AUSTIN, Texas – About half of the residents at a nursing home tested positive for COVID-19 in recent weeks. Even in the face of the outbreak, some families urge officials to let them in to care for their loved ones.

“It’s some of the most pathetic circumstances you could put someone in right now,” said Rachel Finney, whose 90-year-old grandmother tested negative for the disease in Pflugerville Health Care Center, about 15 miles north of Austin. “Having a visit with family … would do a lot for her state of mind.”

Finney is among thousands of Texans waiting for the chance to see their loved ones in person inside nursing homes for the first time in six months.

Although state officials started allowing visitors inside facilities in August, the requirements that facility operators had to meet – including testing staff weekly and being COVID-19-free for at least two weeks – were so stringent that fewer than 10% of nursing facilities opened up.

Thursday, the state cracked the doors to all nursing homes, allowing up to two designated family members per resident to come in at any time to care for their loved ones. Some nursing home resident advocates fear the move would open the floodgates to COVID-19. Family members  argued that the disease can spread even under lockdown protocols that prevent them from entering.

“Their loved ones (inside nursing homes) are already being exposed to people,” said Mary Nichols, a North Texas resident and leader of Texas Caregivers for Compromise, a 2,900-member group advocating for family access into nursing homes. “Plumbers are going in. IT techs are going in. Nursing students are going in. There are so many untested people going in, and here we’ve got family members willing to be tested, willing to wear personal protective equipment.”

A petition asking for family visitations garnered more than 25,000 signatures over a three-month period.

‘Everybody is on edge’

Finney said her grandmother, who has dementia, has been having a hard time. Before the pandemic, most of her socialization came from her son and grandchildren. She had regular outings with her family and spent major holidays with them.

Since her home was locked down, her dementia has worsened, and she recounts events from decades ago as if they happened yesterday, Finney said.

“One thing I’ve noticed is that it’s getting harder for her to get out of her bed to the wheelchair. She’s just not getting out as much now,” Finney said. “No activities are happening. No music is happening. Everybody is on edge and scared for their lives. It must be a nightmare.” 

Finney said she would follow any safety protocols – including being tested, wearing personal protective equipment and conducting visitations outdoors – to be able to see her grandmother beyond glimpses through a glass window.

The outbreak at the center further stripped Finney of contact with her grandmother, who was moved into another room away from residents with COVID-19 and from her landline phone.

Finney no longer can hand off food to staff members to give to her grandmother.

Thursday, her grandmother refused to see Finney.

“It’s just so disorienting,” Finney said. “She doesn’t feel good pretty much all the time.”

Officials with the nursing home, which is operated by Indiana-based Chosen Healthcare, did not return requests for comment last week.

Pflugerville Health Care Center, which has about 95 residents, according to residents’ families, documented 48 resident COVID-19 cases and 10 staff cases on Tuesday. For weeks, the nursing home had documented only three cases, according to the Texas Health and Human Services Commission, which oversees the state’s 1,200-plus nursing homes.

The nursing home has seen two deaths from COVID-19, according to the latest data available from Austin Public Health.

The nursing home prevents family members from visiting, so it’s likely that a staff member infected residents. Texas requires nursing homes to test staffers weekly to allow visitors other than caregivers.

Sue Schnars, whose 44-year-old daughter, Ivana, tested positive for COVID-19, does not blame the staff or the nursing home for the outbreak.

They have treated Ivana, who is nonverbal and in a wheelchair, with compassion, allowed Schnars to video chat with her and texted Schnars every day with updates, she said. The Texas Health and Human Services Commission should be held responsible, she said, because it decided how nursing homes should operate during the pandemic, yet the virus continues to spread inside the facilities.

She said caregivers such as herself should have been allowed to enter the facility since the beginning of the pandemic because locking everyone out hasn’t kept the disease at bay.

“The most difficult piece is not being able to see her,” Schnars said. “I really hold the government responsible, because we are no more at risk of bringing this into a nursing facility than the staff that go home every day.”

‘She never smiled’

Schnars said she has noticed a change in Ivana’s demeanor in the times she has seen her through a window and the one time she took her to a doctor’s appointment.

“When I picked her up to take her to the doctor in June, she never opened her eyes. She never smiled. I had the music blaring in the van, and I was like, ‘Ivana, we get to be together,’ and she never smiled,” Schnars said. “She does that when she’s angry. She doesn’t have the cognition to understand where I am, and I’ve been her constant for 44 years.”

Schnars said that if she thinks about Ivana and her circumstances too much, she starts to cry.

“I’m not sleeping. If I think about it too much, my heart starts racing. But at the same time, what I keep telling myself is these people (the nursing home staff) wouldn’t be there if they didn’t have a calling to work with the elderly. And what they need from me more than anything right now is support,” Schnars said.

She looks forward to being able to visit with Ivana, do her laundry, read to her and decorate her room.

State officials started allowing designated caregivers to enter nursing homes Thursday, but resident advocates did not expect all facilities to be prepared to let outsiders enter.

“With the short time period between release of the rule and implementation, the learning curve for preparedness can be pretty steep,” said Kevin Warren, head of the Texas Health Care Association, which represents nursing homes and other long-term care facilities. “Facilities must develop visitation policies, testing/training policies for visitors, additional screening requirements and data collection requirements, as well as implement visitation schedules and coordination.”

Other states have allowed some family members to enter facilities, including in Minnesota, Indiana, New Jersey and Massachusetts.

All nursing homes must allow designated family caregivers to enter nursing homes at any time. Caregivers must follow certain testing protocols and can’t visit with a family member if they’ve tested positive for COVID-19. Nichols and her group are on the lookout for nursing homes that might take advantage of loopholes in the state regulations to prevent visitors from entering.

The benefits of allowing caregiver visits are worth the risk of COVID-19, said Patty Ducayet, the state’s long-term care ombudsman who advocates for resident interests.

Given how cautious the state has been in reopening nursing homes, Ducayet said she doesn’t expect there will be excessive visitors. She trusts the government will reduce visitations if there’s an increase in cases.

“What efforts were made to protect people’s health and safety really failed to take into account the psychological and physical effects of that separation from people who matter to residents,” Ducayet said. “What state officials have done with Texas nursing facilities and the essential caregiver is a very strong stance that almost gives the resident a right to this person.”

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