As New Hampshire continues to loosen nearly all public health restrictions related to the coronavirus pandemic, one sector remains on alert. Many long-term care facilities across the state have kept up limits on residents and visitors in recent weeks, even as vaccination rates rise and COVID-19 cases have fallen sharply in those settings. NHPR's health and equity reporter Alli Fam spoke with All Things Considered host Peter Biello about the tension within long-term care facilities.
Peter Biello: So what's been going on this week?
Alli Fam: This week's been kind of confusing, especially when it comes to guidelines for long-term care facilities. Last Monday, the state came out with some updated guidance for these facilities, an in-depth 16-page document. It outlined different phases of reopening. A lot of these were based on metrics like county case rates that dictated guidelines on things like trips outside the facility that aren't medically necessary for residents. Then the next day, federal guidelines from the Centers for Medicare and Medicaid Services, which these long-term care facilities are subject to, came out. And also CDC guidance changed. And in some cases, the guidance didn't quite line up.
CDC guidance, for example, was saying that if residents are fully vaccinated, they've got the green light to eat communally, with no masks or social distancing. But the state guidance still, in some places, had some guidelines requiring mass and distancing and didn't have that more nuanced clarification on if things were different for vaccinated residents. I spoke with Brennan Williams, who's the CEO of the New Hampshire Health Care Association this morning, and he said it's just been a confusing week, trying to navigate everything.
Biello: Have things cleared up at all?
Fam: To some extent, I would say that they have. A few hours ago, I sat in on a meeting with the New Hampshire Department of Public Health. A lot of long-term care providers sit in, and it's also just open to anyone. And the state said it's just dropping those April 26 guidelines and pointed facilities to CMS and CDC guidelines and its own universal best practices document, which is on the state website.
Biello: Ok, so what does this mean for things like testing and visitation?
Fam: I do want to just clarify one thing here that's a little bit confusing: Long-term care facilities, those are federally regulated. So the guidelines from CMS, they have to follow those. For assisted living facilities, those are regulated by the state. So for those long-term care facilities, things are a little tighter. CMS says if there's an onset of COVID-19 in a facility, until everyone's tested visitation is suspended.
In terms of assisted living, they've got a little bit more leeway in terms of how they're applying recommendation and they've got decisions to make. One thing that came up in this meeting that I was attending today was, “Hey, is it a good idea that we have a Mother's Day event where family members can come visit and eat and socialize outside?” I think there's a lot of tricky waters to navigate here.
Biello: What have you been hearing from folks in the space?
"You have a risk either way. So you have a risk of the virus, and you have a risk of people being isolated."
Fam: So, so much. I mean, this is a really complicated time. It's this transition period where people are vaccinated, but the pandemic is still here. The science is better, but there's also a lot of unknowns. And I think that can lead to a lot of frustration, too.
I mean, the residents at long-term care facilities and assisted living homes generally have incredibly high vaccination rates. But at the same time, they're still a vulnerable population in other ways. And there are still staff and family members who want to visit who might be unvaccinated.
I spoke to Justine Vogel. She's the president and CEO of the RiverWoods Group, which runs senior living facilities here in New Hampshire. I asked her about some of the challenges with these guidelines and just navigating them. And here's what she said:
Vogel: I think what the public health folks have learned, essentially in the health care side, is there's a risk. You have a risk either way. So you have a risk of the virus, and you have a risk of people being isolated.
Fam: She says, as the virus is becoming less and less of a risk, she's really hoping to continue to reduce that isolation and keep opening up.
And I think another thing that's come up in some of my conversations is that something like COVID cases and deaths, those are very measurable and uncountable. But things like the effects of isolation on someone's health, it's trickier to measure that as well.
Biello: And what are you hearing from residents or people with loved ones in these facilities?
Fam: I want to tell you about a woman I talked to yesterday. Her name is Gretta Olson-Wilder. And Olson-Wilder's mom has dementia and she's been in a facility in Coos County for several years. She actually got COVID this year during an outbreak. Fortunately, she made it through. But her daughter says that some of the more indirect consequences of the pandemic -- that social isolation -- have hurt her mom's health the most.
Olson-Wilder: Yeah, she's changed. She used to walk the halls all the time and say hi to everybody. And now that doesn't happen unless they coax her to do that. So somebody that was extremely friendly, bubbly, talkative and jokey is now quieter and more reserved
Fam: Olson-Wilder says things like not walking in the halls or not going out on trips also have a physical effect. She says her mom's just not getting that same level of consistent exercise. It's been a really hard year for both of them.
