As nursing home death and infection rates rise, how is isolation affecting seniors?

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic leader on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

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Photo: SalFalko via Flickr

As the U.S. enters what experts predict may be the most severe months yet of the COVID-19 pandemic, the number of infections and deaths among residents and workers in nursing homes is rapidly rising.

Much of the nation is experiencing a resurgence of COVID-19 cases, and perhaps no situation is more concerning than that of nursing home residents and workers. A report released Dec. 10 by two senators ― Ron Wyden (D-Ore.), ranking member of the Finance Committee, and Bob Casey (D-Penn.), ranking member of the Special Committee on Aging ― indicate an already-dire situation in nursing homes is worsening.

The report found that more than 15 nursing home residents died from COVID-19 per hour, with 19 residents dying each hour during the week of Nov. 22 alone. The number of weekly deaths from the disease has grown by 133% among nursing home residents and 96% among nursing home workers since Labor Day. Workforce shortages have increased since Labor Day: In November, with one in six nursing homes nationwide reporting they do not have a sufficient workforce.

“It’s with great sadness that we are once again giving a grim update on the toll that COVID-19 is continuing to take on nursing homes,” Wyden and Casey said in a joint statement. “It’s abundantly clear that inaction has contributed to the loss of more than 104,000 mothers, fathers, grandparents, friends and neighbors who lived and worked in nursing homes and long-term care facilities across the country.”

These new findings serve as a warning for what is to come if Congress does not work together to alleviate the COVID-19 crisis in nursing homes, the senators said.

“Experts are predicting that we are heading into the most severe months of the COVID-19 pandemic, marred by climbing caseloads and increasing stress on our nation’s health care system. We are once again calling on our colleagues to work with us to pass a comprehensive COVID relief bill to bring urgently needed help to nursing homes, residents and workers.”

This is the third time that the senators have sounded the alarm about what they describe as the Trump administration’s inadequate measures to stop the virus and its devastating effects on nursing homes and long-term care facilities. Two prior reports, “The Cost of Inaction: 11 Deaths an Hour” and “COVID-19 in Nursing Homes: How the Trump Administration Failed Residents and Workers,” offered several recommendations to address the crisis.

The reports called for comprehensive data collection, additional funding for state governments and nursing homes, adequate PPE and testing for facilities, investment in home and community-based services for older Americans, better support for nursing home workers including premium pay, overtime and other essential benefits, and upholding resident rights and resuming visitation safely.

Meanwhile, residents of long-term care facilities continue to struggle with social isolation and loneliness as facilities prohibit or limit visits by families and friends. Many residents remain confined to their rooms with little personal contact with the outside world. Social isolation significantly increases a person’s risk of premature death from all causes, rivaling those of smoking, obesity, and physical inactivity, according to the National Academies of Sciences, Engineering, and Medicine (NASEM). Social isolation also is associated with about a 50% increased risk of dementia.

Other research has linked isolation and loneliness among older people with worsening heart disease, diabetes, depression, increased mortality and higher health costs, said Carla Perissinotto, M.D., a geriatrician and associate professor of medicine at the UCSF School of Medicine.

“Loneliness and isolation are bad for our health at any age,” she said during a recent webcast. “We think it may be an increased stress response causing chronic inflammation. We’re seeing functional decline and decrease in cognition, and we don’t know how long this may last or if it’s reversible.”

Perissonotto recently led a study of older adults in the San Francisco Bay Area looking at the detrimental effect of shelter-in-place orders on community-dwelling older adults. She found that while many older people were adjusting to a “new normal,” more was needed to mitigate the severe loneliness experienced by many, as well as assistance in overcoming technological barriers that could help reduce isolation.

A survey of older adults in long-term care found they would rather risk catching COVID than remain alone and isolated, as I reported for Next Avenue in October. States and some counties have placed varying levels of restriction on nursing home visitation based on CMS guidance, but protocols vary and are subject to change.

CMS suggests allowing indoor visitation if there are no new cases of COVID-19 infection in the previous 14 days, so long as county positivity rates are less than 10%. Facilities must ensure visitors take adequate protective measures, including wearing PPE and undergoing temperature checks, and they should limit the number of visitors per resident (excluding end-of-life visitation).

While many facilities began lifting restrictions this fall, the increasing number of cases and deaths portend more stringent measures will again be necessary in many communities. Those vaccines — and the latest COVID-19 relief bill — can’t come fast enough.

Here are some questions to ask in your reporting:

  • Are COVID-19 infection rates increasing in long-term care facilities in your community?
  • Have visitor policies been revised or suspended because of this?
  • How are facilities addressing the ongoing mental health needs of residents and workers?

Two resources that can help:

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