To protect Florida’s most vulnerable from the coronavirus, long-term care facilities are turning themselves into fortresses.
All nursing homes and assisted living facilities have been operating on lockdown since the state banned visitors on March 15.
Inside, residents struggle to adjust to a restricted life, one devoid of visits from loved ones or any trips outside, even to the grocery store.
Overstretched employees work long hours and scramble to comply with new requirements, all while worrying about shortages of essential supplies and keeping their own families from being stricken by the coronavirus.
On the outside, relatives hope their loved ones are being properly cared for. Barred from visiting — unless it’s to say goodbye to a dying family member — all they can do is read between the lines of intermittent staff updates and grainy video calls.
And there’s no end in sight.
The virus is a severe threat to long-term care facilities, where elderly and immunocompromised residents live in close quarters. One of the first known coronavirus cases in the U.S. ripped through a nursing home in Kirkland, Wash., killing at least 35. The coronavirus also overwhelmed an assisted living facility in Fort Lauderdale. So far, seven residents there have died.
Florida has nearly 200,000 long-term care beds. There are already 578 coronavirus cases connected with long-term care facilities as of Thursday.
The discovery of new cases associated with these facilities is rapidly rising by an average rate of 65 percent every two days, according to state data. Without widespread testing, the actual numbers could be even higher.
Meanwhile Florida officials have refused to reveal which facilities have COVID-19 cases, citing privacy laws. Critics say the lack of transparency means families can’t assess the risks.
“This virus is ravaging many facilities a whole lot more than we are being made aware of,” said Brian Lee, a former Florida ombudsman for long-term care facilities. “I’m very concerned about the nightmares that could be happening out there for residents and their families.”
Even when Florida and the rest of the nation reach the other side of the deadly infection curve, experts think these facilities will be the last to lift restrictions.
“The question we get from residents is — how long will it go on for?” said Andres Rodriguez, 27, who works at Discovery Village, an assisted living facility in Tampa Palms. “We tell them we have to take it one day at a time.”
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Since the lockdown went into effect, Kathleen Gepp has been trying to cheer up cooped-up residents of The Preserve at Clearwater, a 90-person assisted living and memory care facility.
The community life director makes the rounds with a “Deals On Wheels” cart stocked with candy, toothpaste, pet food and other goodies — the kind of things residents can no longer get on a Publix run.
There’s also happy hour.
“Give me any beer, as long as it’s not a Corona,” one man cracked recently when she came by.
Residents and staff are trying to make the best of a difficult situation, said Gepp, 55.
Once, the Preserve’s residents roamed the resort-quality amenities, like a heated pool, a restaurant with a lake view and a fire pit lounge. But the usually-lively housing complex doesn’t feel the same under lockdown.
The dining room where neighbors gathered is empty, now that residents are served in their rooms. Everyone has their temperature taken once a day. The monthly calendar filled with bingo and painting and exercise classes “has been blown to pot,” Gepp said. One of the last activities residents did together was make hand sanitizer for everyone in the facility. But it’s no longer safe to gather.
Staffers walk the halls wearing homemade masks, a new requirement that makes it harder to communicate.
Keeping stocked with gloves, masks and sanitizer is a constant concern. Amid a nationwide shortage, Gepp said staffers are forced to drive to different shops around the county just to buy a handful of masks at a time. She tried to find some online, but fell victim to a scam.
Dementia care residents need special attention. Though Florida’s Agency for Healthcare Administration says they should stay socially isolated, Gepp said it’s nearly impossible to keep residents in one place.
“A lot of times they will just get up and go where they want to go,” she said. Employees cannot physically or chemically restrain them.
So the staff continues to plan activities and group meals for them, only now in small groups and outdoors, sitting 6 feet apart, Gepp said. Employees are trained to subtly redirect residents when they start moving around and threaten to stumble into others’ space.
Under increased pressure, the staff is “pulling together as a team,” Gepp said. “We are like everybody else — we have kids at home and we are worried about family.”
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Until last month, Rodriguez was a driver at Discovery Village, ferrying residents to their doctor’s appointments or grocery trips.
Then the lockdown ended all outside travel. Now he pitches in to help the facility with daily tasks, like taking out the garbage, picking up deliveries and serving residents meals in their rooms. He says everyone is feeling the strain.
“This is 10 times more difficult than a hurricane,” said Rodriguez, who in 2017 helped evacuate residents during Hurricane Irma.
Nursing home residents have become even more reliant on staffers. Many make about $11 to $15 an hour, yet provide round-the-clock care and company during the pandemic. They change diapers, help residents get out of bed, shower and dress them. Then they rush meals to their rooms and try to keep them entertained when they’re bored.
It’s a constant struggle to implement social-distancing practices, Rodriguez said. He and his co-workers have close relationships with many residents. It’s a natural instinct to try to comfort them — but now they must remind them to stand across the room.
He wears a face mask, but supplies are limited. Sometimes he has to re-use one for a week, spraying it down with rubbing alcohol every night.
Many residents have conditions such as asthma, chronic obstructive pulmonary disease or high blood pressure that render them vulnerable to COVID-19. He can see the anxiety on their faces. Their relatives send puzzles, flowers and balloons.
“We try to make it a non jail-house environment, as much as possible,” Rodriguez said.
But that only goes so far to relieve the long days inside, watching TV alone.
“I feel like we became more of a hospital because they are strictly in their apartment and they rarely go out.”
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As the days wear on, residents and their loved ones try to find new ways to connect.
Workers take pictures of residents holding up whiteboards scribbled with messages to their family, and post them on Facebook:
Los quiero mucho!
Things are very good here, never forget that I love you!
They set up video calls and help residents write letters. Some have arranged pen pals with local schools or neighborhood associations.
At one rehabilitation center in Tampa, family members play tic-tac-toe with their loved ones on the windows.
One man continues to eat lunch every day with his wife — only now he sits in the car outside of her assisted living facility and holds his phone up to his face while a nurse helps his wife inside.
Many residents take the social isolation and loss of routine hard. They call law enforcement and report they are being held prisoner. Others rarely leave their beds.
Uncertainty over how long the lockdown will last worries relatives left at home, as well.
Sandy Wiza, 67, hasn’t spoken to her husband, Michael, 71, in days. He has Alzheimer’s disease and she worries even more now that she cannot see him in person. Is he sleeping well? Eating properly? Who was making sure he gets his daily shower and medications?
Right before the lockdown, her husband was admitted to Sabal Palms Nursing and Rehabilitation Center in Largo for bronchitis. When he began to recover, a plenary guardian decided he should stay there.
Then, the lockdown was announced. Wiza’s visits were cut off.
Michael has since been moved to a memory care facility. Wiza calls every day to try to get an update, and sometimes manages to talk to her husband on the phone. When she brought extra clothing, she included a card with a note, to remind him she loves him.
She knows friends who face different hardships. The adult daycare centers they rely on are closed, so they must serve as primary caregivers without respite, or help, to ease their burden.
Still, the house is too quiet. Nights in bed too lonely.
Their fourth wedding anniversary was on Wednesday. Wiza dropped off a gift: a photo album of wedding pictures and their dogs.
Still, one question hangs over her:
“When I can finally see him, will he remember who I am?”