Dina Halperin had been cooped up alone for three weeks in her nursing home room after her two unvaccinated roommates were moved out at the onset of the omicron surge. 鈥淚鈥檓 frustrated,鈥 she said, 鈥渁nd so many of the nursing staff are burned out or just plain tired.鈥
The situation wasn鈥檛 terrifying, as it was in September 2020, when disease swept through the Victorian Post Acute facility in San Francisco and Halperin, a 63-year-old former English as a Second Language teacher, became severely ill with covid. She spent 10 days in the hospital and required supplemental oxygen. Since the pandemic began, 14 residents of the nursing home have died of covid, .
Over time, Victorian Post Acute has gotten better at dealing with the virus, especially its milder omicron form, which accounted for 31 cases as of Jan. 27 but not a single illness serious enough to cause hospitalization, said Dan Kramer, a spokesperson for Victorian Post Acute. But the ongoing safety protocols at this and other nursing homes 鈥 including visitor restrictions and frequent testing of staff and residents 鈥 can be soul-killing. For the 1.4 million residents of the nation鈥檚 roughly 15,000 nursing homes, the rules have led to renewed isolation and separation.
鈥淚鈥檓 feeling very restless,鈥 Halperin said. She has Cushing鈥檚 syndrome, an autoimmune disease that caused tumors and a spinal fracture that left her mostly wheelchair-bound and unable to live independently. Although she has residual covid symptoms, including headaches and balance problems, Halperin, who has lived in the nursing home for nine years, is usually quite sociable. She volunteers in the dining room, helps other residents with their activities, and shops and runs errands during her frequent forays outside the building.
But covid infections are again spiking at nursing homes around the country. In California, 792 new nursing home cases on Jan. 19, compared with fewer than 11 cases on Dec. 19, 2021. However, the death rates are not nearly as bad as they were during pre-vaccine covid surges. From Dec. 23, 2021, to Jan. 23, 2022, 217 nursing home residents died of covid in California. By contrast, in just the week from Christmas 2020 to New Year鈥檚 Day 2021, 555 people died at nursing homes in the state.
Those numbers, and others cited in this article, don鈥檛 filter out patients who entered hospitals for treatment of other conditions but 鈥 a common occurrence during the omicron wave.
To keep nursing home residents out of overwhelmed hospitals, California public health officials have mandated masking and imposed strict vaccination and testing requirements for visitors and staffers at the homes, said Dr. Zachary Rubin, a medical epidemiologist with the Los Angeles County Department of Public Health. 鈥淥ur approach is to prevent cases from coming into the facility, stop transmission once it gets into the facility, and to prevent serious outcomes,鈥 he said.
Rubin acknowledged that some of these policies may seem like they鈥檙e doing more harm than good 鈥 but only temporarily, he hopes.
The omicron surge has created staffing shortages as nurses and aides call in sick, and the strict testing requirements have the effect of limiting visits by friends and relatives who provide crucial care and contact for some residents, bathing and grooming them, overseeing their diets and medications, and making sure they鈥檙e not being neglected.
Nationally, a requires all workers in federally funded facilities to be fully vaccinated by Feb. 28. The deadline was extended to March 15 for 24 states that challenged the requirement in court. Last month, California issued a similar order, which also requires nursing home staffers to receive .
However, while vaccination rates for staff members and residents are high in California (96% for staffers and 89% for residents), only 52% of nursing home workers and 68% of their residents in California have received boosters, according to . At Victorian Post Acute, 95% of staff and 92% of residents had been vaccinated with boosters as of Jan. 27, Kramer said.
Across the state, many unvaccinated staff members . Others say they can鈥檛 get vaccinated at their workplaces and don鈥檛 have time to get shots on their own, said Deborah Pacyna, a spokesperson for the California Association of Health Facilities, which represents the nursing home industry in Sacramento.
鈥淲e鈥檙e going to have to deal with that as the deadline approaches. If they鈥檙e not boosted, does that mean they can鈥檛 work?鈥 she asked. 鈥淭hat would be an extraordinary development.鈥
The state hasn鈥檛 indicated how it will enforce mandates, especially for boosters, said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform.
Most nursing home visitors, as of Jan. 7, must be fully vaccinated 鈥 including boosters, if eligible 鈥 . Guests also a negative covid test taken within one or two days, depending on the type of test. The federal government is sending four rapid tests to families that request them, and the state of California tests to nursing homes.
That鈥檚 鈥渂etter than nothing,鈥 said Pacyna, but it may not be enough for families that visit several times a week. Some experts think any policy that tends to restrict visitors sets the wrong priority.
鈥淟imiting visitation is bad psychologically,鈥 said , a professor emeritus in social and behavioral sciences at the University of California-San Francisco who has done extensive research on nursing homes. social isolation and loneliness can lead to depression, worsening dementia and cognitive decline, anxiety, a loss of the will to live 鈥 and increased risk of mortality from other causes.
Besides, Harrington said, most are caused by infected staffers, who often work multiple jobs because of the low pay.
Maitely Weismann visits her 79-year-old mother, who has dementia and uses a wheelchair, at a Los Angeles residential facility several times a week. Her mother deteriorated considerably during the initial lockdown, and Weismann is doing her best to slow her mother鈥檚 decline, she said.
鈥淚t鈥檚 much harder to do this during the pandemic because there are so many barriers to entry,鈥 said Weismann, co-founder of the advocacy group Essential Caregivers Coalition. 鈥淔amily caregivers can鈥檛 actually tell if a loved one is doing OK through a screen, or a window, or a phone call.鈥
Responding to the critical health care staff shortages, the CDC issued emergency guidelines in December 鈥 California followed suit in January 鈥 that who have been exposed to or test positive for covid to return to work if they are asymptomatic.
It鈥檚 a short-term, last-resort measure, Rubin said. 鈥淚t鈥檚 just not possible to adequately take care of people and do the daily activities of living if you don鈥檛 have a nurse or caregivers. You just can鈥檛 operate the place.鈥
On one recent day alone 鈥 Jan. 24 鈥 鈥 which is roughly a tenth of the combined staff in California nursing homes. To deal with the crunch, said Pacyna, 鈥渨e鈥檙e asking people to work extra hours, knowing that the peak is near and this isn鈥檛 going to last forever.鈥
In the meantime, families continue to worry about their loved ones. 鈥淲hen residents are isolated, they become completely dependent on the caregivers in the facility,鈥 Weismann said. 鈥淏ut when staff stops coming to work, the system falls apart.鈥
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