What to Expect as Nursing Homes Ease COVID-19 Visitor Restrictions

As COVID-19 restrictions ease in parts of the country, window visits, patio visits and even drive-thru visits are reuniting residents of nursing homes and assisted living facilities with their family members. Unlike visits to nursing homes before the pandemic, however, these are carefully controlled encounters.

It helps to know what’s required as far as scheduling, infection prevention measures and physical distancing requirements, but prepare yourself emotionally as well. The “so close, yet so far” experience can be frustrating. Along with the happiness of finally being together after months of separation, initial awkwardness and even painful feelings can arise. Here’s what you might expect during these restored visits.

Drive-Thru Reunions

The concept of the drive-thru nursing home visit was really born from drive-in movie theaters, says David Pomeranz, chief operating officer for RiverSpring Health, which operates Hebrew Home at Riverdale in New York. With the need for physical distancing and the widespread desire to see loved ones in person, it seemed like a viable solution.

State health officials eventually agreed “after a lot of discussion and negotiation,” Pomeranz says, but strict criteria had to be met. “Nobody could come out of the car at all,” he says. “They couldn’t give (anyone) anything out of the car. We’d have to clean the speakers that go into the car and out of the car. The residents would have to be behind glass and never come into contact. And they’d have to be asymptomatic to come off their floors and be in those spaces.”

At Hebrew Home at Riverdale, residents wait in a vestibule, where they sit behind a window. The visitor pulls up to the window, which is about 6 feet away from the car. “They each have a speaker and they’re looking at each other through the window,” Pomeranz says. “But there’s no contact of any kind.” The separate two-way intercom units are sterilized between each use.

While not perfect, the arrangement brings family members back to the Hebrew Home campus and closer to residents than they’ve been in months. “It allows for some nice moments,” Pomeranz says, like parents holding up a baby to peek through the sunroof for great-grandparents to “meet” for the very first time.

The facility is doing up to 20 visits a day, Pomeranz says. Visitors schedule their time slots online. Visits generally last 10 minutes, although staff is accommodating and flexible as needed. Although residents and family members long for physical contact, most accept the drive-thru visits as a workable compromise. “Frankly, with the way things are going, it’s really the only game in town,” he says.

Some residents can’t resist asking: “Can’t I just go have a quick hug, or can’t I just do a quick kiss?” Pomeranz notes. “They’re understanding when you explain it to them. It’s a time like none of us have ever seen before, where we’re having conversations about being behind plexiglass.”

For the best visit possible, planning what you want to share in advance can help, Pomeranz says. It’s easier than trying to think it through in the moment, and you can make the most of your 10-minute window.

[See: What Are the Symptoms of Coronavirus?]

Strong Emotions

Joyce Silver Koch could not have been more excited when she got the June 10 call. Hebrew Home at Riverdale, where her husband is a long-term care resident, was launching drive-thru visits the next day: Did she want a time slot to come in?

Absolutely, said Koch, who jumped at the opportunity for the first live visit in months, ever since the facility went on lockdown to reduce the risk of COVID-19 transmission. She immediately prepared for a happy reunion.

Her granddaughter handcrafted several signs with messages: “I miss you.” “I love you.” “I’m so happy to see you.” Koch says she would hold the signs and show them to her husband “because we couldn’t even talk to each other (except) through a walkie-talkie.”

In 2017, Koch’s husband went to Hebrew Home for rehabilitation following a stroke. He later moved into the nursing home area and at one point was receiving hospice services, but recovered enough to discontinue. Eventually, the plan was to get him home. Instead, the pandemic intervened.

The separation was difficult. “By Memorial Day weekend, I started seeing more of a decline,” Koch says. “And I attribute it to being exacerbated by COVID.”

Anticipation for the inaugural drive-thru visit with her husband was high. In reality, the experience was mixed. Excitement around the launch actually made him self-conscious and embarrassed, and conversation was awkward, Koch says. Because of some difficulty with his voice, the walkie-talkie connection was challenging. And he didn’t realize it was only a visit.

“When the aide took him upstairs, he was so agitated and disturbed that I had left without him,” Koch says. “I cried the whole way home.”

Koch now uses these strategies to make visits go more smoothly:

— Arranging for her husband to leave the visiting area with an aide before she drives away.

— Scheduling less frequent visits and urging other family members to do the same.

— Visiting earlier in the day while her husband is at his emotional best.

— Smiling and staying upbeat. “Be the cheering section,” she advises.

— Reframing “Do you remember?” questions as “I remember when” statements.

Koch says her husband tries to put on a brave face, but she can sometimes see he’s distressed. “Then I’ll say to him, ‘Do you want me to come back?’ And he’ll say, ‘Yes.'” Until he tells her otherwise, she has no intention of stopping.

[See: 18 Gift Ideas for Nursing Home Residents.]

Walk-Up Window Visits

Some assisted living facilities offer window visits. For instance, family members wearing masks may sit outdoors on a front porch with a window into an indoor area. The resident, also masked, sits indoors and speaks with visitors through the screen of the slightly opened window.

In some cases, patio visits can take place entirely outdoors. Assisted living facilities should refer to guidance from state and local officials when making decisions about relaxed visitor restrictions, according to the Centers for Disease Control and Prevention.

Hearts Grow Fonder

The early pandemic put entire independent living communities on lockdown. Now, residents are gradually regaining the freedom to have visitors in their apartments.

With independent living residents, it’s a matter of encouraging rather than insisting that they take visiting precautions, says Mark Campbell, regional director of sales for Holiday Retirement, which operates senior living communities across the country. The vast majority of residents are willing and eager to comply.

Holiday Retirement is taking a phased approach to easing restrictions, depending on the individual circumstances of each community, Campbell says. Early on in the pandemic, he says, the organization took a conservative lockdown approach across the board.

“We essentially eliminated outside visits,” Campbell says. “We restricted access. We enacted temperature-taking and screening for every single one of our communities.” Only critical visits were allowed, and even mail delivery was modified, he says.

As new visiting stages are phased in, caution continues. “We obviously adhere to CDC guidelines,” Campbell says. “But we also look really closely and lean very heavily on county guidelines, the number of active cases and the growth rate in the individual counties where our individual communities are located.”

Visitors are advised to meet residents in their apartments, rather than common areas. They’re asked to have their temperature taken prior to visits, wear face masks and maintain social distancing throughout their visit in order to keep everyone safe. In general, sanitizing is a priority throughout every community.

Separation has made hearts grow even fonder, Campbell says. “People have been really excited to see their families,” he says. “And our residents were very excited.”

If your loved one lives in an independent living community, Campbell suggests the following:

— Don’t visit if you are exhibiting symptoms, have a fever or have traveled in the past 14 days.

— Wash your hands, wear a mask and practice social distancing.

— If you bring in supplies or care packages for family members, don’t share with other residents.

“Even if you’re visiting mom, wear your mask and stay 6 feet away,” Campbell says. “It’s best for her and it’s best for you.”

[See: Personal Protective Equipment (PPE): Definition and Examples.]

Bittersweet Moments

Lonna Whiting, a freelance writer in Fargo, North Dakota, has been visiting her mother regularly since 2013, when she moved to a long-term care facility. Her mother, who was diagnosed with Alzheimer’s disease at the relatively young age of 61, is in memory care.

“We had a lot of freedom before the pandemic to go and see her as often as we wanted to,” Whiting says. Early on, visits included dinner and other outings with Whiting and her partner — he has always participated in her care. “But she eventually progressed to the point where we physically couldn’t get her in and out a car, for example,” Whiting says.

Since March, the pandemic has made her mother’s world even smaller, says Whiting, who could only empathize from afar. “I imagine that it’s very confusing for my mom to understand why she has to be in her room all the time, when the urge for a lot of Alzheimer’s patients is to wander,” she says. “It makes them feel better and more secure when they can safely walk around and explore their environment.”

Her mother’s physical condition is another concern. “Since lockdown, my mom has lost 5% of her body weight,” Whiting notes. “She’s had multiple falls. That happened (before), but not as frequently.” However, the weight loss is an entirely new development.

In early July, Whiting made her first in-person visit to the nursing home. Before entering the facility, they were required to wear masks, take their temperatures, use hand sanitizer and go through a checklist to make sure they weren’t symptomatic, Whiting says.

Once cleared, Whiting and her partner were seated at a patio table. “They would bring my mom out 6 feet away from us,” Whiting says. “And she’d be masked, too.”

A few times, her mother has pulled off her own mask. Without staff members nearby, those instances become problematic, Whiting says. “I have to stay 6 feet away. It was like: What do I do now? I need to get this mask back on her, but I can’t touch her. So, I buzzed in and somebody came out and helped.”

In other instances, Whiting’s mother would sometimes stand and start wandering during outdoor visits. Normally, Whiting would be able to hold her hand and bring her back. But now, she worries when no one’s around because her mother’s at risk of falling. The bottom line, Whiting says, “If my mom’s going to fall, I’m not going to not touch her just because of the rule.”

Physical and emotional complications put an unavoidable damper on visits. “It’s constantly looking at how much she’s progressed in the months since COVID started,” Whiting says. “It’s seeing how different she’s become. At times, before COVID, she would recognize us on occasion. Now, there’s no recognition at all. She seems really confused and agitated.”

In contrast to Skype calls, Whiting says in-person meetings with her mother are more bittersweet. “It’s having that deep instinct to want to hug her and hold her hand, and make her feel better and soothe her — and you can’t do that. Having that instinct and not being able to act on it is very difficult.”

Despite the emotional stress of these visits, Whiting believes it’s worth the effort for family members to keep visiting. “Just show up anyway,” she says. “Because you don’t know what’s going to happen and you’ll still feel better having gone. Even if your loved one doesn’t understand or recognize what’s happening, you do — and you know that you’re there for them, regardless.”

More from U.S. News

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What to Expect as Nursing Homes Ease COVID-19 Visitor Restrictions originally appeared on usnews.com

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