LITTLE ROCK -- In the seven weeks since the state allowed nursing homes and other long-term care facilities to resume visitation that was halted because of the covid-19 pandemic, some family members have reunited with loved ones while others still find barriers.
Visits, with contact and mask restrictions, were allowed to resume July 1, except at facilities that had active cases.
"One of the most difficult challenges during this Pandemic has been the safety and health of our nursing home residents and staff," Gov. Asa Hutchinson said in an email. "It was heartbreaking but necessary to restrict family visitations last March. But I am grateful for the hard work of the nursing home staff, Department of Health team members and the Arkansas Health Care Association who have worked tirelessly to protect our residents and to prevent the virus from spreading inside our facilities."
Even with precautions, the number of cases in the facilities continues to climb. A daily report on nursing homes and other congregate settings released Friday by the state Department of Health shows a cumulative 1,880 residents and 1,263 employees -- or 3,143 total -- have tested positive for the virus since the pandemic began in March.
In comparison, at the end of July the total was 2,248.
Hutchinson said it should be encouraging that among total active cases, fewer than 100 involve nursing home patients.
According to the Health Department's active cases report Thursday, there are 42 residents and 87 employees in nursing homes with active covid-19 cases out of that report's 5,657 total active cases.
"Right now the vast majority of our homes have been able to have visitors, and I applaud them for the safety measures they have put in place," Hutchinson said.
Among other restrictions, a facility cannot allow visitors if it has had a newly identified case of covid-19, according to state guidelines. It must then be closed to visits for 28 days. Some facilities with no active cases are voluntarily closed in hopes of keeping the infection out.
No agency tracks which nursing homes or other long-term care facilities are open or closed to visitation.
DRAWING FROM A HAT
The July 1 opening of visitation was welcome and long-awaited news for Lance Hines and his family.
His mother, Joyce Hines, 72, had a stroke last spring and was moved to Greenbrier Nursing and Rehabilitation Center in Faulkner County.
Before the pandemic, Joyce's husband, Pete, had been by her side every day at the facility, but he died in February.
"That made her situation a lot worse," Lance Hines said. "He wasn't a resident, but he stayed with her 24 hours a day. She had companionship. After he passed away, we were able to visit and try to keep her spirits up, but then all the visits stopped."
Joyce Hines has maintained her cognitive abilities after the stroke, so she understands the ramifications of the virus, her son said.
"She's been more depressed. It has been really tough on her," Lance Hines said.
When she got the news that visits would restart, Lance Hines said his mother was afraid she would cry all the way through the abbreviated visitation slot.
To keep the visitation schedule fair, the nursing home drew names from a hat and notified the families. About five visits are conducted each day, Hines said.
Hines' name didn't come up until July 17.
"We were so glad to see her, but there was a lot of protocol," Lance Hines said. "Only two of us were allowed to see her, and a staff person was in there the whole time. We had to stay 6 feet apart and wear a mask. It wasn't in her room, but a separate one near the entrance of the facility. She did very well when we got there. She was a little disappointed because she couldn't hug us."
The family is now waiting for Joyce's name to be pulled from the hat for a second visit.
Joyce Hines, from her room at the nursing home, burst into tears when asked about her experience during the pandemic.
"They stopped the visits when I needed my family the most," she said, speaking of the death of her husband. "I know it's important to keep the virus out of here, and that's OK. I'd just like to see them more often."
Joyce Hines said the residents are kept separated and eat meals alone in their rooms.
"We play hallway bingo where we sit in front of our door and play bingo," she said. "I do it mainly because my kids and grandkids urged me to. I've made friends with the woman across the hall. Her daughter-in-law is one of my doctors, so that makes us almost kinfolk."
Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, said she has been continually hearing from families and loved ones who say that many nursing homes remain closed to visitors -- even those that do not have active covid-19 cases.
"The majority of these patients have dementia, and they need the family members to keep them healthy and alive," Deaver said. "It's sad. I'm being called by families begging me to do something."
Rachel Bunch, executive director of the Arkansas Health Care Association, said the issue of visitation during the pandemic has been the most difficult thing she's ever encountered in her role.
"We want families and friends to see loved ones every day. We also want residents and staff to be healthy. The tension between those two desires during covid is beyond description," Bunch said. "I hear from heartbroken family members every day wanting so badly to see their loved ones, and we do everything we can to address their situation and concerns. But the reality is that we cannot unduly risk the health of the residents and staff by totally opening the doors."
STAFF IMPACT
Deaths of workers at the facilities remain at two: one at Dardanelle Nursing and Rehabilitation Center in Yell County and another at Windcrest Health and Rehab Inc. in Springdale.
Covid-19 continues to turn up among employees of all types of congregate settings. In addition to 1,263 cases among workers at nursing homes and assisted-living facilities since the pandemic started, the virus has infected 1,026 workers in prisons, jails, human development centers, the state hospital and other types of residential care facilities, according to Friday's congregate settings report from the Health Department.
Bunch said the struggle is great for nursing homes to keep covid-19 out, and then, when a case occurs, doing all that can be done to help patients recover.
"The health and safety of our residents, as well as our staff, is priority one. This is unlike anything the industry has seen in recent memory," Bunch said. "The good news, however, is our providers, administrators and all staff rise to the occasion every day. We should all be proud of their commitment to our residents."
Staff members are being pushed to the extreme, Bunch said, with many sleeping on cots at the facilities or in campers in the parking lot, just to make up for staff shortages or in an effort to keep from bringing the virus in to the residents.
"The wear and tear on these people is dramatic, and there seems no end in sight. However, as stated, the staff around the state are committed and motivated, even more so in this pandemic, to do what it takes to care for residents," Bunch said.
Staffing issues -- always a challenge for the nursing home industry -- are even more severe in a pandemic, Bunch said. Those employees that test positive have to isolate at home, leaving a staffing hole.
The pandemic has also brought a surge in training for the employees, such as the proper use of personal protective equipment, disinfecting and segregating infected residents, Bunch said.
"One of the largest challenges is that the guidance and directives change so frequently," Bunch said. "That's not a criticism of the regulators. We all know they learn something new about covid daily that calls for flexibility."
Bunch said that while the challenges are many, the successes are also plentiful.
"The triumphs are seen as facilities that have experienced large outbreaks reach a phase of recovery," Bunch said. "We have numerous facilities that experienced previous large outbreaks that are now covid-free for both patients and staff."
Heather McQuade, the administrator at StoneBridge Senior Living in Russellville, said visitation is going well and the nursing home has still not had a single covid-19 case.
The facility allows visitation outside, three days a week, under an awning equipped with fans and 6-foot-long tables to maintain social distancing, McQuade said. It averages about 8 to 12 visits per day.
"It really has been helpful for some of our residents, especially the ones that are confused," McQuade said. "We just have to remind them that we can't do physical touching, and they don't understand that."
Being surrounded by friends and family is central to the mental health of residents, Bunch said. The facilities recognize that and are creative in their ways to keep residents engaged and connected, such as FaceTime visits and phone calls to loved ones, window visits and parades, Bunch said.
TOO LATE FOR SOME
In-person visits had not restarted when Debbie Williams of Russellville went for her usual window visit with her 80-year-old father, Alan Ford, an Alzheimer's patient, at a Russellville nursing home.
She noticed that her father was not his "usual bubbly, smiling self." Williams alerted the staff that something was wrong. She called his doctor, suspecting that Ford was either dehydrated, had a urinary tract infection or maybe an ear infection.
The doctor ordered the staff to collect a urine sample, but workers were unable to obtain a sample for several days, Williams said.
"On July 4th, I went for my normal window visit, but he was even more withdrawn," Williams said. "He had given me a look he had never given me, a look of desperation. In that moment, my gut told me I needed to take him to the doctor to get checked out despite my fear of him being quarantined for two weeks if he was taken out of the facility."
As soon as the staff rolled him out, Williams hugged him and held him. Ford was in a lucid moment and recognized Williams, telling her, "Oh, I love you."
"When the assisted-living staff lifted my dad to put him in my car, I was in absolute shock at how frail and thin his body had become," Williams said. "It is something you cannot see or truly assess when you have no access to your loved one."
Medical exams and tests showed that Ford was dehydrated, had a urinary tract infection and several bed sores, Williams said.
"Once he got admitted to the hospital and in bed, the bed had a scale in it and weighed dad at 122 pounds," Williams said, adding that her father's normal weight was about 138. "I was in shock that he had lost so much weight since covid began, which again is something you cannot see through a window."
Williams was able to be at her father's side for three hours a day at the hospital.
"I was so thankful and grateful for any time with him," Williams said. "It is heart-wrenching and a pain that I cannot even describe to see the strong, happy, full-of-life father you have known, the one who was always your rock, become so frail."
Ford was placed in hospice care, where Williams and her sister were with him as much as they wanted.
"They did have restrictions of limited number of people, questions, temperature checks and mask requirements, but that was completely fine with us, because we still were able to be with dad and he would know we were there," Williams said.
Alan Ford, who had been pastor of First Presbyterian Church in Newport for 36 years, died July 18.
"I do feel the pandemic contributed to dad's death and not being able to accurately assess his decline," Williams said. "I think in an effort to try to protect the most vulnerable population, specifically the ones with dementia and Alzheimer's disease, the restrictions caused the most harm by removing the most important thing to them, familiar human contact, that in turn has caused psychological fallout to them and distraught family members."