Social isolation necessitated by COVID-19 weighs on everyone, especially older adults and those living with disabilities who may have already felt relatively isolated before the pandemic even started, said Greg Shelley, program manager of the Harris County Long-term Care Ombudsman Program at Cizik School of Nursing at The University of Texas Health Science Center at Houston (UTHealth). Likewise, the staff and volunteers who are dedicated to advocating for rights, health, and safety of seniors miss face-to-face visits.
“It’s heartbreaking for all of us not to be able to be inside the facilities,” Shelley said.
His team of seven staff ombudsmen within the Cizik School of Nursing’s Center for Nursing Research, along with 77 volunteers, advocate for residents of skilled nursing homes and assisted living centers, including memory care facilities, in Harris County. Every nursing home and licensed assisted living facility has an assigned staff ombudsman who normally visits regularly and supports the volunteers who would typically visit a specific residential facility once a week to identify needs and advocate for residents.
As of March 13, the Texas State Long-term Care Ombudsman, Patty Ducayet, temporarily halted on-site visits to nursing homes by ombudsmen to help prevent the spread of COVID-19. Residents still have the right to access to an ombudsman, but federal and state authorities have temporarily waived some residents’ rights to visitation, Shelley explained.
Residents retain all other rights – including the right to leave facilities that are only allowing entrance to staff and essential caregivers. An important part of the ombudsman’s job is to educate residents about their rights and options, but also about the potential consequences of exercising them. For example, a resident who chooses to leave a facility these days might be asked to isolate for the following 14 days upon returning, Shelley said.
“Residents also have a right to go against medical advice or refuse treatment, including COVID-19 tests, but they also would be required to isolate for 14 days in that situation,” Shelley added. He sees the state target of testing all nursing home residents by early June as a positive step for everyone involved. “Some of the problems with the nursing homes that have had significant outbreaks is that they didn’t know they had cases until someone was transported to a hospital and tested there,” he said.
For now, the ombudsmen rely on phone calls and videoconferencing to keep in touch with residents, family members, and facility staff.
“It’s kind of piecemeal,” said Jo Latimer, a 13-year volunteer who would normally pay a couple of visits a week to a local facility. “I don’t feel like we are able to do anywhere near what we were doing before. When we visit with people there, we almost always come away with something we can advocate for.”
The overall number of complaints Shelley’s team handles is down, due in part to the lack of in-person time with residents who otherwise may not be aware of the ombudsmen. “On the other hand, we are seeing a fairly significant increase in private, confidential consultations, mostly from family members who are concerned about the restrictions on visitation,” he added.
“The social contact – that’s the biggie,” Latimer agreed.
The lack of social contact for the residents is a major concern, and restrictions vary among facilities. Skilled nursing homes are federally licensed and held to stricter standards than assisted living facilities, which are state licensed. In some cases, socialization is very limited even among residents within a home. Some locations facilitate video chats with family members or allow visits across barriers, such as windows.
Latimer regularly reaches out via telephone to residents and their family members at her assigned facilities and listens to their concerns. Like many of us, one woman in her 90s was worried about missing her usual hair appointments since the on-site salon had to temporarily shut down. “She has been so distraught about her hair that her family decided to buy her a wig to compensate,” Latimer said. “It was a great solution.”
Assisted living centers, like the one where Latimer’s well-coifed client lives, have generally reported far fewer cases of COVID-19 than skilled nursing facilities, Shelley noted. Features of assisted living facilities that could serve to lower the risk of transmission include more private vs. shared rooms, more open space, and less contact with medical professionals providing direct care to multiple patients. However, assisted living facilities do not typically employ nurses and are not required to have nurse staff in the building every day, which poses some special risks to residents who becomes ill with COVID-19.
One positive development Shelley has noticed during the pandemic is that it is has created some serious dialogue regarding ways to improve how we deliver long-term care, particularly in nursing homes.
“I hope it leads to some qualitative changes, benefitting both those who deliver the care and those who receive it,” Shelley said.
Regardless of the pandemic, more volunteers are needed to help advocate for residents of some 400 facilities in Harris County alone. Becoming a volunteer ombudsman is not a decision to take lightly, considering that it requires 36 hours of training, a 60-day internship, and the commitment to visit a long-term care facility once a week for at least a year.
Latimer learned of the program from an ombudsman who visited the nursing home where her mother lived briefly. A few months after her mom’s death, Latimer decided to become an ombudsman herself. She enjoys the opportunity to meet people, continually learn new things, and solve problems for people who really need someone to advocate for them.
The next training session for volunteers is in September and may be virtual instead of in person, depending on the status of the pandemic, Shelley noted.
“I think it’s a wonderful program, and I encourage people to consider it,” Latimer said. “I look forward to the day when COVID-19 is behind us and we can resume our regular visits, but we will get through it like everyone else does.”