The one-visitor limit for care home residents, along with a lack of outings and other stimulation, could well be posing a greater risk than the coronavirus.

TWO MONTHS AGO, on June 30, the BC government announced a “relaxation” of their essential-visitor-only policy for long-term care facilities that had been in place since the pandemic’s first victims in the province in March. The earlier no-visitor policy had caused much anguish among elders and their families, but it’s debatable that the new, still highly-restrictive rules are much better.

The policy, which went into practice in mid-July, allows one family member to visit by appointment and with many precautions in place. Promises were made to reassess these restrictions in August (“the hope is to be able to expand this to safely include other family members or friends going forward”), yet as of August 26, that hasn’t happened, or if it has, nothing has been changed.

What did happen on August 26 was Seniors Advocate Isobel Mackenzie stepping forward to launch a survey of care-home residents and their family members around the visitation rules in particular. More on that in a moment.

I understand the Ministry of Health orders are in force to protect our vulnerable elders, as well as the essential workers who staff nursing homes, but there are serious flaws in the policy and its application—and they are causing a lot of heartache for a lot of people. The current rules allow only one person from the family (or one friend) to visit. Not one person at a time, but one person period—the “designated visitor.” For my own family it meant a difficult choice. My 92-year-old mother Jade lives in James Bay Care Centre. Which of her three daughters would take on the role? In the end, we decided for various reasons that my Vancouver-based sister Brenda, would do so.

We assumed, incorrectly as it turns out, that we could switch the designated visitor from time to time, or that they would soon, after getting the bugs worked out of the new system with one visitor, allow more designated visitors per family. My two sisters and I get along well, and but it’s easy to imagine that for many families, choosing that one and only visitor poses serious issues.

The frequency of allowed visits was left up to each facility. Brenda has visited as much as she has been allowed to—every other week since late July. That means only 3 visits so far. Jade, who has been a trooper through it all, is now showing signs of losing heart. She asks, “Will I ever get to see my whole family again?” and “What’s it like out there?” She was crying at the end of Brenda’s last visit despite my sister’s attempts to be cheerful.

Leslie Campbell (l) and her sisters Brenda and Karen on a pre-COVID visit with Jade at her home in James Bay Care Centre (Photo: Serge D’Allaire)

Jade is unable to walk but she can think, read, and communicate well. She spends much of her time reading books and the daily newspaper. She understands that COVID could be with us for a very long time. Will she ever be able to see not just her other daughters, but others she loves—her son-in-laws, her sister-in-law Marlene, her friend Julie? With BC’s COVID case numbers on the rise recently, running between 60 to 100 new cases per day, it seems less likely that my family’s assumptions about a relaxation of rules will work out any time soon. And Jade’s mental and emotional health is beginning to suffer from the isolation and lack of stimulation.

Pre-COVID, Jade was used to getting out on a weekly basis or more. With my husband David pushing her in her wheelchair, we would go to a park, or Downtown or along Dallas Road to the breakwater. We’d visit cafés and shops or just take a thermos of tea, with China tea cups and sweets, and enjoy them in the sunshine. With Jade bundled up, we could do this even on a sunny January day in a favourite sun trap on Dallas. My sisters and brother-in-law Serge, who came over for a long weekend each month, spent the majority of their time with Jade, whether in her room or out and about. So mom had lots of engagement with her family and the community despite her lack of mobility.

But for six months now, all such activity has been completely off limits. She really misses the togetherness and the sight-seeing, as do we. Also prohibited are residents’ regular bus outings. At James Bay Care Centre, residents were taken in a Handi-dart bus for scenic drives through the area, usually stopping at a beachfront like Willows to be served tea and cookies on the bus. But the Ministry of Health has recommended that care homes “limit outings to essential medical appointments only to reduce the potential risk of exposure to COVID-19 in the community.”

My sister Karen notes that besides the lack of visitors, “With enrichment programs like the bus trips, visiting entertainers, and parties with other floors all cancelled, it’s really too prison-like when it’s supposed to be their home. It’s been six months of lockdown, so given Mom and other residents’ ages, there needs to be more stimulation. Maybe some approved volunteers or designated family members could take wheelchair-bound residents for a walk with an abundance of PPE…”

Though the staff do get residents into the garden at Jade’s home fairly regularly—a huge blessing for her—the weather won’t permit that much longer.

My heart breaks when I think how confined Jade is, how lacking in a change of scenery. A whole six months has gone by where she’s had exactly no outings and three short visits. At James Bay Care Centre, only one 45-minute visit per resident is allowed every other week. We have been able to do some Zoom visits with staff help, but it’s not the same.

Just to be clear, my sisters and I attach no blame to the staff at my mom’s care home. In her two-and-a-half years there, they have proven to be impressively competent, compassionate, cheerful and helpful, even now when stretched and stressed trying to keep up with the extra work involved with COVID policies. We certainly want rules in place that help protect staff members. But as my sister Karen says, “I understand the government needs to protect the staff, but staff get to go home after their shifts and see their family and friends. Residents don’t.”

I WAS IN THE MIDST of writing this piece when the Seniors Advocate for BC, Isobel Mackenzie, launched her new survey around the visitation rules directed at families like my own with an elder in care. She seems to have a good understanding of the situation: “Of the many hardships that COVID-19 has brought, one of the most heartbreaking has been the need to limit those who can visit residents of long-term care and assisted living,” said Mackenzie. “Restricting visitors…has been an enormous sacrifice for our seniors and their families, but it has been necessary for us to protect those who are most vulnerable to this virus. The impact however is having a profound effect on many people and it is time for these people to have their voices heard and their stories told.”

While we would all no doubt prefer no deaths from coronavirus in our loved ones, she pointed out at her news conference, it’s important to look at the “totality of impacts.” Since March, when the first COVID outbreak occurred in a mainland care home, 46 care homes of the total 560 in BC have had outbreaks—about 8 percent (not one of them on Vancouver Island). “We need a balance,” she said. “Yes, we want to keep people safe from COVID-19, but what are we keeping them safe for if it is not to enjoy what is the rest of their life? And for some, their only enjoyment is the time that they can spend with their loved ones.”

Some statistics help put the risks in perspective. There are 40,000 people living in BC’s care facilities. Of the 355 residents who have contracted the coronavirus, 123 have died of it (233 staff have been infected with COVID-19 with no deaths). But during the same period of six months, Mackenzie pointed out, more than 2,000 longterm and assisted living residents died of other causes. “What was life like for them and their loved ones in the final months, weeks and days?” she asked.

The simple math of it is that unless restrictions ease, many families will lose their elders in care without seeing them at all during their final months—or years even— given that this virus will be with us for another year or more. Mackenzie is rightfully concerned about the impacts on the well-being of both the residents and their family members (a lot of whom are seniors themselves). At this point in residents’ lives, family is a critical factor in their over-all well-being.

While COVID deaths in BC care homes are high percentage-wise—61 percent of the 204 total deaths in BC—what else could be expected given that population’s age and infirmities? That percentage is also a reflection of the skill with which Dr Henry has kept COVID at bay throughout the general population, not to mention the skills of health workers in treating COVID patients.

At her news conference, Mackenzie noted that while the one-visitor policy is province-wide, the frequency, duration and nature of the visits vary widely from facility to facility. My mom’s facility allows 45-minute visits every two weeks in a sterile room. Other facilities allow them more frequently, but others only monthly depending on staffing issues. This despite the fact that the Province has provided funding for four full-time equivalent positions for each care home to facilitate visits and the extra precautions needed. (Temperature checks, sanitization, and masks are de rigeur.)

In BC, it doesn’t matter that not one Vancouver Island nursing home has had one COVID-19 case, or that there have been only 173 cases in total here on the Island as of August 27—as opposed to the 1,737 cases of COVID-19 in the Vancouver Coastal Health region and 2,818 in the Fraser Health region. Perhaps we should take a more nuanced, geographical approach. In Washington State, for instance, different counties are in different phases of “re-opening” depending on the number of COVID cases—and care home visitation policies vary accordingly.

I am not advocating a free-for-all expansion of visitation and outings. But allowing more family members to visit, setting a standard or minimum frequency for allowed visits (e.g. weekly), and permitting some carefully planned outings, would be a good start towards a balanced approach. As Mackenzie has noted, there is no situation that is risk free. While there is a risk to opening up, there are also risks to not relaxing restrictions for care homes.

The survey, Staying Apart to Stay Safe: The Impact of Visitor Restrictions on Long Term Care and Assisted Living, is asking residents and family members about their experiences before the pandemic and how these have been impacted over the past seven months. The survey is anonymous. It can be completed until September 30, is available at www.carehomevisits.ca

Leslie Campbell is the editor of FOCUS.