A vial of the Moderna COVID-19 vaccine. Photo by Darrow Montgomery.

Jack Kalavritinos just wanted to bring his mother over for a casual visit on a Sunday afternoon. Maybe share a meal and chat with other relatives. He hasn’t been able to do that since the coronavirus pandemic forced D.C. into lockdown more than a year ago. His mother, Vivian, is 94 and lives at Chevy Chase House, a senior residence on Connecticut Avenue NW. Despite being fully vaccinated against COVID-19 for more than six weeks now, if she left the facility for any  period of time with the exception of essential medical visits, she would have faced a confinement period when she returned. “No one in my family can understand it. We moved her to this wonderful facility. We understand that best practices are to be followed. But in this case, this is a little known rule that people aren’t focused on,” Kalavritinos says with exasperation. “They’re saying that even after the vaccine, if residents leave the premises they need to quarantine in their rooms for 14 days.” 

Not only are residents required to quarantine upon return, according to D.C. guidelines, they aren’t even allowed to socialize among themselves within the facility. If indoor visitation is to occur there’s a whole slew of requirements that must be met including screening guests for possible COVID exposure, taking temperatures, having a designated visitation area, and ensuring that a staff member is available to escort the guest in and out of the visitation area. D.C.-area nursing homes are not allowed to do any of that just yet.  

Kalavritinos and his family are not the only ones bewildered by this seemingly baseless rule. Joseph Sternlieb is also confounded by the restrictions. His father, Herschel, is also a resident at Chevy Chase House and is not allowed to have visitors inside his apartment. “My father is almost 94 years old and he doesn’t like leaving his apartment. So I’ve been waiting for permission to visit him in his apartment because he’s fully vaccinated and I’ve been fully vaccinated. Still not allowed in the building.” 

About an hour before speaking with City Paper, Sternlieb received an email from the manager at Chevy Chase House saying that DC Health had issued new guidance. “She said under certain rules and I don’t know what those rules are,” Sternlieb says.

Many D.C. area nursing homes and assisted living care facilities have met the minimum requirement of having 70 percent of residents and staff fully vaccinated against COVID-19. Families and advocates were confused about why harsh visitation restrictions remained in place. 

War of Words

In March 2020, as the coronavirus pandemic took hold of the U.S., the Center for Medicaid and Medicare Services issued a memorandum restricting all visits to nursing homes and assisted care facilities with the exception of compassionate care visits such as end of life situations. By September, COVID-19 vaccinations had been authorized for emergency use and CMS revised their guidance. The new memorandum stated that facilities should allow visitation at all times and for all residents “regardless of vaccination status.” The guidance further recommends allowing visitation to occur within a resident’s room in order to limit movement. 

Earlier this month, Ward 7 Councilmember Vince Gray sent a letter to DC Health Director Dr. LaQuandra Nesbitt urging her to lift the restrictions on nursing homes since most facilities had over 90 percent of residents vaccinated. Gray also pointed out in his letter that even DC Health tweeted on March 30 that vaccinated people can safely socialize with other vaccinated people. “The science around COVID-19 and vaccinations has developed, and we now know that there is a significantly lower risk that a fully vaccinated senior will experience a serious reaction or be able to  spread the virus,” Gray explained in his letter.

DC Health stated that guidance for nursing homes allows for group dining and activities when certain criteria are met, as long as a resident is not isolating or quarantining due to COVID-19. When asked about why the restrictions remained in place earlier this month, even after the Centers for Disease Control and Prevention recommended lifting them, DC Health affirmed in an email that “the recommendations for fully vaccinated persons are different based on community or congregate settings. DC Health will continue to update the guidance based on the local epidemiology and most recent CDC recommendations.” City Paper inquired again on Monday about any changes. According to a DC Health public information officer, “There are no restrictions on visitors, just guidelines for safe practices. Guidelines for quarantine after leaving the facility are based on a number of factors, including vaccination status and exposure to a known case.” 

The Detriment of Social Isolation

Social isolation can have devastating effects on the elderly. One Journal of the American Medical Association report explained that older adults in homes with restrictions are at risk for an increase in depression, anxiety, and a failure to thrive. CMS encouraged outdoor visits, as residents can properly social distance and increased air flow would significantly lower the risk of transmission. But depriving older people the right to see their loved ones can decrease their lust for life. A survey from the Altarum Institute showed that at least 64 percent of respondents who live in nursing homes don’t even leave their room for communal meals or to socialize with other residents when it’s safe to do so.

Mark Miller is the D.C. state long-term care ombudsman, part of AARP’s Legal Counsel for the Elderly program. His office has heard multiple complaints from families about restricted visitation after being vaccinated. He is concerned about the toll isolation takes on residents of long term care facilities. “Isolation kills. People just give up. They feel like prisoners because they can’t leave,” he says. He proclaims families have suffered long enough and it’s time to loosen the restrictions.

City Paper reached out to Nicki Beekman, executive director of Chevy Chase House, to see how they respond to families and resident concerns. Beekman says they continuously thank residents and keep them abreast of the latest information. “Our staff continues to work meticulously and creatively to ensure that our residents are engaged every day by providing activities such as daily exercises classes in our activity room and new gym, art projects, music therapy, spontaneous socially-distanced dance parties and connecting residents with family members virtually,” she says.

Numbers Show Positive Results

Nursing home deaths nationwide have sharply declined since the release of the vaccine last fall. According to the Kaiser Family Foundation, more than 1.4 million residents in long-term care facilities and more than one million staff members have been vaccinated since last December. D.C.’s average death rate at long-term care facilities dropped from 4.1 per 100,000 residents in April 2020 to 0.3 per 100,000 residents in April 2021. Comparatively, D.C. nursing homes death rates have fared well. Maryland has seen a 63 percent decrease in nursing home deaths since December while Virginia’s nursing homes struggle with having the second highest COVID-19 death rate in the country. 

The successful rates in D.C. are in part because restrictions have been in place for so long and facilities are abiding by them for the most part. Veronica Sharp, president of the DC Health Care Association, praised DC Health for their leadership through this pandemic. “As frustrating as it is for some of us, they have led us through this pandemic with such good decision making,” she says. “We have raised our concerns because mom may not be here next year. But they make so many good decisions towards getting everyone what they want. So we are working with them.”

Reopening Plans

As long term care facilities prepare to open their doors back up to indoor visitation, DC Health has asked them to submit their reopening plans for approval. Miller says no other municipality has put that expectation on facilities and questioned why this is expected given that neither the CDC nor CMS requires it. “The District is the only jurisdiction in the country that we can find that requires facilities to submit a reopening plan that must be approved by DC Health’s epidemiology center,” he says. “This further delays people getting back in.” 

Miller explained that out of the 17 nursing homes in the District, he has counted six that have submitted plans. “But,” he notes, “it was an unnecessary step.”

When asked about this, DC Health stated that nursing homes must submit policies for review, but that is not a prerequisite to allowing visitors.

As for Jack Kalavritinos, he was impressed by how fast his mother was vaccinated but the disappointment in not being able to move forward after so long lingers. “We can’t even have her leave for a Sunday brunch or see her grandchildren play outside after being vaccinated,” he says. 

Joseph Sternlieb believes the lost time should be a motivator for getting residents reunited with their loved ones sooner rather than later. “It’s been 13 and a half months. And we’re not going to get that time back. At some point, people have to say we’re going to take a tiny bit of a calculated risk for the quality of these people’s lives for the time they have left.”

If you need legal assistance or have concerns about a long-term care facility in the District, call the Legal Counsel for the Elderly’s Office of the D.C. Long-Term Care Ombudsman at (202) 434-2190.