Older people are generally far more vulnerable to pathogens, and the shared space of an elder-care home adds its own risks. More than 40 percent of those who have died from Covid-19 in the U.S. were residents or staff members at long-term care facilities, a New York Times database shows.
“We felt they were being responsive and protecting residents,” Dr. David Grabowski, a health care researcher at Harvard Medical School, said of the federal Centers for Medicare and Medicaid Services, which ordered the shutdown in March.
But studies have repeatedly shown that isolated older adults have elevated rates of heart disease, stroke and dementia and increased mortality rates, comparable to those linked to smoking. And in a study co-authored by Dr. Grabowski, nursing home residents with dementia received a better quality of care at the end of life if a family member visited regularly.
“Some have termed this isolation ‘involuntary confinement,’” said Dr. Christian Bergman, a geriatrician and internist at Virginia Commonwealth University. “We can’t continue down this path for another six months.”
In May, Medicare officials issued recommendations for state and local officials on phased reopening for nursing homes. It includes expanded visiting with masks and distancing when a home has entered Phase 3, meaning that it has had no new Covid cases for 28 days and can provide adequate testing and protective equipment, with no staff shortages.
Dr. Bergman, who heads a panel of health care professionals developing reopening guidelines for long-term care, estimated that fewer than 5 percent of facilities nationally have reached that point.
At facilities that have already resumed family visits, the most common approach has been scheduling brief contacts outdoors or encounters through windows, sometimes supplemented by video chat and phone calls.