With nearly all of the residents vaccinated at her mother’s nursing home on Maryland’s Eastern Shore, Sheree Sample-Hughes thought the days of visits being limited to waving from outside were over.
With a “Happy Birthday” banner attached to the side of her Jeep Wrangler, Sample-Hughes and about a half-dozen family members and her son’s Irish doodle, Hunter James, gathered in mid-August, peering through a glass door while holding balloons, a cake and cupcakes to celebrate her mother’s 72nd birthday.
“When we were able to visit and have face-to-face contact, it was reassuring that things had gotten better, and I saw the change in my mom’s mental state,” said Sample-Hughes, a Democratic state delegate from Wicomico County. “Now it’s been shut down again, and it’s been very difficult.”
With the highly contagious delta variant of the novel coronavirus sweeping across the country and some nursing home employees expressing reluctance or refusing to get vaccinated, nursing homes in Maryland are again seeing a rise in infections. Each time a new case occurs among staffers or residents, federal guidance means nursing homes must immediately suspend visits.
That has meant a new wave of despair in facilities that were hit hard by covid-19 and by the isolation that came with visitor restrictions.
The toll of loneliness on the health of the elderly, especially those with dementia, has been extreme.
As of last week, though, employees at all of Maryland’s 227 nursing homes were to have had at least one vaccine dose, under an order from Gov. Larry Hogan (R) intended to protect the most vulnerable against hospitalizations and death.
Nursing homes that fail to comply will be subject to fines from the state, just as those that failed to institute proper infection control or report on coronavirus infections and covid-19 deaths were sanctioned.
Nearly 90 percent of all nursing home residents in the state have had at least one vaccine dose, and 86.1 percent are fully vaccinated. Almost 79 percent of nursing home staffers statewide are fully vaccinated. Since Hogan’s order, the percentage of employees who have received a dose of vaccine has increased slightly, from 80 percent to 82 percent.
Officials recognize that nursing homes, like the communities in which they operate, will continue to see coronavirus infections as unvaccinated staffers and visitors transmit the virus to residents and vaccinated people experience breakthrough infections. Officials’ main goal remains getting people vaccinated to keep hospitalizations and deaths at bay.
In July, fewer than 10 nursing homes in Maryland had an outbreak — defined by the federal government as at least one covid-19 case, according to the Health Facilities Association of Maryland. By early August, the number was 33. On Friday, it had reached 92.
Although current numbers pale in comparison to those of early January, when there were nearly 600 cases and 100 deaths among nursing home residents, recent state data shows a significant increase in cases and deaths in that population.
In the week ending last Wednesday, there were 74 covid-19 cases and seven deaths among nursing home residents, and 90 cases of infection and no deaths among employees.
A month ago, only 12 covid-19 cases were recorded among residents and 30 cases among employees, with no deaths in either group.
As they have watched case numbers rise, nursing home staffers have felt frustrated and discouraged, though not entirely surprised, said Allison Ciborowski, chief executive at LeadingAge Maryland, which represents 120 nonprofit operators of long-term-care facilities.
“Everyone has this pit in their stomach of, ‘Oh no, not again,’ ” she said.
She said that this time, staffers know more about the virus than they did during the first wave last year, so they have been able to strengthen policies and procedures to control the virus’s spread. And since the vast majority of the state’s nursing home residents now are vaccinated, they tend not to become as sick or need to be hospitalized.
Still, Ciborowski said, staffers are emotionally exhausted and fearful of returning to the grim days they had hoped to have left behind.
“It is like watching a tidal wave get closer and closer,” she said that one nursing home leader recently told her. “And you pray you are on high enough ground.”
Industry leaders in Maryland say they are preparing for the type of surge the state experienced in December and January, when case numbers were at their highest so far in the pandemic. They have predicted a challenging environment over the next several weeks, perhaps lasting into October. But they say they also are hopeful that the high vaccination rates among residents will mean nursing homes will be spared the devastating death toll seen earlier.
“We’re entering a challenging time,” said Joseph DeMattos Jr., president and chief executive of the Health Facilities Association of Maryland. “We’ve got to sound the alarm.”
The first few recent positive coronavirus tests at Ginger Cove, a continuing care retirement community in Annapolis, were a bitter reminder that the virus is not going anywhere, said administrator Phyllis Boulden.
“We were like, ‘Here it is,’ ” she said. “And it is going to keep peeking its head.”
She said the nursing home focused on educating its staff but did not on its own mandate vaccinations.
Since May, the Maryland Department of Aging has posted data on the vaccination rates of residents and employees at each skilled nursing home in the state. More recently, the state Health Department has been releasing a top-10 and bottom-10 ranking based on staff vaccinations.
Most of the facilities found at the bottom of the ranking are generally in rural parts of the state, where vaccination rates are below the state average.
DeMattos said he was pleased that the state decided last month to launch a pilot program to detect the immunity level of nursing home residents. Under the program, 500 nursing home residents are being tested for antibodies. The results, which were completed last Wednesday but have not been made public, will be used in administering booster shots.
While the state pushes for nursing home residents to get booster shots, Health Secretary Dennis R. Schrader said employees also remain in the state’s focus.
In some nursing homes, nearly 100 percent of staffers have been vaccinated, but in some others, he said, vaccination levels are below 50 percent.
“We still believe that getting people vaccinated is the most important thing,” he said. “The problem is that the staff and the visitors bring the virus into the nursing home. And it is very hard to say we’re not going to let in visitors when staff is not vaccinated. So we’ve stepped up our insistence that they get vaccinated.”
At Wicomico Nursing Home, where Sample-Hughes has been restricted from seeing her mother, more than 96 percent of residents and nearly 75 percent of staffers are fully vaccinated.
“It’s draining on her and on the families as well,” Sample-Hughes said of being isolated from each other. “It’s such an empty spot, not having that regular communication.”
Sample-Hughes said that over the past few weeks, she has been second-guessing her decision to have the celebration at the nursing home.
She could tell that her mother was happy to see her visitors and was particularly tickled to see Hunter, the Irish doodle. But Sample-Hughes said she also saw that her mother was confused and hurt at being separated from her visitors, who were socially distanced behind the glass doors.
“It was a little traumatic,” she said. “I just don’t know.”
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