But while most long-term care residents are now fully vaccinated, most other Americans are not, meaning there are still plenty of opportunities for the virus to reenter facilities. The threat is compounded by vaccine hesitancy among many long-term care workers. And there are unknowns about just how effective the vaccines are in protecting long-term care residents as a specific group.
“It’s OK to be optimistic,” says Jennifer Schrack, an associate professor in the epidemiology of aging at the Johns Hopkins Bloomberg School of Public Health. “But we still have to be diligent. This is a new disease. We don’t know how it’s going to behave. We don’t know how the variants are going to behave.… Just because you’re vaccinated doesn’t mean you can’t get it.”
That puts the country’s long-term care facilities in an awkward in-between phase. Getting back to a semblance of normal is now possible, but not without continued safety measures. Just how cautious facilities must be is “the million-dollar question,” says Schrack, who predicts that confusion and stumbles are inevitable.
Beach balls in the garden
The Jewish Home Family includes a nursing home and assisted living, where communal activities that were either heavily restricted or completely canceled during the pandemic are starting back up again. Nearly every resident except hospice patients, and around 75 percent of staff are fully vaccinated against COVID-19.
Residents can now eat with each other in the dining rooms, take exercise classes in the boxing gymnasium or rehearse for the upcoming annual musical, The Lion King, which had to be postponed last year.
Infection-control protocols still hold, including wearing masks, social distancing where possible and capping the number of people participating in each activity, in accordance with federal guidelines. But these activities represent some of the first opportunities for socialization that residents have had in months.
“In a lot of ways, we’re coming back to ourselves,” says Silver Elliott, who is calling the next few months of programming at the Jewish Home Family “Project Welcome Home.”
The toll of the past year on residents is clear, she says: “The cognitive decline is significant, and it breaks my heart.” Her facility’s activities are focused on ending isolation and revising restrictive environments as quickly as possible, while still being careful.
The Holly Heights Nursing Center in Denver is taking a similar approach. Now that the majority of the facility’s residents and staff are fully vaccinated, bingo and exercise classes are back on the agenda, as are some group meals. But precautions, such as masks and social distancing, continue.
And whenever possible, the center continues to follow federal recommendations for hosting activities outside, where the coronavirus is far less likely to spread. On a particularly warm day in early March, executive director Janet Snipes jumped at the chance to blow up beach balls and invite residents to pass them around in the garden, enjoying the sunshine.
“It was a lot of fun,” Snipes says. “After such a devastating year, you could see that spirits were starting to improve.”
Chomping at the bit for visitors
At many facilities, visits are also resuming. New recommendations this month from the federal Centers for Medicare & Medicaid Services (CMS), which regulates America’s 15,000-plus nursing homes, represent the most dramatic steps toward reuniting residents with loved ones since nursing homes were first shuttered to guests in March 2020.
Citing widespread vaccinations and drops in COVID-19 infections, CMS said “facilities should allow indoor visitation at all times and for all residents [regardless of vaccination status].” There are exceptions, including for residents who have COVID-19 or who are unvaccinated and in high-risk environments.
Fully vaccinated residents can choose to have close contact with visitors, the recommendations say, including touching and hugging while wearing a face mask and washing hands before and after. The CMS acknowledged “the toll that separation and isolation has taken” on residents and said “there is no substitute for physical contact.”
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