For the first time in four months, families will be allowed to visit their loved ones inside senior care homes, as Minnesota health authorities cautiously lift lockdown restrictions meant to prevent the spread of the novel coronavirus among vulnerable older adults.
The Minnesota Department of Health is recommending that nursing homes and assisted-living facilities allow certain family members and outside caregivers inside these facilities to help monitor residents' care and alleviate the harmful effects of prolonged isolation and loneliness. These "essential caregivers" will be designated by the facilities and will be allowed to make scheduled visits lasting up to three hours a day, or until caregiving tasks are completed, under new guidelines issued Friday.
The announcement marks the most significant step so far toward the reopening of Minnesota's 1,700 senior care communities, which have come to resemble locked fortresses since the pandemic began. With virtually all visitors barred from nursing homes since mid-March, senior home residents have endured months of wrenching isolation in their rooms.
Across the state, seniors have not hugged or kissed their loved ones for months. Adult children have resorted to waving at their parents from a distance and talking to them through cracks in windows, like visitors to prisons.
"Words cannot express how significant this [guidance] will be for families," said Dustin Lee, chief executive of Prairie Senior Cottages, which operates seven assisted-living and memory care homes statewide. "This has already brought such intense relief that families have been calling us, quite literally, with tears of joy."
Amid encouraging signs that COVID-19 is abating in Minnesota's senior homes, state health regulators are publicly recognizing the critical role that family members play in the care of vulnerable seniors as well as the significant risks posed by isolation and loneliness. It also reflects a growing recognition that while coronavirus outbreaks could stretch on for months or even years, seniors in care homes cannot be cut off from their support networks indefinitely.
Prolonged isolation has been linked to a wide range of serious health problems in older adults, including heart disease and stroke. As a risk factor for early death, social isolation now eclipses obesity, according to national research. At least two residents of Minnesota nursing homes have died partly due to social isolation related to COVID-19 restrictions, according to a Star Tribune analysis of death records.
"Some of the most heartbreaking stories of the whole epidemic, frankly, involve the separation of loved ones from their families and the very real psychological and physical harm that isolation causes," Health Commissioner Jan Malcolm said in an interview Friday. "I think many of us have family and friends in that very situation and we have seen the really incredible toll that [isolation] takes."
Some families said they have become so troubled by the prolonged confinement of their aging relatives that they have considered removing them from their senior homes and bringing them home.
"It's been torture," said Karen Schneider of Coon Rapids, whose 91-year-old mother moved into an assisted-living facility in March after she suffered a stroke.
Schneider said her mother, a former factory worker, has recovered physically from the stroke but is starting to show mental and emotional stress from spending months confined to her room with little human interaction. In recent telephone calls with her children, Schneider said her mother has broken down and pleaded to be taken out of the facility. "She will cry and say, 'Get me out of here, get me out of here, I'm going downhill,' " Schneider said. "It's just killing my mother not being able to see her children and friends."
Lee said the severe lockdown measures were necessary at first, but he has become increasingly concerned that they were eroding the health of seniors living at his homes. In recent weeks, staff at his facilities have noticed increased levels of anxiety, depression and insomnia among residents at Prairie Senior Cottages stemming from their sense of isolation. Several of his homes have seen an increased number of falls as residents have become more disoriented without human contact, he said.
"They say social isolation is deadly, and I agree," said Lee, who expects to begin allowing visits early next week. "When you're not connected to others, you lose part of your humanity."
The decision to permit limited indoor visits by relatives and outside caregivers is the third time in the past month that state health authorities have relaxed lockdown restrictions on senior homes. In mid-June, people were allowed to visit their loved ones through the windows of their facilities. Then they were permitted to visit with them outside, provided they wore face masks and avoided touching. It marked the first time in months that many vulnerable residents had seen their loved ones in person, without the use of video conferencing technology.
The state's latest loosening of restrictions comes amid signs that the pandemic is finally ebbing in long-term care settings after ravaging hundreds of facilities this spring. The weekly death toll in long-term care settings has declined significantly since early May, and several nursing homes that had large and deadly clusters of the virus have reported no new cases for several weeks. Overall, however, long-term care facilities continue to account for nearly 80% of the deaths from COVID-19, state health data show.
"We know it has been a long four months for our residents and essential caregivers," said Patti Cullen, president and CEO of Care Providers of Minnesota, a long-term care industry group. "We hope that this designation will provide the needed support as an interim step until it is safe to resume visitations on a broader scale."
Under the new guidance, senior care homes are encouraged to work with families to develop a process for designating certain people as "essential caregivers." These caregivers can be a family member, friend or volunteer who provided regular care and support to the resident before the pandemic. The move is a recognition that a resident's relatives and close friends are often the most invested in their care, and can be best positioned to detect changes in their condition and advocate on their behalf, officials noted.
The new guidance is voluntary, which means that some nursing homes and assisted-living facilities may not permit the visits. Essential caregivers must also comply with a number of rules, such as wearing face masks and eye protection while inside the facilities and maintaining physical distancing. Visiting caregivers won't be allowed to take residents into the community except for essential medical appointments. They should also not visit residents who have COVID-19 or who have experienced symptoms, the guidance states.
In some cases, senior home residents may be able to designate more than one essential caregiver based on their daily needs and past involvement. Long-term care facilities have until July 25 to draft policies and prepare to implement the new visits.