It was late April when a Covid-19 outbreak was reported at the Seven Hills Health and Rehab Center, a nursing home just south of Cleveland. And when Mehdi Saghafi, an 89-year-old resident, was tested for the disease, the result came back positive.

He was immediately transferred to a separate unit and is being kept in isolation there for 21 days, even longer than the two-week isolation period recommended by the Centers for Disease Control and Prevention. But his family worries Saghafi feels abandoned — and fears for his psychological health on top of any physical conditions he could develop. They also don’t know what the future holds.

“After the 21 days are up, then what?” Saghafi’s son, Dariush, told STAT. “Are they going to retest him for coronavirus? Are they going to do an antibody test?”

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At nursing homes and long-term care facilities across the country, a sense of uncertainty has set in. Some states are relaxing social distancing restrictions, and some non-essential businesses are even reopening. But for nursing homes and assisted living facilities, which account for roughly one-third of all coronavirus deaths in the United States, there is not yet a return to normal.

It’s not clear when there will be. Two months after the Centers for Medicare and Medicaid Services directed nursing homes to significantly restrict visitors and all nonessential personnel, the agency on Monday released guidance to state and local officials on factors to consider before reopening. Those factors include staffing levels, testing capacity, and access to personal protective equipment.

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But it’s still up to those local and state officials to make difficult decisions.

For now, industry officials say the lockdowns have been unforgiving in many facilities. Even in nursing homes without Covid-19 cases, communal dinning and group activities have been restricted, taking a tremendous toll on residents’ emotional well-being, said Kristen Knapp, director of communications of Florida Health Care Association.

“Residents like to play bingo and interact with each other. All of that is part of the psychosocial needs of our residents. But returning to a normalcy at this point, those are decisions that we can’t make, as we have certain requirements by our federal regulators,” she said.

Health officials say that one of the keys to reopening, as in the rest of society, is testing. The Trump administration has reportedly recommended that all nursing home residents and staff be tested for the coronavirus in the next week or so. But it has left testing to state authorities, and in many states, there remain shortages of test kits.

David Schless, president of the American Seniors Housing Association, said the government has been of little help to long-term care facilities in accessing rapid testing kits and personal protective equipment.

“I think our members in the industry generally have done the best that they can under the circumstance. … The blame that’s been placed on these providers is really pretty outrageous,” he said.

Although it is unclear when the federal government will ease restrictions on long-term care facilities, the reopening of some parts of the U.S. economy has prompted conversations in the industry on developing a strategic plan that will allow them to reopen safely and responsibly. Schless said the American Seniors Housing Association has recently engaged a firm to help advise their members on developing such a roadmap.

In the meantime, nursing homes and long-term care facilities are doing their best to keep families connected through technology and other means, while following strict social distancing protocols.

“Mother’s Day was especially hard for families. One of our members set up a tent outside of their building, and families could come one by one and talk to their loved one through the glass,” said Katie Sloan, CEO of LeadingAge, an association of nonprofit providers of aging services, including nursing homes and assisted living facilities.

Sloan said she worries the reopening of the country might lead to a spike in infections at long-term care facilities, despite strict restrictions on visitors. Staff who work in these facilities, she said, will be going out into the community, “where the virus may be more prevalent than it was when we were all in lockdown.”

Nursing home workers “may unwittingly bring the virus into the facility,” she added. “In the absence of quick and reliable testing, we won’t know.”

  • I went ama in 2 nursing homes I’m sick and tired of it I’d rather be homeless rather than be locked up like a prisoner all you see are Alzheimer’s patients and dementia cases walking the floor

  • All long term living facilities where residents are seniors should be prioritized for testing with a single goal: ISOLATE AND QUARANTNE ASYMPTOMATIC BUT
    INFECTED RESIDENTS FOR 14 DAYS AND RETESTED IF FOUND NEGATIVE TO ELIMINATE TESTING ERROR BEFORE ENDING THE QUARANTINE.

  • (State) government decision makers need to seek input from long term care experts who know this sensitive and large demographic group. And testing is absolutely crucial – now and on the path forward. Germany is so successful and now opening up, because it excelled in testing (their leader is a scientist). The US has to test much, much more (get them not only from Abbott Labs but also better tests from Roche, Quotient, etc). Without stepped-up testing, the US keeps running in circles in the dark, and nothing can be succesfully planned.

  • Significant numbers of long term care residents have tested positive but asymptomatic. More than 50% in some cases: https://www.boston.com/news/local-news/2020/04/04/coronavirus-cases-wilmington-nursing-home

    If testing becomes mandatory, long term care facilities will have to isolate all those infected and could lose staff at the same time more staff would be needed to manage the situation. This is a huge problem in dementia care facilities where residents cannot understand the reason for masks, social distancing or isolation.

    A recent talk by Teepa Snow, leading dementia care educator discussed the lack of understanding of such care among public health authorities. Imposing rules that those suffering from dementia CANNOT follow will be a nightmare for the staff and residents of dementia care facilities.

    • Yes completely agree. LTC is a different breed and memory care/dementia units are an even more special breed. Yet there are a lot of LTC residents who require the extra help with Activities of daily living, medications etc who are still “with it” and they are suffering as well-having the socialization taken away is hurting them. No one in the public “lockdown everything forever until 100% vaccine here” chanting crowd will acknowledge this. I have many many residents who are now giving up, refusing to eat, and have stated they’d rather die if they have to stay in “prison”.

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