WESTMORELAND — When Kathryn Kindopp heads to work every day, it feels like 2020 all over again.
The administrator of Maplewood Nursing Home in Westmoreland said she and her staff always wear N-95 masks and other personal protective equipment, including disposable garment covers and goggles in some cases. They regularly test themselves for COVID-19. Outside artists or community groups coming to visit residents remain rare due to strict requirements related to the viral illness.
“If you hadn’t been in a nursing home, you would think the world is almost back to normal. But in a nursing home, it looks like we are at the height of COVID,” Kindopp said. “Little has changed in care homes since the height of the pandemic.”
Kindopp and other nursing home leaders recognize that these precautions continue to protect their vulnerable residents. At the same time, she agrees with family members and caregivers who say lingering pandemic protocols are diminishing the quality of life for nursing home residents.
Of course, there are major differences between 2020 and 2022. Most residents and all staff are vaccinated. When there is a case of COVID, the prognosis is much better.
Despite this, the county-run nursing home is subject to strict regulations from the Centers for Medicare and Medicaid Services (CMS). These are based on recommendations from the Centers for Disease Control and Prevention. These two agencies have imposed strict rules, particularly around personal protective equipment and distancing, on nursing homes in hopes of saving lives, but Kindopp said years of requirements are hanging over residents and staff.
“We haven’t had much, if anything, relaxed,” she said.
A positive test and a closed door
Suzanne Stevens understands nursing home regulations on both sides. She is the former Director of Administrative Services for Covenant Living of Keene, a retirement community on Wyman Road.
Her husband and father were both in nursing homes before their deaths. Her great-aunt resides at Covenant Living and her mother currently resides at the Keene Center on Court Street. Stevens is the proxy for both.
Stevens’ mother recently recovered a case of COVID-19. The illness itself was fairly mild, but what was worse, Stevens said, was the fact that her mother had to keep her bedroom door closed during the outbreak, which included several other cases on her floor, and still had six active cases among the community on Friday, according to a spokesperson for the facility.
“She’s claustrophobic and she’s gotten depressed,” Stevens said. “All she wanted was for her door to be open.”
Residents aren’t required to keep their doors closed during a flu outbreak, Stevens noted, and she thinks COVID-19 should be treated the same way.
“It’s really not necessary at this point,” she said. “There is a hyper-response now.”
However, the policy of keeping doors closed during COVID outbreaks is a CMS requirement, according to Genesis Healthcare spokeswoman Lori Mayer. In addition to the Keene Center, Genesis owns the Applewood Rehabilitation Center in Winchester, Keene’s Langdon Place and the Pheasant Wood Center in Peterborough.
“We followed these guidelines to protect lives,” Mayer said.
COVID-19 is an airborne virus that can spread long-distance through the air, according to the World Health Organization. The flu is transmitted primarily through droplets from an infected person, so it requires less stringent precautions, according to CMS and CDC guidelines. Because of this difference, the infections are not directly comparable in terms of the precautions taken by CMS, Mayer said.
A letter to the director of the CDC
Kindopp’s main frustration is how the CDC measures the spread of COVID-19 and the associated requirements for nursing homes. The federal agency is tracking and reporting community levels of COVID-19. This measure takes into account the number of new cases in the population and the number of hospital beds occupied by COVID-19 patients.
As of September 21 and through most of the summer, Cheshire County had low community levels. The CDC does not recommend masks indoors when community levels are low.
However, the nursing home response is beholden to another measure: the CDC’s COVID-19 transmission levels. This metric takes into account new cases and the percentage of positive COVID-19 tests in the previous seven days in a given community. During the same period, the county of Cheshire had “high” transmission, the highest of the four ratings.
“These rates don’t allow for many positive cases before you need to have a high response,” including staff wearing full PPE, testing more often and staying six feet away from residents, Kindopp said.
Kindopp sees this as a Catch-22. The wider community is free to go about their daily lives without masking up, but this inevitably leads to more transmission of COVID-19. While this usually doesn’t have too much of an effect on the community as a whole, she said it has a huge impact on nursing homes.
“Nursing homes are being held hostage by what their communities are doing. The more people exercise their rights as citizens, the greater the impact on care homes,” she said. “I think we discriminate against our elders in nursing homes.”
She said she was so frustrated with the response that she wrote a letter to CDC Director Rochelle Walensky on August 8. She didn’t receive a response, so she contacted U.S. Representative Annie Kuster, who also sent her own letter to the CDC on Tuesday.
The CDC also did not respond to The Sentinel’s request for comment.
However, a CMS spokesperson said the agency has continued to update regulations throughout the pandemic to protect the physical, mental and emotional health of patients. For example, the agency now allows visitors to nursing homes.
“CMS recognized the physical and emotional toll the separation from family members and other loved ones has taken on nursing home residents,” the spokesperson said. “CMS worked with the CDC to provide guidance on how nursing homes could safely facilitate visitation while adhering to basic infection control principles.”
The primary focus for CMS and healthcare facilities, including those operated by Genesis Healthcare, continues to be preventing COVID-19 infections among nursing home residents, who are particularly vulnerable to serious complications, according to their interviews with The Sentinel.
People in nursing homes are at increased risk of serious illness and death because they are generally older and often have underlying health conditions. With many people living in close quarters, the virus can also spread rapidly in congregate care settings, according to the CMS spokesperson.
Mayer said Genesis must remain vigilant with testing, PPE and screening for COVID-19, especially as potential new variants continue to be a threat.
Some family members agree.
Amy Hathaway from Keene takes care of her 92-year-old father, who lives in Covenant Living. Her father is hard of hearing and Hathaway said she believes the mandatory masking has impacted her already limited social life. Still, she is in favor of precautions.
“That’s appropriate,” she said.
Her father, Vernon Martin, had COVID-19 three times. He has the cognitive ability to understand that wearing a mask reduces the risk of contracting the viral disease not only for him, but for the people around him. He has no problem wearing one, Hathaway said.
Still, she says now that COVID-19 is closer to endemic status — meaning it’s circulating regularly in the community — it’s hard to say where regulations need to be made.
“From a political point of view, should they have a choice [whether to mask]? It’s tough,” Hathaway said.
While nursing homes are indeed homes for their residents, CMS also considers them to be health care facilities. As such, there is an additional burden for disease prevention, according to the CMS spokesperson.
“As CMS and CDC will continue to seek opportunities to reduce the burden on infection control practices, we must remember that nursing home residents are particularly vulnerable to COVID-19 and severe symptoms, including death. , due to their age, underlying health conditions, and communal living environment,” the spokesperson said. “It is important that we ensure the appropriate practices are in place to reduce the risk of COVID-19 infection.”
For now, that includes the masking requirement, the spokesperson said. Regulations will continue to evolve as the pandemic continues.
“CMS will continue to work with the CDC to help protect nursing home residents from COVID-19 to provide the quality of care they need, while recognizing the need to reside in a home-like environment. a home, [and] to provide the quality of life they deserve,” the spokesperson said.
The NH Department of Health and Human Services had received complaints from family members regarding COVID-19 precautions, according to spokesperson Jake Leon.
“Sometimes it’s because families don’t like the CMS requirements, but far more often the complaints are about the stricter retirement home COVID-19 policies than CMS requires,” Leon said, without sharing specific examples. “In these cases, we are working to educate facility staff to try to align with current CMS guidance.”
Protection, but at a cost
With most residents vaccinated and treatments for COVID-19 more widely available, Kindopp thinks it’s time the regulations were relaxed. The risk of death from COVID-19 has decreased by 69% for people 65 or older living in nursing homes since January 2020, according to the CDC.
“[COVID] is still very contagious, but we have things we can do to lessen it or treat it,” she said. “It was awful and so many elders were lost, but that’s just not the case anymore.”
Residents should be able to choose whether they and the people around them wear masks, according to Kindopp.
“Why don’t our residents have the same capacities as citizens to make these choices? she says. “They are vulnerable and we must protect them, but at what cost?
Kindopp said she is particularly worried about residents who don’t have regular visitors. For them, the staff often becomes like family. For two and a half years, these residents have not been able to approach or see the faces of their loved ones, as staff are required to wear masks.
“Some residents say, ‘I’m not worried about catching COVID, I’d rather see their faces,'” Kindopp said. “It’s not just isolation, it’s like keeping people at a distance. It affects relationships. I just wonder if it’s all worth it.
- Slammed by COVID, NJ nursing homes must plan to prevent the spread of outbreaks under new law
- Nursing homes face the dilemma of vaccinating staff or not getting paid.
- Nursing homes need to invest in a more complex, tech-savvy patient, says Thrive Center CEO
- NJ has over 100 active COVID-19 outbreaks in nursing homes – NBC New York