Nursing homes have relied on lawns and patios for visits. What will happen as weather grows colder?
New York state nursing homes were permitted to reopen for visitation in July, and since then, many have limited visits to outdoors, keeping families on lawns and patios while taking advantage of the warm summer and early fall weather.
But now, in mid-October, many question what will happen as the temperature drops.
On a warm, mid-August afternoon, Albert Pautler visited his wife, Marilyn Pautler, at the Elderwood nursing home in Lancaster.
Like many Western New York nursing homes, Elderwood at Lancaster only offers outdoor visitation. The nursing home agreed to bring Marilyn Pautler to a screened-in back porch, so long as her husband sat on the other side of the screen and behind a yellow piece of tape.
“The yellow line, that’s where we have to sit behind and then she’ll be behind that square [on the porch],” explained Ann Pautler, the couple’s adult daughter, who also joined for the visit.
Once a staff member wheeled Marilyn Pautler onto the porch, the family chatted about Marilyn’s day, reminisced about her winning $600 off a lottery ticket she got for her birthday this year, and discussed what they’ll drop her off for dinner that night.
Albert and Ann Pautler appreciated the half-hour, outdoor visit. It was the closest they’ve got to their wife and mother since the COVID-19 pandemic closed nursing homes across the U.S. in March.
“Bittersweet,” Ann Pautler said of the visit. “So there's the excitement of seeing her, and then the 30 minutes goes faster than you could ever imagine, and then when they wheel her away, it's very tough.”
However, these outdoor visits may not be possible for much longer. The cold weather will almost certainly soon prevent nursing homes from bringing vulnerable residents outside for extended periods of time.
Following their August porch visit, the Pautlers haven’t been able to visit since September due to COVID-19 cases at the nursing home, as state guidelines say a nursing home must be 14 days COVID-free before allowing visitors. The family is unsure whether visits will be outdoors or indoors once they can resume.
“I hope to goodness that they have a plan in place because there's no way that we're going to have our loved one sit out there and be cold,” Ann Pautler said.
"We're just in limbo because we don't know what they're planning or how they're planning to do it,” Albert Pautler added.
Advocates for nursing home residents are also worried whether nursing homes will offer indoor visitation once the weather grows colder.
The Center for Elder Law and Justice, a nonprofit Buffalo legal agency for older adults, has called on the New York State Department of Health, which regulates the state’s 613 nursing homes, to better align its visitation guidance with guidance from the U.S. Centers for Medicare and Medicaid, which regulate nursing homes at the federal level.
The federal guidance issued last month says outdoor visitation is preferred because the increased air flow decreases the risk of transmission, but that indoor visitation should be accommodated. The state guidance says visits should be held outdoors, and only “under certain circumstances” be held inside, in a well ventilated space with fewer than 10 people. CELJ worries that the state’s language is not as forceful and could lead nursing homes to not offer visitation even when they are eligible to.
Also, while the federal government permits in-room visitation, New York state “strictly prohibits” it, unless under special circumstances.
“So right now we're waiting for the Department of Health to release an updated guidance that complies with the federal guidelines because there's a lot of discrepancies,” said CELJ attorney Bria Lewis. “It's just really important now that we're approaching these colder months that residents are allowed to see their visitors inside. It's also not the best for them to be outside during these colder temperatures. So it’s just really imperative that the guidelines are updated.”
A state Department of Health spokesperson, Jeffrey Hammond, did not directly respond to a question about how many nursing homes are currently allowing indoor visitation. In a statement, he said approximately 63% of the state’s nursing homes are currently eligible to allow some form of visitation.
“As this unprecedented pandemic evolves, we’ll continue to closely monitor the data and review requests, while also acknowledging that this pandemic is not over and people are still at risk,” Hammond said.
Even nursing homes are arguing for less restriction on visits. The New York State Health Facilities Association, a trade group representing 400 nursing homes and assisted living facilities, wrote a letter to Gov. Andrew Cuomo last week, asking him to drop a new requirement that nursing home visitors get tested within a week of their visit. NYSFHA says New York should follow the federal guidance, which only mandates visitors get tested if they live in counties with a high infection rate.
Schofield Residence, a 120-bed nursing home in Kenmore, has had over 530 outdoor visitors since July; it’s twice had to pause visits over the last five weeks due to COVID-19 cases. Schofield Residence is currently planning how it will offer indoor visits but it has no definitive date for when that will happen.
“We're looking at how we can restructure some visitation locations within our building that will allow us to maintain six feet apart and give us enough space so that we can be socially distanced, while also giving as much privacy as we can for people visiting,” said Schofield President and CEO Randy Gerlach.
Lewis said she understands nursing homes may be cautious to allow visitors inside their buildings. A state Department of Health report from July found that visitors, as well as staff, likely unknowingly carried the virus into nursing homes in February and early March, leading to the state’s more than 6,000 nursing home deaths.
“But the state has done a pretty good job of now controlling the spread of COVID. That risk that was present a few months ago is not as present anymore,” she said. “I think that nursing homes should still be cautious, but they should still open the facility for families to come in and see the residents because the residents have a right to receive visitors, and right now the restrictive visitation ban is doing more harm than good to these residents and their facilities.”
Families should advocate for indoor visitation by calling their state representative, or just addressing their nursing home directly, Lewis said.
“The Department of Health right now makes it clear that visits are allowed inside of a well-ventilated area when the weather is inclement. So residents and family members can present this notion to the staff of the facility and see what they can do in order to facilitate indoor visits,” she said.
For the Pautlers, they’re unsure what they’ll do. Ann Pautler has been hoping New York will allow families to designate an essential caregiver who could enter the nursing homes to take care of their loved one’s needs. A bill was just introduced into the state Assembly last week to do just that.
However, after the recent COVID outbreak at Elderwood at Lancaster, Ann Pautler said she is willing to wait to enter the nursing home if it means keeping her mom safe.
“Now I'm just worried that if they open the gates and let families in … there may be a bigger problem,” she said. “Basically I feel that we're playing Russian roulette, and at some point, the ball’s going to stop at Room 204. I truly feel that we've dodged a lot of bullets since March and my mom has been fortunate. But one of these times, we may not be so fortunate, we may be told that our loved one has just tested positive.”
Albert Pautler is 85 years old. With no end in sight to the pandemic or the visitor restrictions, it’s been difficult for him to now know if he’ll ever be able to hug or kiss his wife again.
“Either of us could go down at [any] time,” he said. “Might never be able to touch each other. I could go down, she could go down. It’s a tough time to live. After 62 years of marriage, tough.”