As the coronavirus spreads, many nursing homes and assisted living facilities are discouraging family members from visiting loved ones, and they are screening those who do come. President Trump created additional confusion last night when he urged facilities to “suspend all non-essential visits.” What should you do?

There is good reason for concern. While there is no evidence that older adults are more likely to contract COVID-19, the disease caused by the coronavirus, they often suffer more severe effects. And they are much more likely to die from the disease than younger people. In one nursing home in the Seattle suburb of Kirkland, 19 people have died from the disease, and COVID-19 has been reported in nine other facilities in the area.

But not visiting loved ones living in a nursing home, skilled nursing facility, or assisted living facility is hard. And it creates some difficult challenges.

Keep in mind that, with some exceptions, facilities are discouraging family visits, not prohibiting them.

Nursing homes may be barring nearly all visitors if they are located in communities where the virus has become widespread, such as King County, WA or Westchester County, NY.

Screening visitors

Otherwise, facilities likely will only urge you to stay home. And most will actively screen visitors. They may ask you questions, such as whether you have been coughing or sneezing, have a fever, or have visited a foreign country recently. If the answer is yes, they may ask you to leave. Some facilities may routinely take the temperature of all visitors (including vendors and even visiting health professionals) to determine if they have fever.

All this could change if government turns Trump’s idea into a flat prohibition. But for now, facilities and families still have some flexibility, based on guidelines issued last week by the Centers for Medicare and Medicaid Services.  States have issued their own similar guidelines (for example, here is Maryland’s) I asked the American Health Care Assn. whether Trump’s remarks would change its guidance to members, but it did not reply.  For now, assume you will be discouraged from visiting, but not barred. What should you do?

First bit of advice: Let the facility staff do their job. They are asking about your health and travel history for good reason. Cooperate with them. And, for the sake of everyone involved, tell the truth. Even if you’ve just had the “sniffles,” let them know.

And if you are not feeling great, stay home. Don’t visit.

Even if you are OK, and not in a community with a large number of cases, you still should think about what to do. If you are a young adult, you could be a coronavirus carrier without knowing it. Many young people may have COVID-19 yet show no symptoms.

Risks of not visiting

But not visiting raises issues. Without company, residents will be lonely and bored. Some may not understand why you have stopped visiting, and that can make them upset and agitated.

Even worse, many facilities also have barred volunteers. That means no friendly visitors, no pets, no one to help support staff with resident activities.

And staff, already overworked in many facilities, now has even more to do. They have to meet tougher infection control standards, both for themselves and their facilities. And, I suspect, many are worried about their personal health. As a result, they may be less attentive to individual residents.

Even in the best of times, it is critical that family and friends are a presence for their loved ones who are in facility care. Not only to provide support, but also to act as advocates. A family member can prevent problems, and make sure that issues are addressed quickly when they do arise.

What will happen when those family members are not there? Phone calls or video chats through Skype or Zoom can help, but they are not the same as a personal visit.

Coronavirus is forcing many hard choices on us all. Whether or not to visit a loved one in a residential care facility is an especially tough one. But, at least for now, when in doubt, don’t.