Nothing I have written lately has generated more heartfelt response than my articles about family members who, due to the covid-19 pandemic, are unable to visit their loved ones in long-term care facilities.

And the writers are consistent: They want to visit, no matter the risk. Here are just some of the emails I’ve received in the past few weeks:

“It is gone on far too long and it is time that those who are in the last months or even weeks of their lives get to see their loved ones again. You can’t keep families away from their loved ones for 4-6 months, it is beyond cruel. I will take any COVID test.. .before a visit…ANYTHING to see my sweet mother again! “

“ I’ve not seen my mother in 70 days. She has end stage Alzheimer’s, vascular dementia, and Parkinson’s… What began as emergency efforts to flatten the curve have morphed into the government micromanaging life and death of our most vulnerable.”

“ My mother is in a…nursing home, in a wheel chair with dementia. No one in the family has been able to visit her for almost 3 months. My last visit with her was March 12.”

Chaotic rules

The separation, which one resident called “benevolent incarceration,” is brutal for both residents and their relatives. Starting in mid-March, when the Trump Administration barred visitors (with a handful of exceptions) from nursing homes, facilities had no choice. But on May 18, the Centers for Medicare and Medicaid Services issued ambiguous guidance that effectively left the decision to states and facilities. The predictable result: Chaotic and inconsistent rules and practices.

Long-term care facilities are faced with an impossible choice. They can keep their doors shut and minimize the possibility that visitors will risk the lives of their residents by bringing in Covid-19. But if they continue the lockdown, residents will suffer more weeks or months of social isolation and heart-breaking loneliness—itself a serious health risk.

Or, they can allow visitors. That would give residents a long-awaited chance to see spouses, children, and grandchildren. But, without accurate and rapid testing and personal protective equipment (PPE)—still missing after these many months and despite repeated White House promises—those visits inevitably will increase the spread of Covid-19 among the highest-risk population in the nation.

They are making this choice at a time when more than 46,000 residents and staff of long-term care facilities have died from the pandemic over the past four months.

Residents are at extremely high risk of death if they contract the disease, and we’ve learned that once the virus enters a facility, it spreads rapidly. Three research studies also tell us that outbreaks and deaths are most likely to occur in facilities located in communities with widespread Covid-19.

In other words, people likely are bringing the disease into facilities from nearby communities. In recent weeks, those carriers probably have been staff—the only outsiders allowed in. But as facilities reopen to visitors, family members—often showing no symptoms–will be spreading the disease to residents.

That’s why rapid testing and PPE are so important. And why reopening without them is so dangerous.

Choosing to open

Still, state and facilities increasingly seem to be choosing Door #2.  The Wall Street Journal reported on four states that are beginning to end the lockdown:  Massachusetts, Indiana, and Ohio are allowing only outdoor visits. In Massachusetts and Indiana, visitors and residents must stay six feet apart. In Ohio contact-free visits are merely “encouraged.”

On Oklahoma, outdoor visits are “preferred” but not mandated. Many other rules are up to the facilities themselves.

New Hampshire is about to allow “no contact” outdoor visits only, at the discretion of the facilities.

Minnesota is allowing “open window” visits only.

Most states require visitors and residents to wear masks, but Oklahoma leaves that up to the facilities. Most states do not mandate other personal protective equipment, such as gloves or hospital gowns.

Violating social distancing

Here is the reality: The social distancing rules will be violated, early and often. Can you imagine not hugging your mother or wife after not seeing her for three months? Can you imagine a resident, who may have some dementia, remembering she is not supposed to hug her son?  Can you imagine staff trying to enforce this rule?

If my emails and what I’ve heard from facility managers is representative, families have grown weary of the lockdown. It will be increasingly difficult to keep them away. We can only hope that testing and PPE is sufficient and facilities and families are careful enough to prevent another disaster.