December 22, 2020
At a recent geriatric conference, the Eastern Pennsylvania Geriatrics Society invited 12 speakers from diverse backgrounds to share their stories about how COVID-19 has changed their practices in a session entitled, “Lessons Learned from COVID-19.” One of the participants, Jen, was not a health care professional, but rather the daughter of parents who both had advanced dementia who were living in a long-term care facility. She discussed how prior to COVID-19, she would come to the nursing home every morning, help feed her parents their breakfast, take them outside if the weather permitted, and assisted with their grooming needs.
Since the first wave of COVID-19, Jen had been unable to visit her parents or to receive what she believed to be credible information about the status of her parents, both of whom contracted the virus. She is now committed to getting herself tested twice a week at her own expense and presenting the results to the facility in order to visit her parents.
Clearly, the health of her parents has declined since the imposition of visitor restrictions in March, as well as the impact of their progressive dementias. Jen argues that she has been and continues to be an essential COVID-19 worker as a provider of care to her elderly parents who happen to reside in a nursing home. As an essential worker, she believes she has the right as well as the responsibility to following the PPE rules, to report any possible symptoms of COVID-19 and to protect the nursing home’s staff and residents while she provides personal care to her parents. She believes strongly that she should be allowed to continue her role and should not be considered a “visitor” but an essential worker.
Jen’s sentiment was echoed by Diane Menio, the Executive Director of CARIE, an advocacy agency that focuses on the care of nursing home residents. Diane discussed the impact of social isolation on the health and welfare of institutionalized individuals and argued that the imposition of state and federal policies limiting visitation has caused undo harm to the nursing home population in general. If such policies were initiated because of fears of PPE shortages or the inability to test visitors, then focusing on addressing supplies of PPE and access to testing should be focus instead of prohibiting visits.
Should there be a separate category of nursing home visitors: those who provide physical care to family members which can supplement the services provided by the staff and those who do not provide such services? If we consider this distinction, should visitors who provide social support and encouragement for long-term care residents also be deemed essential workers?
Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, is an assistant professor in the Department of Geriatrics and Palliative Medicine at the Philadelphia College of Osteopathic Medicine. Dr Warner-Maron is also the executive director of the Eastern Pennsylvania Geriatric Society.