Controlling infectious diseases in facilities; is this common where you live?

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Controlling infectious diseases in facilities; is this common where you live?

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This is a topic that comes up every winter among my acquaintances because local facilities (ALs) are closed during respiratory outbreaks (I believe the threshold is more than 3 active cases), usually for weeks at a time but sometimes for months. That means visits are discouraged, all group activities are cancelled and in some cases congregate dining is as well, more or less amounting to house arrest for some of the people living there who don't have the ability to leave the site. I've never seen any complaints here on the forum about this and I'm curious, is this common where you live? If not what is done differently?

Assisted Living Flu Senior Health

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So far this year the nursing home my mom is in has only been on quarantine once, for about a week, because of the flu. The residents are not allowed outside of their rooms, not even allowed to go to the beauty shop. I can’t imagine how awful it is to be stuck in one of those small rooms for that long! Last year, there was a two week quarantine. Visitors are allowed to drop things off for the residents, but we’re not allowed past the receptionist desk.

Infection control is definitely important, but despite best efforts this kind of thing is going to happen.

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My dads facility did not implement any quarantine procedures and when one person got sick, everyone got sick. I wish they would have taken precautions to protect residents from contagious illnesses.

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This happened once in the four years my mother was in a NH. There was a flu outbreak despite flu shots being given. They did a deep cleaning and kept everyone away for a week. We could call and residents who were able could talk on phone. Infection control is important, maybe ask what additional cleaning is being done?

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The funny part is that in memory care and in the nursing home they are not allowed to restrain the residents so basically they can't force anyone who is ill and contagious to stay in their rooms, and of course many rooms are double or multi occupancy so that adds a whole different complication to the mix.

Something that has also come up for discussion is that cleaning staff are not being allowed into the rooms either, so for one local facility it has been over 6 weeks without cleaning - not good when many AL residents have incontinence and some degree of dementia too.

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We were fortunate and only experienced it once, after the long 7 month hospital to specialty care hospital (repeat once) and then rehab, where it occurred. Dad had a shingles outbreak. Staff and I gowned, gloved and masked, deposited them in a special bin if I remember correctly.

Dad had therapy and meals in a private room (the best part), and the segregation was actually not long. I don't remember how many days but I don't think it lasted more than a week.

And fortunately, it wasn't something like Coronavirus!

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I totally get quarantining the people that are sick GA, that only makes good sense.

What I question is locking down the whole place and banishing healthy people to virtual house arrest, especially when the number of people affected low. I really believe that staff showing up for work when they are sick and/or moving from room to room taking shortcuts with quarantine protocols (which I observed first hand) is a much more likely vector of transmission.

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But lots of people imagine that they are healthy when they are in fact starting cold/flu. "It's just a few sniffles" could mean pneumonia to an elder.

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CWillie, sorry, I didn't quite answer your question. I think it would depend on the reason for the quarantine as to whether they're overreacting. I know that's not a succinct answer though.

If this is in existence now, it might be because staff and/or Admins are worried b/c of the Coronavirus and its rapid and extensive transmission.

I do think it's unfair to patients and relatives though; both need that interaction, and masks can be worn.

I think what's more appropriate is to handle the situation as hospitals do, by quarantining only select rooms, or wings, where the infectious patients are.

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Hopefully this is standard practice. Many elders are very vulnerable to respiratory infections and for sure too many visitors are not realistic and conscientious about limiting their visits when they should. Fairest thing to all is to limit risk. Why not use SKYPE in a situation like this?

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I suspect a lot of the residents aren't in a position to skype. Many might not have computers or other modern electronic devices, know how to use them, or even still be mentally capable of using them. Most residents of the nursing homes are of the "silent generation" (so-called in the US) who were born in 1945 and earlier.

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Overreacting is better than underreaction. Afterall, this is a an elderly, not so strong anymore immune system population. There is also the matter of liability on the part of the facilties owners & management so many see fit to take all precautions neccessary.

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So my question was whether this is common practice where you are and whether or not you have a problem with it.....

The consensus is that most places have closed facilities for much of the winter, and everyone is OK with that.
Thank You

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My father's MC went on "restricted" visitation during flu season in the area or when a resident in either wing (AL or MC) became ill. The sick residents were required to remain in their room at any sign of illness and the common rooms were thoroughly cleaned daily instead of weekly. The daily cleaning included wiping down every table/counter surface, chair arms and seats, light switches and the like. The thorough cleaning included cleaning chair and table legs, window sills, just about every possible surface. Visitors were allowed, but only after being screened by a nurse or aid who took your temperature and accessed you for illness, including asking questions about anyone ill at home or your work. You could drop things off for the residents if they were "sealed" (no open packages) but any clothing or blankets were washed by the facility before being given to the resident. I provided a lot of cooked meals/food for my father's salt restricted diet and they accepted the food I brought, but they did wipe down each container. My brother didn't like the MC wouldn't allow the foam plate containers of food from a grocery meal bar in, but would allow a meal "plated" in a restaurant kitchen or even one picked up from a drive thru, although I saw them wipe down the containers. My understanding is there was a plan for a complete quarantine where no visitors or outside food/supplies would be allowed, but that was never implemented during my father's stay.

I thought these were reasonable safe guards. There were never more than 4 residents in my father's MC wing (out of 32-34) ill at once and no one died from illness or its complications. The staff didn't have much illness and that was very important to being able to maintain good care for the residents. My father had the flu once and the MC required an extra "half" attendant (1 attendant for 2 residents) during the 3 days of his acute illness and an extra cleaning fee when he recovered (I was surprised his supplemental insurance covered the extra fees). Generally, I dropped things off for my father, spoke to the staff and to my father over the phone and didn't physically visit him much during restricted visitation. I was as concerned about bringing illness home as taking some illness into the MC.

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This happened at my MIL's nursing home. They had a note on the door that there was an outbreak and to please consider changing your visit to another time. We could not as we were leaving the country the next day. Nobody stopped us from coming in and the nurse stated that MIL was worried we wouldn't come and say goodbye so she was glad we were there.

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I think precautions are completely reasonable 90% of the time, nobody should be too inconvenienced when a facility limits outside visits for a couple of weeks. The problem I have is with the other 10% when things start to go off the rails -

The facility I mentioned earlier that had one or two new cases almost as soon as the old ones were cleared, resulting in weeks and months of restrictions

And staff who are over zealous and try to prevent ALL outside contact for ANY reason

Underlying this is the niggling reality that some of these people are in their final months of life, and they are paying a high financial price for services that are not being delivered as promised. I find that troubling.

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I can understand why a facility would do this. Most flu and "winter colds" are spread in droplets from a cough. There are more cases of deadlier outbreaks since people are not getting vaccinations. Residents with memory issues do not remember to cover their cough. Most residents are older and have weaker immune systems - easy to sick - and won't wear face masks when outside of their rooms. Staff do a good job of cleaning surfaces but that doesn't stop the spread if there is a lot of susceptible residents who don't take personal precautions... and mildly sick visitors that don't realize they are infecting their seniors.

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Restrictions for a period of time, yes, but lockdown for MONTHS on end sounds out of line. Also, cleaning should be increased, not basically STOPPED. True quarantines, I believe, must be reported to the health department (for CDC statistics). You may want to ask someone in the NH's county about this.

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My dad was in a nursing home that initiated a lock-down due to flu. It was hard for him but at the same time, it protected him as well as my mom who was living "in community." I worked around it by making regular phone calls. I even read aloud a beautiful short story (over several days worth of phone visits). He really enjoyed that.

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ALF number 1 where my folks lived had a lock down situation when the flu broke out in 2014. I moved them in 2015 to a privately owned ALF and there's never been a 'lock down' situation since. In fact, they've had very little flu outbreaks at all. If a resident shows symptoms, they're asked to stay in their apartment until they feel better; food is served to them in their apartments. Activities have never been cancelled due to illness. Visitors are asked not to come into the building if they're exhibiting any signs of illness at all.

Memory Care, on the other hand, is different. They cannot have a 'lock down' situation b/c the residents do not understand that they can't come out of their rooms, so it doesn't happen. At least at the 2 MCs I'm associated with. Life goes on as usual, visiting is discouraged, and the disease runs its course. At the MC I work at, there has been an outbreak of a stomach flu so far this year which has affected about 60% of the residents. Food is served on disposable plates/forks etc. during the outbreak.

All illness outbreaks must be reported to the State for all of the ALFs and MCs I've been involved with.

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I'll have to ask the facility where my friend Jim is in a memory care apartment. I've never been banned or discouraged from visiting him each week. Everyone in the AL/MC facility gets a flu shot early in the fall. When I visit each week, I don't encounter anyone with an apparent cold, either. Jim has now been there since June of 2015 and if I haven't seen anything over all this time, they must be doing something right or else they have been very lucky. I know they regular health check-ups--every 90 days for the memory care residents. Jim's health insurance covers the cost.

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We have had this situation 2x,, when my dad was accepted for MC, the day before he went in they went into quarantine in the MC,, so he was placed In the AL with a "sitter" at their cost (not ours) for a week. Next my mom, who was just in the hospital and we wanted rehab.. the one we wanted was closed for flu., so we just brought her home with home care from visiting RNs and therapy. I think this is pretty common

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Just today at my dad's NH, they diagnosed two cases of the flu on his floor (there are 50 residents on his floor, all single rooms). There was a sign in the elevator that asked that visits be limited, but there were many, many visitors and between visitors and staff, I only saw one mask. The ward clerk offered masks when we went to visit said we could stay or we could go, wear the mask or not. They also said they're starting all residents on Tamiflu, with permission from family, to try and head off the spread.

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Even in Independent Living facilities-- it was like rolling tidal wave-- yeah most of us went down. AND SUFFERED. And the county never sent a Visiting Angel ! My mother was in such bad shape and I was there in equally bad shape, throwing up and all. I think the truth was no one wanted to be exposed to us or anyone else. So we had to muddle on from within, without any help except my sister who left Gatorade outside the door, bananas, white bread, apple sauce, and cooked white rice which helped alittle…. it was long week many years ago in 2012 while I kept watch over my mother in her 13th year of dementia.

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These answers are helpful and enlightening. I was recently spooked by hearing of a family trying to hire a private caregiver to come into their home to care for their father who had "c diff". I wasn't familiar with this contagious disease until I researched it. As a private caregiver it made me realize there is more to be concerned with than the typical upper respiratory and gastrointestinal illnesses.

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I will give you my take on hospitals, during which these things can also happen. After my late mother had a stroke & was in the hospital she developed a contagious condition, akin to C-Diff. All of her visitors had to wear medical gowns.

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My mother’s nursing home has never had a lock down due to illness in the over two and a half years that she has been there. Just this week, two cases of flu have been diagnosed and they are asking all visitors to disinfect their hands upon entering and to don a surgical mask if they haven’t had a flu shot, though nobody was there to enforce it. They said these measures would last a week. I noticed their daily Bingo was also cancelled.

I cannot in my worst nightmares envision a facility that would ban visits and confine residents to their room for an extended period of time. Months? Unimaginable! Let me tell you, the residents of my mother’s nursing home would mutiny! Many of them, including my mother, are fairly spunky! I also could not imagine not being able to check on my mother’s welfare. Part of what keeps any elder care facility on its toes are regular visits from family and friends. My mother would be one of those residents mentioned in earlier posts who is unable to Skype or FaceTime and can’t use a phone either, though she can communicate somewhat if someone else makes the call for her. Even then, she is at times unintelligible. I am glad a shutdown has never happened where she lives. I have to have eyes on to make sure she is OK.

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Treeartist - the spunky residents (and their families) push back but the timid, compliant ones will do what they are told.

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Even aside from the infections with obvious, swift symptoms like the flu, I witnessed more insidious, subtle symptoms develop at my Mom's AL Memory Care Unit in mid- late 2017, Starting with one resident having a constantly running nose (at the dining room table with no Kleenexes), 2 others having coughs, (probably not treated), another having a " head cold" (Luckily her daughter transferred her due to uncontrolled diabetes). Then amidst these residents, my Mom developed an infrequent cough, vague loss of energy, not wanting to walk in the garden. Meanwhile, I was looking for another place to move Mom which was taking time due to the visits, interviews, etc. Notice at your AL/MCs: Are the employees wearing gloves while serving food, if it's being assembled from a rolling cart & their hands may be touching some of the foods, i.e. chips; IMO, residents with coughs or running noses should eat in their rooms, not in the dining room; are tables being disinfected after each meal, etc, etc. None of these measures was in effect there. Without realizing it, Mom was slowly collecting fluid in her lungs. She had a massive heart attack after being sent to the hosp. due to difficulty breathing & very high blood pressure, despite a visiting MD saying 2 days prior that her lungs sounded OK & it was probably "just a virus". I was out of town; my sister was there. Nurses & MDs at the hosp said her lungs were completely filled with fluid which is what led to the heart attack and she was also diagnosed with pneumonia. One of the residents with a cough, was also soon diagnosed with pneumonia and died soon after. The lady with the runny nose-- same thing. Mom had to be placed in a SNF, due to how deconditioned she was after the heart attack and not into the different AL that my sister & I had found to transfer her to the week after the heart attack. She lived another 14 mos, and , other than 2 falls, they were pretty good, but, I'm sure not nearly as good as if she had received decent care at the orig. AL /MC and/or been able to transfer to the new AL. We found one of her BP meds on the floor (the 3rd time) when we were moving her things out, in spite of the fact that the Med. Techs were supposed to stay with residents, making sure they swallowed the meds b4 leaving the room.----So, maybe TMI , but to sum up, cross-contamination does occur and staff need to be very proactive about it. Facilities should have Infection Control Policies that they actually follow and families and residents should be able to see Health Dept inspection reports. Also, find out how qualified the employees are. My Mom's facility was staffed with people practically "off the street" She was there 2 yrs. There was an RN on staff maybe 2 mos out of those 2 yrs. Director of MC was a CNA!, not even an Lpn. Facility Director---no health background, had a Marketing degree. So, ask lots of questions up front. I definitely did not ask enough and ended up regretting it.

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My mom's ALF was quarantined (all locked down) for two weeks last Christmas with the Norovirus. It was extremely hard on all the staff and residents. My mother became so depressed although her hospice aides and nurse checked her regularly, and I talked to her daily by FaceTime and dropped off her favorite foods. Thankfully, they lifted the quarantine the day before Christmas eve and we were able to take her out for two family holiday gatherings. It was still hard on her since she hadn't had her hair done and everyone was asked to not make physical contact with her.

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Controlling infectious diseases in facilities; is this common where you live?

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