For months, long-term care facilities in Washington were closed not only to visitors but also to state regulatory authorities due to the COVID-19 pandemic. These facilities were early hotspots, driving the nation's coronavirus death toll this spring.
That posed a big problem for the staff and volunteers of Washington's long-term care ombuds office.
"For our role, visitation is key," ombuds Patricia Hunter told KNKX.
Hunter runs the federally-mandated program that receives complaints from long-term care residents and their loved ones.
Long-term care refers to a variety of facilities, from nursing homes to rehabilitative centers. These facilities generally serve the aging and elderly as well as adults with physical, developmental or behavioral needs.
More than six months into the pandemic, KNKX checked in with Hunter to see where things stand now. She spoke with Morning Edition host Kirsten Kendrick. Listen to their conversation above or read a transcript of the interview below. Both have been edited for length and clarity.
Kirsten Kendrick, KNKX: If you can think back to March and April, can you describe what it was like as (the pandemic) was unfolding?
Patricia Hunter, Washington Long-Term Care Ombuds: Oh boy, it was...You know, I'll be honest, it was frightening. It was chaotic in many ways. We had rules and guidelines and directives coming from many different directions: from state government, governor's office, as well as the CDC. You know, we didn't know as much, particularly in March, as we do now. It was definitely unnerving, and we had a good idea of what needed to be done. And there was definitely frustration in not being able to necessarily get the resources or tools that were needed early on in order to stop the spread.
Hunter says those tools included testing and personal protective gear, both of which were in short supply early on.
But worries about sanitation and safety pre-date the coronavirus. KNKX recently reported on the situation at Gibraltar Senior Living near Parkland in Pierce County. That facility suffered a COVID-19 outbreak this spring, but it also had a pattern of complaints going back years.
KNKX: To what degree were you hearing about those issues from families and residents before the pandemic?
Hunter: The specific facility that your station reported on, I was not hearing specific concerns or complaints about that facility in terms of sanitation. However, I want to say that infection control and sanitation is something that's frequently cited by state licensors. It's a very common deficiency. So, you know, it's something that existed before COVID.
I'll also add that this particular facility serves a group of folks who have serious mental illness. And I do wonder if that maybe the interpretation of the standards are a little lower. And they shouldn't be, right? We shouldn't tolerate dirty window sills or mold or bed bugs just because the population may be, you know, more difficult to manage because they have challenging behaviors related to mental illness. We all deserve to live in a clean, sanitary, home-like environment, regardless of our disability or our mental health condition.
KNKX: Part of the problem at Gibraltar was that issues continued, despite citations from the state. Do you think Washington could do more to hold these facilities accountable?
Hunter: I think there's always more room for improvement. And the state, I believe, they're trying over the last year. They're trying different ways to hold the facilities more accountable. I've worked on legislation in terms of fining and penalties. In this example of Gibraltar, I believe they received a $2,000 fine. Had this been three years ago, before legislation was passed, that fine would have been $100 instead of $2,000. So that was an effort that was put forth by the ombudsman program, by advocates, and in the end, in partnership with the provider associations. We need fines that make a difference. Otherwise, it's just cost of business.
KNKX: So you've noted that some changes have happened, that there's a need for more. Someone hearing this conversation in our listening audience may be having to put a loved one into one of these long-term care facilities in Washington. What would you tell them about how you can ensure that these facilities are safe?
Hunter: That's an important question. I would say that there is more public information available for consumer needs, such as shopping for a refrigerator or car, versus shopping for a home where your loved one who's vulnerable needs care and is dependent on others.
But there are some resources out there. I would encourage anyone who's looking to call their local ombudsman office because we can have a conversation about what kinds of complaints we've seen over the last year. And then nothing does the job more than making visits. Visit the facility if you have that time. Talk to residents who are living there. Use your nose, your eyes.
And then the last place to look is I would tap into any kind of support groups that are in the community. So whether they be family caregiver support groups or mental health peer-led groups, ask them about their experiences and what they know about the care facility.
Hunter's office has recently resumed in-person visits. She says that's brought a mix of relief and caution among ombuds staff and volunteers.
Hunter: We've been training throughout August on how to wear PPE, how to observe infectious control processes and policies, and also just to prepare emotionally for the potential trauma that we might be witnessing in residents. You know, they've lost their peers. They've lost their roommates and friends. We were prepared to see weight loss, significant weight loss in residents. We were prepared for residents to not recognize us and maybe appear more confused because of the lack of stimulation due to isolation.
KNKX: To what degree do you think not being able to make in-person visits had (a role) in some of the expectations of decline that you expect to see in some of these facilities?
Hunter: You know, it's hard to say. By us not being present, did care or quality of life decline? I would say that we received less complaints because we weren't there to receive them. And it's not not just the ombudsman program, but Adult Protective Services, their call volume was down; licensing enforcement, their call volume was down. So there was a sort of eerie, eerie silence at the beginning. And then as time went on, we started to see an uptick.
So, you know, I'm sure not having ombudsmen in the building, but also not having licensors in the building, APS in the building, and most importantly, families and friends were not allowed — and still not completely allowed — in the buildings. I think that is pretty detrimental. I think it's more important for residents to have an essential support person, a family member or friend, as their touchstone coming into that building than it is to have us or adult protective services or other protective authorities.
The long-term impacts of isolation are very concerning on the mental health and physical health of these residents. I just don't see how we can continue to isolate residents and expect them to come out of this better or strong or even at baseline.
KNKX: How do you think that will influence your work, especially around the pandemic response moving forward?
Hunter: Well, a couple things: We've done more virtual work in terms of using tablets and phones.
I'll tell you a good story. We've mailed out probably 40,000 postcards to residents and to their families to let them know that we're still here and how to reach us when we weren't making visitations. And while one of the ombudsman, Heidi up in Snohomish, she was visiting an assisted living facility. There were several residents who came up to her and said, 'I know who you are. You sent me a card. Are you so and so?'
That was a really hopeful message and a boost to our ombudsmen that what we've been doing has made a difference.