After months of not being able to see their loved ones in person, outdoor visitations have begun at many long-term care facilities in Johnson County, as the state health department began allowing facilities with no new COVID-19 cases among residents or staff to reopen in early June.
But local health officials say the risk is still there and urged long-term care facilities to consider whether now is the right time.
‘It is still too soon’
Though the state’s guidance is thorough, the Johnson County Health Department is urging local facilities to use caution. While fewer cases and deaths are being reported than before, there is still an elevated risk for the elderly, said Betsy Swearingen, health department director.
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In June so far, eight additional coronavirus-related deaths have been recorded in Johnson County bringing its death toll to 117 on Sunday, and between one and six new cases are reported each day, down significantly from the last three months when new cases would rise by 10, 20, even 30 or more each day, according to data from the Indiana State Department of Health
There is always a chance of a spike as things open back up and larger gatherings begin again, Swearingen said.
Another concern is the likelihood that an asymptomatic carrier could spread the virus to a facility without their knowledge, she said. The Centers for Disease Control and Prevention estimates that 35% of those who have been infected with COVID-19 are asymptomatic carriers.
The health department has reason to be cautious given anecdotal evidence. At some point during the outbreak, an individual made an unauthorized outdoor visit to an assisted living facility and caught COVID-19, spreading it to others and causing three deaths, Swearingen said.
“Right now, they are encouraging outdoor visitation. But we have known in the past that outdoor visitation can still lead to the contraction of COVID-19, and it has led to the subsequent deaths of three Johnson County residents,” she said. “So it is our line, as the health department, that it is still too soon for these types of things. I can’t force long-term care facilities not to allow visitors, but we will strongly caution against that at this time.”
In its visitation guidance, the state health department cites a Japanese study that found “odds that a primary case transmitted COVID-19 in a closed environment was 18.7 times greater compared to an open-air environment.”
Though outdoor transmission is possible, it is less likely, according to a Chinese study the state cited in the guidance. The study looked at 318 cases where COVID-19 was transmitted from an infected person to multiple other individuals. Of those 318 cases, just one of the situations originated from an interaction that took place outdoors, the study says.
Not all facilities are allowing outdoor visitors and are opting to stay closed due to the ongoing risk or because the facility does not meet one or more of the state’s requirements to begin visits.
“The long-term care facility residents are our most vulnerable population and they are the ones who need (to be) protected. Obviously, we have seen that in our numbers. That’s why we are thinking like we are thinking,” Swearingen said.
As for the long-term care facilities that chose to open back up, she is urging administrators to do what is best for their residents and follow CDC and state health department guidance closely, she said.
Visiting with caution
The state handed down several guidelines before allowing long-term care facilities to take this step, and all had to come up with individual plans.
According to those guidelines, facilities must: not have a new COVID-19 infection reported within 14 days; establish a set visitation schedule; have adequate staff to help enforce the guidelines during visits; wipe down visitation areas between visits; require visitors and residents to wear masks; screen visitors for symptoms of COVID-19; and provide hand sanitizer.
Visitors must be age 12 or older and have to agree to follow the state’s guidelines and any additional guidelines set by the facility to visit. Visitors must submit to a health screening, provide their contact information and provide a doctor’s note or test results if they have been diagnosed with COVID-19 at any time. Visitors may bring food, but cannot share food with the resident, according to the guidance.
Several facilities, including The Hearth at Stones Crossing and Homeview Health and Rehabilitation Center, are also directing visitors to keep their distance and not share hugs or kisses with loved ones.
Facilities that have reopened to visitors did so with an abundance of caution, administrators said.
Some long-term care facilities and assisted living communities that reported multiple deaths have opened back up, as the outbreaks are now under control.
At one of the hardest hit long-term care facilities in the county, Otterbein Franklin Senior Life Community, conditions in the assisted living community have improved enough to allow outdoor visits, but not yet for nursing home residents.
“I know how anxious each and every one of our residents in nursing care are to spend quality time with their loved ones. It has been a long time coming and for that, I am so sorry. We will work to provide an ultra-safe set of protocols to ensure everyone’s health and safety, and in the meantime, we will do everything we can to provide even better virtual visits,” Otterbein Franklin executive director Rob Newcomer said in a statement.
Otterbein recorded 58 cases of COVID-19; 16 residents died, 38 recovered and four are still fighting off the virus in isolation, Newcomer said.
David Sease, a spokesperson for Otterbein, said the facility is cautiously optimistic and is working on a plan to allow nursing home visitations at a safer time. The plan will be made with input from the health departments, he said.
Another hard hit facility that has not yet opened is Greenwood Meadows. The facility, which offers a variety of skilled nursing services and memory care, experienced an outbreak that claimed 32 lives. However, 76 residents have recovered, and no new cases have been reported in more than 72 hours, according to the facility’s website.
Sherri Davies, a spokesperson for the Greenwood Meadows’ parent company American Senior Communities, said a plan to resume visiting is being developed, but the facility is not ready to open for visits.
“The residents and families we serve are very important to us and we will continue to move forward with compassion and an overabundance of caution and quality care. As residents begin to recover, Greenwood Meadows continues to remain steadfast in protecting and continuing to serve them.” Davies said in a statement.
Greenwood Meadows’ sister site, Franklin Meadows, is open for visits, as no COVID-19 cases have been reported at the facility.
The Hearth at Stones Crossing, a Greenwood assisted living community that recorded 11 positive cases and one death, is allowing 30-minute visits at two sites on the property, a tent and a gazebo, said Kevin Hunter, chief operating officer of Hearth Management, its parent company.
Since visits are closely monitored by employees for social distancing, and all are wearing face coverings, the visits are as safe as possible, Hunter said. The Hearth wanted to reopen for visits as soon as possible because the distance has been hard on its residents, he said.
“The Hearth has been closed to outside visits for a total of 12 weeks. We believe it was time for our residents to see their loved ones after such time apart. Technology—Facetime, Zoom and Skype—have been very helpful over these past 12 weeks. However, nothing is better than a face-to-face visit, albeit practicing social distancing,” Hunter said.
Homeview Health and Rehabilitation Center, a skilled nursing facility, had no cases of COVID-19 among residents, but reopened later than some other facilities that had recorded deaths. It reopened for visitations today after much planning and input about the facility’s safety plan from the health department, said Mark Gavorski, Homeview’s administrator.
Four visits an hour can be accommodated in seating areas set up six feet apart outside under a covered carport, Gavorski said.
Visits are spaced out to accommodate a thorough cleaning between visits, and they purchased new outdoor furniture that would be easier to clean, he said.
Though some families might get upset about it, Homeview staff is planning to strictly enforce social distancing, Gavorski said.
“People are going to say, ‘I want to hug and kiss my mom,’ but let’s take this one step at a time. Maybe we can hug and kiss after there is a vaccine,” he said.
During the recent hiatus, Homeview staff got creative to make living in isolation as bearable as possible, through Facetime, Zoom, Facebook, window visits and a window cupcake celebration on Mother’s Day. There is no substitute for seeing family face-to-face, Gavorski said.
