cant operate the place.
On one recent day alone Jan. 24 which is roughly a tenth of the combined staff in California nursing homes. To deal with the crunch, said Pacyna, were asking people to work extra hours, knowing that the peak is near and this isnt going to last forever.
In the meantime, families continue to worry about their loved ones. When residents are isolated, they become completely dependent on the caregivers in the facility, Weismann said. But when staff stops coming to work, the system falls apart.
This story was produced by , which publishes , an editorially independent service of the .
