Just as it’s crept into schools, hospitals and offices, omicron has made its way into California’s nursing homes and assisted living facilities, prompting warnings from industry leaders that they’re likely to need help from the state to shore up staffing in the coming days and forcing families to contend, once again, with visitor restrictions.
Leading up to Christmas, a few hundred health care workers at skilled nursing facilities across the state had COVID-19. But in the days after the holiday, the number shot up, to more than 5,650 active cases this week. Infections among residents, among the most highly inoculated groups in the state, have also started to rise. So far, thanks in large part to the vaccines, deaths have remained relatively flat.
“We have to be concerned that it’s going to continue to go up,” said Michael Wasserman, a geriatrician and immediate past president of the California Association of Long-Term Care Medicine.
In a bid to prevent cases from skyrocketing further, the state’s public health officer, Tomás Aragón, announced new rules for visitors to long-term care settings starting Friday — some of the strictest anywhere. People who want to see loved ones indoors must present both proof of vaccination, including, if eligible, a booster, and a negative COVID test result. People who are not fully vaccinated can visit outdoors, but are still required to provide proof of a negative test — within one day of visiting for antigen tests, and within two days for PCR tests. There are some limited exceptions, such as if a resident cannot leave their room.
The updated requirements have alarmed some advocates and families, bringing painful reminders of the early days of the pandemic when visitation ground to a halt, even as they desperately want to keep their loved ones safe.
“It makes me feel better in some regard, but the inconvenience is going to be problematic,” said Erika Shimahara, who regularly visits her elderly parents at a memory care facility in Redwood City. “If the facility could provide the tests, I would be all for that.”
Tony Chicotel, a staff attorney with the organization California Advocates for Nursing Home Reform, agrees.
San Francisco, which has a separate requirement that rapid antigen tests be performed on-site before visitors can enter nursing homes, has said its health department “will use its best efforts to supply tests for this purpose.” But it’s unclear how many tests will be supplied, with potentially thousands of visitors on any given day. And there is no similar statewide promise. “For a lot of folks,” Chicotel said, “they’re almost impossible to come by…I’m beside myself with frustration and sadness.”
He’s also concerned that some nursing homes could see the new visitor restrictions as an opportunity to cut corners.
“It’s substantially less safe without visitors,” he said, “and, you know, less fun.”
Shimahara worries about that, too. Earlier in the pandemic, her parents lived at a different facility in San Francisco where visitors had to schedule an appointment to stop by. Without informing her and knowing she wouldn’t be around, the facility sent someone to conduct a cognitive test on her mother, Shimahara said, which made her mom uncomfortable. Shimahara filed a complaint and the facility was cited. But, she said, “it’s an example of what can happen when you keep visitors out.”
For Wasserman, the idea of testing people amid a coronavirus surge where fully vaccinated people are regularly infected makes scientific sense. But he and others are troubled that members of the staff aren’t subject to the same level of testing.
“We’re asking significantly more of the caregivers and loved ones of residents than we’re asking of the facilities and the staff,” he said. “I believe that’s ethically wrong.”
Nursing home staff must be vaccinated and the state recommends they undergo regular testing for the virus. The California Department of Public Health did not immediately respond to a request for comment about the new rules.
Nursing homes were among the hardest hit places by the pandemic. Less than 2% of California seniors live in skilled nursing facilities, yet these congregate living settings with some of the most vulnerable residents have accounted for roughly 13% of the state’s COVID deaths. Assisted living facilities have also been devastated, and families have been forced to reevaluate care plans for elderly loved ones.
Industry groups say they’re already grappling with staffing shortages because of workers coming down with the virus.
“We definitely suspect we’re going to have some serious resource needs soon,” said Deborah Pacyna, a spokesperson for the California Association of Health Facilities, a trade association representing nursing homes and other facilities.
According to the latest state data, some facilities have dozens of positive workers — including 84 at Laguna Honda in San Francisco, 34 at Avocado Post Acute in San Diego County, and 47 at the Veterans Home of California in Los Angeles County. With people working overtime, nurse registries tapped out and counties thin on resources, Pacyna’s organization has warned the state that facilities are likely to need outside help in the coming days.
“A lot of facilities are on admissions bans right now,” she added, meaning they’re not accepting new patients because they’re dealing with COVID cases.
Christie Bilikam is grappling with that reality now. Bilikam, who cares for her husband, Ed, and his twin brother, Bob, was featured in a story last year by this news organization exploring how the pandemic has upended the already emotional task of caring for aging loved ones. Bob, like Ed, has dementia and he has declined rapidly in the last several weeks physically and cognitively. He was admitted to Stanford’s hospital shortly after the new year, and it quickly became clear that he needed to go to a skilled nursing facility rather than return to Bilikam’s home, where she and round-the-clock caregivers had previously provided for his needs. But the nursing homes they’ve reached out to are either not admitting new residents right now or asking families to sit tight while they sort out their policy.
“It’s in suspense,” Bilikam said. “We’re just muddling our way through.”
In many ways, so are the facilities.
“We don’t want to see an end to visitation,” said Pacyna. “We think it’s a fantastic goal to test everybody. We have absolutely no testing resources.”
William Snow’s father, in his early 90s, lives in a memory care facility in Palo Alto that recently moved to temporarily bar most visitors amid the latest surge. His mother, who still lives independently but visited her husband regularly, has struggled.
“She understands,” Snow said. “But it happened quickly and it’s been emotionally tough for her.”
Wasserman’s group recently passed a resolution urging the government to distribute tests to nursing home and assisted living facility workers and their families — disproportionately people of color, from communities hit especially hard by the pandemic — and residents’ families. Instead, many tests have gone to families with students and educators.
“Why aren’t we prioritizing nursing homes?” he asked. “It’s never been a priority throughout the pandemic.”
He’d like to see more transparent, vigorous discussion about elder care.
“We should never be in that position again where we’re treating nursing home residents as if they are incarcerated,” Wasserman said. “We should be better than this.”