Social isolation necessitated by COVID-19 weighs on everyone, especially older adults and those living with disabilities who may have already felt relatively isolated before the pandemic. The long-term care ombudsmen staff and volunteers dedicated to advocating for the rights, health, and safety of residents have also missed face-to-face visits.

“It has been heartbreaking for all of us not to be able to be inside the facilities,” said Cizik School of Nursing at UTHealth’s Greg Shelley, program manager of the Harris County Long-term Care Ombudsman Program, which is operated in partnership with the Harris County Area Agency on Aging.

Shelley’s team of seven staff and 73 certified volunteer ombudsmen advocate for residents of nursing and assisted living facilities, including memory care facilities, in the county where Houston is located. A staff ombudsman is assigned to each site and supports volunteers. Before pandemic restrictions were put in place, ombudsmen would visit their assigned long-term care facilities weekly to identify needs and advocate for residents.

To prevent the spread of COVID-19, the Texas State Long-term Care Ombudsman, Patty Ducayet, in March temporarily halted on-site visits to nursing and assisted living facilities by ombudsmen. However, on Aug. 3, Ducayet notified providers that ombudsmen would be returning to visits immediately. Texas Health and Human Services also issued guidance Aug. 7 allowing some visitation by friends and family under limited conditions.

During the pandemic, residents still have the right to access to an ombudsman, but federal and state authorities temporarily waived some residents’ rights to visitation, Shelley explained. Residents retained all other rights – including the right to leave facilities that only allowed entrance to staff and essential caregivers.

An important part of the ombudsman’s job is to educate residents about their rights and options, but also about the potential consequences of exercising them. For example, a resident who chooses to leave a facility during the pandemic will likely be asked to quarantine upon returning, Shelley said.

“Residents have a right to go against medical advice or refuse treatment, including COVID-19 tests, but they also would be required to quarantine for 14 days in that situation,” Shelley added, stressing the importance of testing and quick turnaround on results. “Some of the problems with the nursing facilities that have had significant outbreaks is that they didn’t know they had cases until someone was transported to a hospital and tested there.”

Throughout the spring and summer, ombudsmen relied on phone calls and videoconferencing to keep in touch with residents, family members, and facility staff.

“I don’t feel like we have been able to do anywhere near what we were doing before,” said Jo Latimer, a 13-year volunteer who would normally pay a couple of visits a week to a local facility. “When we visit with people there, we almost always come away with something we can advocate for.”

Latimer regularly reaches out via telephone to residents and their family members at her assigned facilities. Like many of us, one woman in her 90s worried about missing her usual hair appointments when the on-site salon shut down. “She has been so distraught about her hair that her family decided to buy her a wig,” Latimer said. “It was a great solution.”

While the ombudsmen are excited to get back to in-person visits for many reasons, Shelley emphasizes that face-to-face contact with the residents is one of the most enjoyable parts of the job, and it provides opportunities for residents to express concerns confidentially with an ombudsman who they might not otherwise meet.

During the period in which ombudsmen were not visiting, requests for private, confidential consultations from family members increased primarily over concerns about the restrictions on visitation. The lack of social contact for the residents has been a major concern, and restrictions on visits by friends and family have varied among facilities. In some cases, socialization can be very limited even among residents within a facility. Some locations have set up video chats with family members or allowed visits across barriers, such as windows.

Assisted living facilities, like the one where Latimer’s well-coiffed client lives, have generally reported fewer cases of COVID-19 than skilled nursing facilities, Shelley noted. Differences between the two types of facilities that could serve to lower the risk of transmission include more private vs. shared rooms, more open space, and less contact with medical professionals providing direct care to multiple patients. However, assisted living facilities are not required to have nurse staff in the building every day, which poses some special risks to residents who become ill with COVID-19.

With restrictions beginning to ease in early August, staff ombudsmen underwent detailed training required by their state office so they could resume inside visits starting Sept. 1. Staff ombudsmen planned to accompany volunteers on their initial visits and to coordinate closely with facility management to ensure compliance with safety protocols. 

“We will provide PPE as needed to our staff and volunteers,” Shelley said. “We are hyper aware of the health and well-being of the residents, volunteers, and facility staff.”

One positive development Shelley has noticed during the pandemic is that it is has created some serious dialogue regarding ways to improve how we deliver long-term care, particularly in nursing facilities.

“I hope it leads to some qualitative changes, benefiting both those who deliver the care and those who receive it,” Shelley said.

Sherri Deatherage Green