Lori DeMatteis hasn’t seen her 86-year-old father for 135 days.
After returning from a three-week business trip in February, DeMatteis was hoping to visit him at the Reutlinger Community, where he lives in the skilled nursing unit. But the senior home in Danville was under a flu quarantine at the time and visitors were restricted.
Then in March, the coronavirus pandemic caused senior living communities across the nation — including Reutlinger, the S.F. Campus for Jewish Living and Moldaw Residences, among other Bay Area Jewish facilities — to shutter their doors to all outside visitors. That left DeMatteis with very few ways to communicate with her father.
Months later, DeMatteis says her father’s cognitive and emotional health are in freefall because of the absence of contact with family.
“He’s lost his zest for life,” DeMatteis said in an interview. “The decline is huge because we’re not there.” She is now seriously considering removing her father from the facility and providing him private care at her home.
“This is not just a Reutlinger issue,” said DeMatteis, who added that her father has been taken care of very well there. “This is a nationwide issue.”
Interviews with senior residents and family at Jewish senior facilities in the Bay Area reveal a major tension at play: As the coronavirus has killed tens of thousands at senior care homes, strict measures have been instituted to help curb its spread. But those precautions have prevented family members from visiting their loved ones in person, causing frustration and pain.
A body of research shows how harmful isolation can be for seniors, according to Dr. Ashwin Kotwal, an assistant professor of geriatrics at UCSF. Increased isolation can cause depression and anxiety, he said, and chronic emotional stress can increase the risk for stroke and even death.
“The effects can be pretty substantial,” Kotwal said. “One of the things I keep hearing from patients and family members is this feeling of being trapped. Being boxed in. I think it’s taken a large emotional toll on residents.”
Family members across the Bay Area are calling for a compromise that will allow them to safely visit their loved ones again.
Such decisions are made on a county-to-county basis. In Contra Costa County where Reutlinger is located, for example, the health department is allowing facilities to establish their own visitation rules. In San Francisco, the health department is still prohibiting visitors to skilled-nursing and long-term care facilities.
Alyssa Porras, life enrichment coordinator at Reutlinger’s skilled nursing facility, said the restrictions have “really impacted our residents, family members and staff. Everybody involved. It’s really hard to see the emotional decline. The family members are such a vital component.”
Despite efforts to connect families through technology, most would argue it is no substitute for human contact, and, in many cases, simply does not help.
“We immediately reach for technologies,” UCSF professor Kotwal said. “But it’s so hard to replace in-person interaction, especially with people with cognitive impairment.”
Andrea DuBrow, whose 74-year-old mother is in Reutlinger’s memory care unit with Alzheimer’s, said video conferencing confuses her mother.
“For people with dementia, Skype and FaceTime videos are not sufficient,” said DuBrow, who hasn’t seen her mother in person since March 11. “They don’t have cognitive processing skills to connect [the] image in their brain and voice.”
The longer the restrictions continue, the more she fears that her mother will forget who she is.
“We have to find new ways of being with folks,” DuBrow said. “The solutions we have right now don’t work for people with dementia.”
Kotwal, who called the impact of Covid-19 on senior care homes “devastating,” said that while he understands why facilities have taken a conservative approach, he is in favor of finding a solution to alleviate the negative health impact of isolation.
“We need to adapt some of these restrictions, some type of middle ground to strike the balance between safety and allowing for some visitation,” he said. “It remains to be seen how to successfully do that safely.”
Reutlinger has been following guidance from the Centers for Medicare and Medicaid Services on visitation policy. On June 15, it announced it would allow scheduled outdoor visits for families of seniors in the assisted-living and memory care units. However, visitors are still restricted from the skilled nursing unit.
As of June 18, Reutlinger had no reported cases of Covid-19. Universal testing of staff and residents, per county orders, are underway and the results are expected in a few days.
Similarly, the San Francisco Campus for Jewish Living reported zero cases of Covid among its residents, patients and staff at the end of May after a round of universal testing of nearly 900 individuals. Another round of testing will happen sometime this month.
A woman whose mother is a resident at SFCJL said “there needs to be a happy medium” with visitation policies. The woman requested that her name not be shared due to privacy concerns.
“It’s just not OK to not have some kind of modified visitation,” she said, adding that she wished she could see her mother in person, even if that means keeping 6 feet between them. “I don’t see a risk in that. I only see benefits.”
Visitation policy was the main topic at a June 15 SFCJL virtual town hall for family members.
“We know how badly our family members want to come back on campus,” CEO Daniel Ruth said, according to audio of the event obtained by J. “And the staff completely empathize with that desire.”
Ruth said he’s been in touch with the San Francisco Department of Public Health and asks regularly about when visitation policy will change. He said the answers have been “less than satisfactory.”
Ruth urged family members to get in touch with the SFDPH to press for a change in the visitation policy.
“To be perfectly candid with you, as family members, it would not hurt for you to apply a little pressure so that everybody is taking this particular issue as seriously as we do, and as we know that you do as family members. And that [the SFDPH] have the same sense of urgency in trying to get to a resolution on this matter,” Ruth said.
Queried on the city’s plans to ease up on visitor restrictions, the SFDPH replied by email, “Seniors and people with preexisting health conditions are especially vulnerable to Covid-19. It’s important to stay home and limit contact with other individuals to reduce chances of getting sick.”
The email also included a list of resources and a telephone number for seniors who need a “a friendly ear and warm conversation any time day or night.”
At the Moldaw Residences in Palo Alto, an assisted-living residence that offers skilled nursing services through the SFCJL, Henry and Lottie Burger haven’t seen their family since March. The couple, who didn’t want to share their ages but described themselves as “older” seniors, said they feel luckier than others. Their apartment faces a parking lot where their grandchildren and son have made visits.
“We throw them kisses there,” Lottie said. “That’s more fortunate than some people.” The two said they’ve been keeping busy watching the news, video conferencing with family and playing Scrabble.
“We are in touch with the world,” Lottie said. But she and her husband also feel frustrated, especially over the uncertainty about when they will get to be with their families. “We don’t have a date in mind where we can go back to almost the way we used to be,” Lottie said. “The future looks far off and grim in the meanwhile.”
At the same time, the couple say the restrictions are absolutely necessary. So far, Moldaw has no reported cases of Covid. The county’s health department has not conducted universal testing for residents.
“We feel the unfortunate effects of [the isolation],” Henry said. “But the fact remains that this is the only way we can protect the community.”