After a year of birthday celebrations behind plexiglass, air hugs and socially distanced window visits, local nursing home residents who are fully vaccinated against the coronavirus can enjoy standard in-person visits with family for the first time since last spring.
On March 10, in a step toward post-pandemic normalcy, the Centers for Medicaid and Medicare Services announced updated nursing home guidelines with revised visitation recommendations.
The policy guidance comes as coronavirus cases and deaths among nursing home residents have plummeted in recent weeks at the same time vaccination rates have accelerated.
In Pennsylvania, nearly one million people aged 65 and older have been vaccinated and more than 390,000 total vaccine doses have been administered to long-term care facilities as of March 20, according to the Pennsylvania Department of Health.
In the release, officials acknowledged isolation deepened the misery for residents at nursing homes.
“There is no substitute for physical contact, such as the warm embrace between a resident and their loved one,” CMS said in the statement. “Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.”
Matthew Richardson, an administrator at Hearthside Rehab and Nursing Center, said the updated CMS guidelines come at a time when the center needs it most.
“Over the last year, our residents have been deeply affected emotionally and spiritually because of the distance,” Richardson said. “[The facility staff] can do our best to stay optimistic, but nothing can really compare to the reassurance a family member can bring.”
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While the guidelines specify fully vaccinated residents, visitors do not need a coronavirus test result to see family nor do they need to show proof of vaccination. However, they are encouraged to seek out any opportunity to do so.
Richardson’s team at Hearthside has started to adjust its protocols and ease into the next phase of visitation, but he stressed the importance that a transition this big takes time.
“We’ve got a long way to go to even think about normalcy,” Richardson said. “But it’s in those moments when you see a little boy hug his grandfather for the first time all year when you think to yourself, ‘All of the struggle leading up to this point was worth it because we got here.’”
Hearthside has followed DOH guidelines — including health monitoring of staff and residents, temperature checks and sanitizing, according to Richardson. He said the facility has reintroduced extended dining hours, social activities and small group gatherings.
While a nursing home has the freedom to create its own policies specific to its facilities when it comes to in-person visitation, Richardson said Hearthside has looked toward the regulations set by federally run programs like the CMS.
Under the new guidance, if the coronavirus county positivity rate is more than 10% and less than 70% of the facility residents are fully vaccinated, visits should still be restricted.
But in Centre County, as of March 20, the positivity rate is 6.6%, according to the data tracking nonprofit Covid ActNow. More than 22,000 residents have been vaccinated, according to the DOH.
Carol Licastro has been living in State College since 1959 and is a resident at Juniper Village. She tested positive with coronavirus earlier this year before moving to Juniper.
“A lot of what I experienced I do not remember,” Licastro, a former art teacher and Penn State alumna, said. “It was honestly a blur — I couldn’t speak for two weeks. It was definitely a low point in my life.”
Though people living in long-term care facilities represent just 1% of the U.S. population, they have accounted for 1 in 3 coronavirus deaths, according to the COVID Tracking Project.
“Even after I recovered, it was still hard for my family to see me,” Licastro said. “My children both have jobs away [from Licastro], so they can’t just drop everything when it’s convenient for me. I was in this new facility all alone, and they could only see me through a window.”
Licastro said she was worried about the potential risk of exposure to the virus again, but after receiving her final dose of the vaccine at the end of February, she said she was able to see “a light at the end of the tunnel” for the first time.
“It’s a relief to have some protection against the virus as someone who experienced it firsthand,” Licastro said. “I’m especially thankful I was able to receive it so quickly and that I don’t have to worry as much as I did before about contracting the virus any time I left my room.”
Elizabeth Plozner-Chalfa, executive director at Juniper Village, has been working in the Juniper community for 15 years and said she is “overjoyed” that the recommendations from the CMS have been put in place to make visitations a priority.
Plozner-Chalfa said Juniper Village Brookline Senior Living currently houses around 200 year-round residents, serving a mix of independent living residents and those who need more intensive nursing care.
“Our community is designed to be full of visitors and family members, so to go so long without frequent in-person interaction was something we have never had to do,” Plozner-Chalfa said. “It was heartbreaking to see our residents not be able to hug and celebrate the basic necessities of life.”
According to Plozner-Chalfa, residents adapted well to the new, distanced version of their lives at Juniper Village before restrictions were lifted.
“[Juniper Village is] a very social place,” Plozner-Chalfa said. “Year round we try to make any and all opportunities open for our residents, and for once, that was no longer an option in the typical way we had done things pre-pandemic. We had to get creative.”
For residents like Licastro who moved to Juniper Village in 2021, the new visitation recommendations offer a chance to interact with fellow residents for the first time.
“I don’t think there’s time to feel lonely anymore,” Licastro said. “Since most [residents] have now been fully vaccinated, being able to interact with others in even the slightest way through the camaraderie of the activities we can now partake in, makes me feel grateful at least some parts of the pandemic have gotten better.”
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Plozner-Chalfa said she credits Juniper Village’s screening questionnaires, temperature checks and consistent socially distanced measures for preventing the spread of the virus.
The nursing home recently partnered with CVS Pharmacy to deliver Pfizer vaccines to both independent living and personal care residents at Juniper Village facilities so residents wouldn’t have to travel. According to Plozner-Chalfa, Juniper has since successfully vaccinated 95% of its residents and team members.
The partnership is a part of the Centers for Disease Control and Prevention’s Long-Term Care Program that facilitates on-site vaccinations of residents and staff at more than 65,000 long-term care facilities nationwide.
Lisa Harrington, the director of residency planning and marketing at Foxdale Village in State College, said the staff has gone above and beyond in its efforts to make the best of the situation, but noted the updated recommendations from CMS allows the facility to do more.
She said while they have kept in contact with families throughout the past year, the reunions between residents, family members and even staff have been “special.”
“It’s the best feeling in the world to have so many families share how much gratitude they have for us and all we do for our residents,” Harrington said. “I think it shows what we have always felt — that Foxdale is family and that we will do everything in our power to get through any obstacles in our path. This year is definitely a testament to that.”
CMS guidelines recommend nursing homes conduct visits with family members outdoors whenever possible. At Foxdale, that guideline was deemed a priority — booths of plexiglass were made ready for residents to sit safely outside.
Harrington said its next goal is to set up an outdoor patio space so more families can spend time with loved ones for longer periods.
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As one of the larger long-term care facilities in the area — with 250 residents in the independent living area and 100 in the personal care and skilled nursing area — Harrington said it had to adapt quickly and effectively.
“Our one goal is to be transparent in everything we do,” Harrington said. “Because of the trust we have in our residents and the trust they put in us, our communication through this difficult period has continued and we have been able to serve our residents better because of it.”
Since the updated guidelines, Foxdale opened dining services for those willing, offered fitness activities in the courtyard throughout the week, virtual hikes and continues to utilize internalized television channels to share programs with residents.
The facility has reported a cumulative total of nine residents and 35 staff members who have tested positive, and according to Harrington, every resident who has consented to a vaccine has now received it.
“There’s still so much work ahead of us,” Harrington said. “But being able to see hope in our residents’ eyes for maybe the first time really validates the hard decisions we had to make.”
Like Harrington, Plozner-Chalfa said she believes vaccinations give residents hope to begin moving forward with their lives.
“To think back on a year ago during this time, it truly amazes me just how far we have come.”