But even as she gets better, Morsillo’s family now worries Maria won’t survive the depression and loneliness she endures as she remains separated from her family while living in a nursing home.
“I can hear it in her voice, she’s depressed," said Vera Morsillo, her daughter-in-law. “She says it’s the same thing day in and day out — she sits there. There is no interaction except for her roommate...Their final days -- and I hate that term -- shouldn’t be like this,” she said.
As the pandemic started to escalate, the state Department of Health suspended visits at all 678 long-term care facilities in New Jersey on March 14, with exceptions only for people who were near death.Three months later, as the state slowly starts to reopen, officials now face the toughest of decisions. Do they keep the ban on visitors in place to protect the safety of medically fragile people or do they lift it to relieve the emotional cost of isolation?
And that emotional toll is coming with devastating consequences. Without a visit or hug from the people who love them, the residents’ mental health is also affecting them physically, families and caregivers say.Some residents and their families are reporting bed sores and weight loss, said Laurie Brewer, who as New Jersey’s Long-Term Care Ombudsman takes calls from nursing homes and their families every day. More than that, they are becoming increasingly desperate.
"Residents who have told us on the phone ‘I just can’t take this anymore and I don’t want to live any longer,’ " Brewer said. “That is why I feel strongly we really need to start to look at the severe emotional distress and trauma the residents of long-term care facilities have experienced. And I would add the staff, as well.”
Nowhere in New Jersey has the disease taken more of a toll than inside nursing homes. Of the 12,489 New Jerseyans who have died from COVID-19, 5,768 of them or 46 percent called these facilities home, according to state data on Friday. That’s far more than the rest of the country, where one-third of all COVID-19 death occurred in nursing homes, according to the AARP.
How New Jersey can lift the ban without putting residents at further risk is a daily topic of discussion, Health Commissioner Judy Persichilli said Wednesday.“The disease in nursing homes is still there in most of our facilities, so we have to be extremely vigilant when we put out guidance for visitation,” said Persichilli, a nurse and former hospital CEO. “We’ve identified some guidelines that we’re just not ready to put out yet, but we will be soon."
“We understand both sides of this issue, but it’s not something that we’re going to be putting out without a lot of thought. But we will come up with a way for individuals, residents to have visitors in very selected circumstances,” Persichilli said.
Jonathan Dolan, president and CEO of the Health Care Association of New Jersey, a long-term care industry group, said they are working with the state "to develop and identify policies and procedures to reopen visitation as quickly as possible for the benefit of all those in our care.”
Until those procedures are ready, nursing home employees “are stepping up with tablets and phones for virtual visits and are more involved than ever in assessing resident needs to connect with their families, friends and caregivers," Dolan said.
The U.S. Centers for Medicare and Medicaid Services, or CMS, shared detailed guidelines for “reopening” nursing homes in a May 18 memo. It recommends nursing homes first be able to conduct weekly testing of employees and residents with COVID-19 symptoms. Visitors should wait until a facility has gone at least 28 days without a new case originating onsite, according to the memo.Facilities also should demonstrate there is ample personal protective equipment at “pre-pandemic levels." Employees would say this is an unspoken acknowledgment of how employees have been forced to reuse PPE and to wear cloth masks, bandanas and makeshift gear like garbage bagsbecause of a national shortage.
The AARP published an article Tuesday suggesting most facilities are likely “months away” from resuming indoor visits. COVID-19 infections were detected inside 7,700 long-term care facilities in the nation, including 551 in New Jersey.
In considering options, Persichilli said she is looking at other states for ideas.Massachusetts is requiring all visits to be held outside with no more than two friends or family at a time. Everyone must be masked. Residents with the virus cannot have visits until they recover. Indiana adopted a similar model.
Brewer, the state ombudsman, said she favors Connecticut’s policy, which in addition to allowing outdoor visitation, allows activities among residents who have been tested and separated based on their COVID-19 status.
Over time, Brewer said, “Perhaps they can gather in dining rooms or outside with social distancing."
Meanwhile, residents and families are struggling to cope.
Bob Whitfield, a resident of United Methodist Communities at Collingswood, an assisted living facility, said recently he has been allowed to sit outside on the porch with residents from the same hall because they have all tested negative. That will end if someone tests positive, he wrote in an email.
“I don’t see this as a viable, long-term option,” said Whitfield, president of the Resident Council. “We can’t shut down the community every time someone tests positive. It is detrimental to mental, emotional and physical health, even as it intends to protect physical health. I’m in favor of permission to move freely and live normally within the building, given basic precautions (masks, limited numbers together). There are risks no matter what course is taken.”
As the virus is expected to persist and a vaccine is not expected until next year, the threat it poses to elderly people in long-term care centers “is a very real issue that isn’t going to end any time soon," said Nancy Berlinger, a scholar with the Hastings Institute, a nonpartisan bioethics research institution.As a society we owe it to residents to find that balance between protecting their health and preserving their dignity and emotional stability, because “people will continue to need nursing home care," she said.
“The reality of the environment is there is a tremendous reliance on families to show up for people in nursing homes," she said. "To have that end so abruptly for a person in a nursing home who does not understand fully the pandemic - because of dementia or another incapacitating condition — is inhumane.”
One Mercer County woman said she has seen that first hand.
Before the pandemic, she said she would spend 25 to 30 hours a week at her 83-year-old sister’s nursing home playing bingo, singing songs and praying the rosary. Her sister, a stroke survivor with dementia, has all but stopped speaking since the lockdown.
“Looking through the window at someone doesn’t cut it. The more we are away, the more she doesn’t remember us," said the woman, who asked that she and her family not be identified for privacy reasons. “I see everything else opening up. And I get it. But these people need TLC.”Hackensack Meridian Health, which operates 16 long term care facilities including the one that is Maria Morsillo’s home, is taking all the necessary steps to make visits happen once they are allowed, said spokeswoman Mary Jo Layton. That includes testing its 9,000-member workforce every week, she said.
“We have facilitated thousands of virtual visits throughout our network, but we understand it cannot take the place of real visits with loved ones,” Layton said. Anticipating the outdoor visits are the first step toward reuniting families, “We are reviewing every location to develop outside visiting areas,” she said.
Even with the “amazing” staff at the West Caldwell Care Center accommodating virtual family visits for Maria Morsillo, her daughter-in-law said it’s still “heartbreaking” not to be with her. As she recovers from the virus, "she is weak and is on oxygen more than she has ever been.”
“We’ll take the proper precautions. We want to be respectful. We just want to see her, and for her to see us.”