Residents at nursing homes, assisted living facilities can leave for the holidays but, amid COVID-19, will they?

Liz Freeman
Naples Daily News

Dr. Marvin Parker and his wife, Suzanne, are perfectly content staying put in Southwest Florida for Thanksgiving.

The retirees say it’s just too risky to travel to Minnesota to see family or venture in the community for a Thanksgiving gathering with the COVID-19 pandemic raging.

“It’s really a no-brainer,” said Parker, 86, whose practice was in internal medicine before retirement. “It was an easy decision not to get together.”

The couple, who live independently at Vi at Bentley Village in North Naples, recognize some elders in the assisted living or nursing home side in the continuing care retirement community may opt for “holiday leave.”

Suzanne Parker, left, and her husband Dr. Marvin Parker, right, pose for a portrait in the garden of the plant house at Vi at Bentley Village in North Naples on Thursday, November 19, 2020. The couple has decided to stay in Southwest Florida for the holidays rather than traveling to Minnesota to be with family because of COVID-19.

That’s how the state Agency for Health Care Administration describes a guidance issued in early November where residents in long-term care centers can leave for the holidays to visit family and friends.

The Florida Health Care Association, which represents nursing homes in the state, doesn't know how many families will take advantage of the leave, said Kristen Knapp, spokeswoman.

“It may be more on the assisted living side than nursing homes,” she said. “Nursing homes may be less likely because of the level of care they require.”

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Directors of long-term care facilities have asked for clarification on what to do when residents return after a period of time away, she said.

The state guidance calls for screening when residents return but does not spell out they must isolate although that’s what nursing home directors say they are planning, she said.

Florida’s nursing homes and long-term care facilities recently reported 99% of their residents are free from the virus and directors don’t want to lose that momentum, according to the association.

AARP Florida, which created its own dashboard to track COVID-19 in nursing homes, said Florida is doing better than the national average in controlling infections and deaths.

For instance, during a four-week period ending Oct. 1, the state averaged 2 active cases per 100 nursing home residents while the national average was 2.8 active cases per 100 nursing home residents.

And in Southwest Florida, COVID-19 deaths among residents in long-term care centers have been on the decline.

On Nov. 1, data showed COVID-19 deaths in Lee nursing homes represented 50% of all virus deaths in the county. That's compared to 72 percent of the deaths back on July 1, state health data shows

In Collier, nursing home deaths from the virus have consistently been even lower, accounting for 45% of virus deaths in the community Nov. 1, slightly higher than the 47% on July 1.

Emmett Reed, executive director of the association, said wearing a mask and social distancing around elders is a sign of respect for them.

“We understand everyone wants to see their family and friends during the holidays, and we need to consider our parents and grandparents who are living in our state’s long term care centers, as well as the caregivers who are working tirelessly every day to keep these residents safe from the virus,” he said in a news release.

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Florida nursing homes opening up

Florida Gov. Ron DeSantis lifted the ban on nursing home visits Sept. 1 as long as a facility reported no new infections for 14 days, except in a dedicated COVID-19 unit.

Last month, he loosened restrictions even more to allow children and outdoor visits regardless of any positive cases within a given facility. The action last month allows each home to set its own visitation limits.

Leslie Vollmer, senior administrator at HealthPark Care and Rehabilitation Center in south Fort Myers, said letters went out recently to families of its 90 residents regarding holiday leave.

"We have less than 5 patients going home for the holidays," she said. "Families understand the numbers are rising and feel everyone is better off to stay here."

Cases of COVID-19 are up and that’s concerning, she said.

“I think with what’s happening in the community with the numbers going up and nearly 10% (positivity rate), I think any gathering could potentially cause a problem,” she said.

In Southwest Florida, October brought a dramatic uptick in new cases and November has been no different.

More recently, Lee County's seven-day new case average was 225, which is 70% higher than the same seven-day average of 132 cases for the week of Nov. 1, according to state data.

Collier reported 1,836 COVID-19 cases in October, 60% more than the 1,145 cases in September. 

The seven-day average in Collier the second week of November was 90, which is nearly 10% higher than the average of 82 on Nov. 1.

Families may opt instead for outdoor visits on Thanksgiving and a traditional meal will be served to residents in their rooms, she said.

For residents who leave for a Thanksgiving gathering, Vollmer said the plan is to test and isolate them in their room for 14 days.

The isolation won’t be a hardship since there have been no social activities or communal dining since the pandemic began, she said.

Directors at nursing homes owned by HCR Manor Care in Florida and elsewhere will also isolate residents for 14 days after returning from leaving for a holiday event, spokeswoman Julie Beckert said. The company owns seven facilities in Lee and Collier counties.

In essence the returning residents will be treated like new admissions, Beckert said.

“We are placing patients in single rooms until their quarantine is over,” she said.

Retirement communities carry on

The Parkers, of Bentley Village, acknowledge they will miss seeing their grown children and grandchildren for Thanksgiving in Minnesota.

“We often would fly up to be with them, but we can’t,” Suzanne Parker, 82, said. “We don’t want to put them in danger and we don’t want to expose ourselves.”

She worked as a registered nurse and taking into account her husband’s internal medicine practice, they've passed on good health habits to their children, Parker said. She knows their adult children and grandchildren are following mask wearing and social distancing.

The holiday reunions usually involve 13 family members so they will use Zoom this year, she said.

“We are getting a little more used to it,” Marvin Parker said.

Bill and Pat Smith, another retired couple in Vi at Bentley, often had family come to Southwest Florida for the holiday but not this year. They will not be leaving the retirement community for any visits with others.

“It just seems sensible to stay safe,” Bill Smart, who is in his 80s, said.

They did not hesitate about their decision to stay in their apartment and will have Vi deliver Thanksgiving Day dinner.

“It’s just a mind set, we’ve come this far in being safe,” Pat Smart, who is in her 70s, said. “Thanksgiving is one day.”

The national picture

The American College of Emergency Physicians wants families to make safety a priority for Thanksgiving and follow recommendations from the Centers for Disease Control and Prevention of limiting gatherings to household members who live in their home on a daily basis.

A college student returning home for the holiday is not considered a household member and may be asymptomatic and can put an elderly relative at risk.

“Unfortunately, the safest option for older individuals or people with weakened immune systems is to skip in-person gatherings this year,” Dr. Mark Rosenberg, president of the emergency physicians’ group, said in a news release.

“It may be disappointing to adjust traditions or modify plans in the short-term, but these decisions can save lives,” he said.

The emergency physicians group points to the recent spike of one million cases in six days and how hospitalizations could set the stage for a more dangerous wave than what the country faced in summer.

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Hospitalization rates are rising in 47 states and are higher in at least 24 states than any previous point of the pandemic, according to the organization and the COVID Tracking Project.

The surge combined with the holidays and flu season creates a lethal combination, Rosenberg said.

“It is likely that the weeks ahead will be the hardest yet, so people should listen to public health experts to protect themselves and those they care about,” he said.