As a state task force hammers out a plan to reopen long-term care facilities to visitors, more than a dozen Central Florida nursing homes are battling devastating coronavirus outbreaks and a rising number of deaths that threaten to keep them shuttered for the foreseeable future.
In Seminole County — where 70 percent of all COVID-19 deaths have been in nursing homes and assisted living facilities — the hardest hit has been the 228-bed Life Care Center of Altamonte Springs. There, more than half of the residents have been infected and 28 have died.
“Residents are — and have always been — our highest priority,” Executive Director Francisco Gonzalez said in a prepared statement. “Our residents are part of our family, and we all feel the loss deeply.”
The facility is home to “exceptionally vulnerable seniors with compromised health conditions,” Gonzalez added. His staff is working with state and local health officials to address the outbreak, which has also infected 42 employees. Of those, 33 already have recovered, and the others are recovering at home.
Gonzalez did not say if the facility has identified the source of the outbreak — though the nursing home, like all long-term care facilities in the state, has been closed to visitors since mid-March.
These are the Central Florida long-term care facilities with five or more COVID-related deaths reported as of Thursday.
Those closures have prompted a growing coalition of family members and loved ones to call for at least limited visitation of nursing home residents to halt the prolonged isolation, which they say is causing anguish, confusion and in some elderly patients a loss of the will to live.
Their outcries prompted Gov. Ron DeSantis to appoint a statewide task force earlier this month on the “safe and limited” reopening of long-term care facilities, which has been meeting to plot out who should be allowed to visit, how often and in what setting. It is also weighing whether facilities will be mandated to allow visitors or simply “strongly encouraged,” as well as how visitors will be screened and who will pay for the screening.
In Central Florida, where there were once only a handful of nursing home COVID cases, there are now nearly 3,500 across Lake, Orange, Osceola, Seminole and Volusia counties. More than 350 long-term care residents have died.
All told, residents of nursing homes and assisted living facilities account for nearly 40 percent of the region’s total coronavirus death toll.
Seminole County, home to more than two dozen facilities with COVID cases, has proved especially vulnerable.
In addition to the for-profit Life Care Center, for instance, Eastbrooke Gardens — a Casselberry assisted-living center specializing in Alzheimer’s and dementia patients — 19 residents have died from COVID while 26 residents have been transferred to isolation units or hospitals after becoming infected. The facility is licensed for 78 beds.
Oakmonte Village of Lake Mary, billed as a “luxury” assisted living and memory care center, has had 10 infected residents die and 16 have been transferred out.
Even Longwood’s Village on the Green, considered one of the region’s premiere continuing care retirement communities — a place where residents can move from independent living in upscale villas to a skilled-nursing and rehabilitation center if their health declines — has had nine residents die of COVID.
“No setting is immune,” said Bennett Napier, executive director of the Florida Life Care Residents Association, which represents over half of the 25,000 people who live in continuing care communities across the state, including those in Village on the Green. “This is a virus that spreads like wildfire.”
Because of that, some of the corporate owners of continuing-care communities have begun asking residents to sign liability waivers acknowledging, in one example, that “because of the nature of COVID-19, it is impossible to eliminate or fully control all risks … and we cannot assure you will not be exposed to or acquire COVID-19 while at the community.”
Napier said it’s unclear what will happen to residents who refuse to sign, although they could be barred from visiting their community’s recreational and dining areas — or even from seeing loved ones in campus nursing homes — once those areas reopen.
While many younger people have been able to restart at least some of their pre-COVID work and social lives, older Americans are more likely to be frozen in a surreal and lonely existence that has put them at greater risk for anxiety and depression.
“Our board has not taken a position on whether residents should or shouldn’t sign these waivers — which, by the way don’t preclude you from suing in cases of gross negligence,” he said. “But most people don’t understand the legal difference, and they may not be expecting to be presented with these waivers. We just don’t want them to be caught off-guard.”
The politically powerful nursing home industry also has pushed to limit its legal exposure to coronavirus lawsuits, and in some states, including Florida, it has sought blanket immunity from COVID litigation.
In early April, the Florida Health Care Association, which represents nearly 700 of the state’s nursing homes, sent a letter to DeSantis saying it was “imperative” that health care providers — including nursing homes — be given immunity from all civil and criminal liability in COVID cases, except in instances of intentional criminal acts or gross negligence.
“We don’t believe that long-term caregivers and other front-line health care workers and institutions should be held liable for the spread of COVID-19, especially when there are national studies that show that the strongest predictor of seeing cases in a particular setting is community spread,” said Kristen Knapp, the association’s director of communications. “It’s unfortunate that while our caregivers work tirelessly to protect residents and create supportive environments, trial lawyers have already been positioning themselves to profit from this tragic situation.”
Knapp did not answer whether nursing homes would insist on liability immunity before allowing visitors, and DeSantis has yet to address the association’s plea. But some think it could become a bargaining chip on the future visitation plan.
Brian Lee, executive director of the national watchdog group Families for Better Care, said that without testing every visitor each time, facilities that allow visitation are setting themselves up for trouble.
“If I’m a nursing home administrator or operator, I wouldn’t allow it in this present environment,” he said. “I hate the fact that residents have been isolated for so long, and I understand the families are desperate. But until these facilities are buttressed with the right testing, it would be deadly if they open to foot traffic.”
The state task force charged with drafting a plan for reopening has no representation from the long-term care residents themselves, Lee noted, nor does it include the state’s long-term care ombudsman, whose job it is to protect the residents’ rights and well-being.
It does, however, have the wife of a resident — Mary Daniel, who took a job washing dishes at a Jacksonville memory-care center so she could see her 66-year-old husband there. Daniel has spoken out for the facilities to allow at least one “essential caregiver” — a loved one who helps to feed, bathe, clothe or provide emotional comfort — for each resident. She and members of her popular Facebook group, Caregivers for Compromise, have argued that residents are already dying of loneliness and grief.
The task force has not yet officially proposed the “essential caregiver” idea, but as it begins to draft a plan for the governor’s approval, it appears headed in that direction.
“It’s not going to please everybody — nothing ever does,” Daniel said at a task force meeting this week. “But it is opening the door to get to our loved ones, and I couldn’t be happier.”
The task force is expected to require all visitors, including essential caregivers, to undergo screening and wear personal protective equipment. But the group also may recommend a waiting period during which there are no new coronavirus cases — possibly 14 to 28 days — before allowing more general visits.
That move is likely to keep the Life Care Center, Eastbrooke Gardens and other hot spots from opening anytime soon.
“On the one hand, time is of the essence,” Napier said. “On the other, you have to do it safely. No one wants higher infection rates.”
