For months, families have pined to see their loved ones who live in California's skilled nursing facilities, which have been shut down to outside visitors to keep the coronavirus from spreading.
California health authorities recently issued guidance for visits to resume, but few are happening as infection rates surge in many communities. Facilities are being cautious after many suffered severe outbreaks earlier in the pandemic.
"I'm desperate at this point," said Sue Mathis, who hasn't seen her 94-year-old mother in San Francisco in four months. "My mother calls me crying, sometimes several times a day, begging me that she wants to see me, and when will she see me, and will she be able to see me before she dies. It's crazy."
California's skilled nursing facilities closed to visitors in March, but their residents still have been among the hardest hit by the pandemic because many are elderly, frail and live in close proximity. Statewide, the facilities account for about 40% of California's nearly 7,000 deaths.
For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some — especially older adults and people with existing health problems — it can cause more severe illness, including pneumonia, and death.
Families have relied on phone and video calls to stay in touch with loved ones. In some cases, they can chat through windows at the facilities. But these visits can be challenging for residents with impaired vision or hearing or cognitive difficulties.
Under California's new guidance, indoor visitation is limited to one person at a time and only may occur if there's adequate staffing, testing and no new virus cases in a facility for 14 days and a decline in new cases, hospitalizations or deaths in the surrounding community — a combination of standards few can meet. Otherwise, facilities are supposed to allow outdoor visits and follow infection control protocols.
Rodger Butler, a spokesperson for California's Department of Public Health, said outdoor visits should be allowed even in facilities reporting virus cases, though local health officers can choose to limit visitation if they feel it's too risky for nursing home residents.
Tony Chicotel, staff attorney for California Advocates for Nursing Home Reform, said the state's guidance hasn't made much difference yet.
"I have not heard from anybody since the new policy went into place on June 26 who said, 'Hey, I am now able to visit my loved one in a nursing home, at least outdoors,'" he said.
DeAnn Walters, director of clinical affairs at the California Association of Health Facilities, said outdoor visits need to be monitored and require staff time, and facilities might be reluctant to take that on while dealing with virus cases.
"Having some kind of safe visit really is important," Walters said, but added, "just because one entity says, 'Hey, this is OK,' we still have to be responsive to our other agencies that guide us."
The American Health Care Association/National Center for Assisted Living isn't tracking each state's rules or procedures but says more are allowing visitation or will soon. Many relatives say the prolonged isolation and lack of activities for residents, who are largely confined to their rooms, has contributed to a decline in their loved ones' mental and physical health.
Chaparral House, a skilled nursing facility in Berkeley, created special procedures for outdoor visits for residents who can't join in video chats because of their health conditions or if they are dying, said KJ Page, the facility's administrator. Visitors must make appointments, wear masks and get tested for the virus.
Larry Yabroff, 78, has been able to visit his wife, Mary, who has Alzheimer's, under these conditions. She couldn't grasp video chats and became agitated during window visits, he said. So he wears a mask, gets tested regularly for COVID-19 and largely stays home except for walks — and the handful of times he has gone to see his wife.
On Friday, he had his temperature taken at the front entrance to the facility before being escorted around the building to a garden out back. His wife was brought out in a wheelchair, and they sat on a bench and talked.
"I enter into her reality, whatever it is, and that is calming for her," he said. "She is definitely happy to see me, which is a blessing."
Page said the facility wants to offer outdoor visits to more residents, but it won't without approval from city health officials.
"God forbid we reopen, and everybody gets COVID," she said.
Tim Carlson, compliance officer at the Los Angeles Jewish Home, said the facility is planning to hold outdoor visits once county health officials approve. It is also looking at ways to cope with the at-times sweltering Southern California heat, possibly by creating a tiny module with two compartments to allow for cooler — and separate — air.
Before the state guidelines were issued, some nursing homes came up with creative ways to provide for outdoor visits. At Vienna Nursing and Rehabilitation Center in Lodi, California, residents were brought out to an open air patio enclosed by a wrought-iron fence, and relatives could make appointments to see them from a spot on the public sidewalk nearby, albeit over the din of traffic.
Mia Hanna said she had only seen her 91-year-old mother on Skype calls until last month when she got a visit at Monte Vista Grove Homes in Pasadena, which had installed a plexiglass booth. Her mother wanted to reach out and hug her, she said, but the visit, at least, was something.
She hoped to continue the booth visits but said the facility canceled them after a worker tested positive for the virus.
"There has to be a better way," Hanna said, adding her mother likely needs to undergo surgery this summer. "These are the last months on earth, and I'm spending them on Skype with her. I try to be grateful about that, but it's not the same."