California nursing homes limit social visits, ramp up prevention as coronavirus hits elderly

Mar. 10--For the dozens of seniors who regularly arrive at the Stanford Settlement Neighborhood Center to play bingo every morning, the daily ritual is still unchanged. At least for now.

But the looming danger of COVID-19 was still important enough that the senior center's executive director, Julie Rhoten, gave a talk on hand washing before lunch was served Monday. About 35 people filled the building on West El Camino Avenue.

Ronny Speir, 83, a regular at the senior center, said he wasn't sure whether the illness is being over-hyped. He's become worried that some of the broadcast stations -- on the left and right -- are publicizing it too much.

"I do the standard thing that I do all the time. I keep my hands clean, keep my fingers out of my eyes and nose," Speir said. "I've become a little more careful. I don't know what to visualize with this thing."

Public health officials in recent days have stepped up their response to the challenge of COVID-19, suggesting seniors and the medically vulnerable limit close contact with others, reconsider their travel plans and consider stocking up on supplies in case of an outbreak. The American Health Care Association, a leading group for the long-term care industry, recommended limiting most non-essential visits in the thousands of nursing homes and assisted-living centers across the country.

The group also suggested cutting back on large public gatherings and social outings, and allow for remote communication.

"Our priority right now is to prevent the virus from getting into long term care centers and if it does get in, to prevent it from spreading," Dr. David Gifford, AHCA's chief medical officer, said. "We believe providers must take dramatic action to limit individuals from entering our buildings and to ensure that employees who are sick stay home."

The number of confirmed cases in California continues to mount, reaching at least 167 as of Tuesday. And the state has seen two deaths. Close to 800 have tested positive for the illness across the country, with the most lethal outbreak focused on a nursing home in Washington.

Sacramento County's Department of Health Services last week encouraged health facilities to "consider re-evaluating visitation policies." The department said any visitor with symptoms of a respiratory illness should be blocked from visiting patients and residents and that only two visitors at a time should meet with particularly vulnerable loved ones.

Directors of nursing homes, assisted-living facilities and other health care organizations say they are relying on the guidance to decide whether to restrict visits or alter day-to-day activities. How it's interpreted varies from facility to facility. Some 370,000 people reside in nursing homes in California. Far more of the state's population over 65 are active and mobile.

"We want to do everything we can to keep our residents safe from exposure from any illnesses," said Robert Godfrey, executive director of the Pioneer House in downtown Sacramento. "This is right in the middle of a normal flu season. This added illness that is now nationwide and global is just one more thing."

Godfrey said Pioneer House last week began restricting visits with its roughly 49 most vulnerable residents on the skilled nursing ward. They are dissuading all visits -- including from those who are healthy -- though Godfrey said if families show up, they'll be allowed to meet.

At the Stanford Settlement Neighborhood Center, Rhoten said: "From what we know today the risk is worth it to stay open at this point. That could change at any time." The Centers for Disease Control and Prevention said this week that older adults and people with chronic conditions like heart disease, diabetes and lung disease are more vulnerable, the federal agency said. If an outbreak occurs, the CDC said susceptible people should stay at home as much as possible.

ACC Senior Services, which operates several facilities in the Greenhaven and Pocket areas, also began limiting visitation, said the organization's CEO Derrick Lam.

They told the families of its nursing home residents to reconsider visiting if they have respiratory symptoms or recently traveled to countries identified as high risk by the CDC, Lam said. And they've posted signs in the assisted-living area for visitors and residents to check in and be screened.

Lam said he is awaiting guidance from the California Department on Aging on how to manage Meals on Wheels deliveries throughout Sacramento County. An early plan would ensure seniors get three to five "shelf-stable" meals at once but needs a final approval.

"The most difficult thing is independent living because those are apartment complexes," Lam said, meaning residents usually live alone and are not as restricted. "We have informed the individuals about this situation but it's hard to manage."

COVID-19: A risk for seniors

COVID-19's threat to older populations in Northern California became clear last week when a 71-year old Rocklin man died after testing positive for the disease. It was the first known death from the new coronavirus in California.

The man, who was isolated at a Placer County hospital when he died, was among the passengers on a cruise ship who disembarked from San Francisco last month.

The episode fits squarely within what's known about the population who is most at risk. The demographics for confirmed cases skews toward middle-age, but the death rate increases in older patients, according to a study of the outbreak by the Chinese Centers for Disease Control.

The evidence from China, where COVID-19 has been widespread, is grim but the outlook worsens the older the patient. The China study -- one of the largest examinations of the outbreak to date -- measured the death rate of nearly 45,000 people as of Feb. 11.

More than half of the 1,023 people who died were over the age of 70.

The global death rate for COVID-19 is still a moving target but the World Health Organization announced that it currently lurks at 3.4 percent.

Princess Cruises said an investigation determined the Placer County man was already infected before boarding the ship. The company, owned by Miami-based Carnival Cruise Line, said 21 people onboard subsequently tested positive for COVID-19.

Seniors group cancels meeting

LeadingAge California, a statewide advocacy group for seniors, canceled its annual affordable housing rally and meet and greet with lawmakers that was planned for next month. Organizers said the event typically draws as many as 200 people but decided against it after the news of the first death.

"We decided to cancel it out of an abundance of caution because we didn't want to have seniors on the capitol grounds if there's an outbreak just for their safety," said Eric Dowdy, LeadingAge's government affairs officer.

The California Department of Public Health suggests containing the virus by washing hands and staying away from work if feeling sick.

No restrictions have been placed on gatherings or travel in the state.

Since early February, the state public health department has issued three letters to all nursing homes and other health facilities in the state, advising them on how to prepare for a possible COVID-19 infection and prevent it from further spreading.

"The most important action skilled nursing facilities can take is to screen visitors for signs and symptoms of respiratory infection and restrict visiting if symptomatic," a spokesperson said in an email.

There is no vaccine. However this week the Centers for Medicare and Medicaid Services said it would begin covering the COVID-19 test for people who believe they have symptoms. Gov. Gavin Newsom also ordered insurance companies to cover the cost of the test after declaring a state of emergency.

"It's the active adults I'm most concerned about because they may be planning a cruise or may know somebody that did go on a cruise," said Tatiana Fassieux, a training specialist with California Health Advocates, a group that represents Medicare beneficiaries in the state.

"Being exposed during a social event with friends that may have been on a cruise, that's something people don't normally think about."

Fear of isolating seniors

Forcing older adults into isolation to protect their health has a downside that could leave some reeling. Loneliness has been shown to have a damaging effect on the mind, particularly for the aging.

A quarantine of health facilities is not unheard of but still pretty rare, said Joseph Rodrigues, the California long-term care ombudsman.

"Sometimes in years when the flu season is really bad, they can go into a lockdown. So it's not unheard of -- it's just so drastic because residents have a right to see visitors," Rodrigues said. "That can have a devastating impact on their psychological well being. It could be necessary but that's really a worst-case scenario."

For now, Julie Rhoten, the Stanford center's executive director, said they're taking it "day by day" as the guidelines from public health officials change. She said they're hesitant to stop programs since so many rely on the center to connect.

"Isolation is what prevents seniors from aging safely and healthily in their home," Rhoten said. "It would be a very serious risk for us to have to close the senior center."

It couldn't be truer for daily visitor Ruth Standley, 74, of Sacramento, who comes every day to swap stories and gossip. Lately, the coronavirus has been on everybody's tongue; how it's especially troublesome for the elderly.

Standley found all the fuss about hand-washing to be a little redundant. And the alarm a little overblown.

"Every day it's something different and they say it's like the flu," Standley said. "I am not concerned about this. It's not anything that I have control over."

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