Worried about COVID-19, long-term care facilities discourage residents from leaving for Thanksgiving

Thanksgiving at senior facilities will have features that reflect the changes required because of the COVID-19 pandemic: catered dinners brought directly to residents’ units, heated and ventilated outdoor tents for visits, a “pie on wheels” drive-by event for family members and health care workers to pick up dessert.

The effort to make Thanksgiving special for residents isn’t new, though it’s taken on an added significance this year as facilities remain locked down. But it’s also a way, providers say, to encourage residents to stay where they are, instead of attending Thanksgiving events elsewhere.

“As far as gatherings go, we are just really, really trying to discourage that,” said Kevin McFeely, CEO and president of Tacoma Lutheran Retirement Community. “We’re not trying to be the Grinch, but it’s the safest thing to do.”

While long-term care providers such as nursing homes and assisted living facilities can restrict who comes into a building, there’s no rule preventing residents from leaving the site and coming back. That’s left officials worried that, as COVID-19 cases rise throughout Washington, some residents who join their families for Thanksgiving at a loved one’s home could bring the virus back to an environment that’s especially vulnerable.

“We have been concerned about the Thanksgiving holiday, but at the same time we have been concerned about residents not being able to celebrate the holidays with their families,” said Robin Dale, CEO of Washington State Health Care Association, which represents nursing homes. “It’s a difficult issue, and we have to walk a fine line to pay attention to what is best for the resident.”

Federal and state agencies advise against any holiday travel and gathering with anyone outside your household. That advisory applies to long-term facility residents, especially as COVID-19 cases surge throughout the United States. Seema Verma, administrator at Centers for Medicaid and Medicare, said in a call with nursing home providers earlier this month that she worried about Thanksgiving and the risks that outside visits pose for facilities.

“They (residents) have already endured loss and loneliness to a degree that would have been unthinkable before this year began, but they and their families – along with facilities themselves – must not let their guard down over the holiday season, especially with a safe and effective vaccine so close to reality,” Verma said in a news release.

State health officials have said that as the virus spreads throughout a community, it’s likely to find its way into a long-term care facility. As of Monday, 365 nursing homes, assisted living facilities and other residential providers have at least one active case of COVID-19 among residents and staff. That’s the highest number since the pandemic began. It’s also a jump from last week when there were 339 facilities with active cases, according to the state Department of Social and Health Services (DSHS).

Some providers are mapping out what precautions they’ll need to put in place before the holiday. Era Living, which operates eight retirement communities in the Seattle area, has asked residents who are planning to leave to share details of their plans in advance, according to Nisan Harel, vice president of operations. In some cases, residents will have to isolate and then get a coronavirus test.

For residents who do return from an off-site visit, DSHS spokesperson Chris Wright said the state is following federal guidance and recommending that facilities take extra precautions such as testing. The state provides facilities with risk assessment guidelines, which helps determine what level of restrictions the resident should have.

For example, a resident who returns from a Thanksgiving event held outdoors, with two other people wearing masks and for less than an hour will be considered low risk. Meanwhile, someone who goes to an all-day Thanksgiving indoors with seven people who don’t always wear a mask would be labeled high risk and would need to quarantine for 14 days.

Bruce Hill, who lives in a senior community in Seattle’s Bitter Lake neighborhood, decided to stay put instead of joining anyone for Thanksgiving. He quoted a phrase that has been brought up in various forms by health officials: “If you gather at Thanksgiving, you’ll get together for Christmas at the funeral.”

“It’s as simple as that,” Hill said. He plans to call his “sweetheart,” who lives in a Seattle long-term care facility, and spend the holiday talking to her, like he does every day.