While Montgomery County has lifted most pandemic restrictions and COVID-19 transmission continues to decline, local nursing homes, memory care facilities and independent living centers are continuing to enforce some coronavirus policies that limit visitors and activities to protect their vulnerable populations.
As of Tuesday in the county, there were 7.5 COVID-19 hospital admissions per 100,000 residents over a seven-day period, according to the Centers for Disease Control’s (CDC) data tracker. According to the CDC, a community is in the “low” category when there are fewer than 10 admissions per 100,000 residents and less than 10% of hospital inpatient beds are occupied by COVID-19 patients. As of Tuesday, the CDC was indicating that Montgomery County was in the “low” category.
Sean O’Donnell, the county’s public health emergency preparedness manager, said recently it’s important to keep in mind that the county has been seeing proportionally fewer outbreaks in smaller congregate care facilities.
“There’s fewer numbers of staff, there’s fewer individuals [in smaller facilities],” he said. “In some ways it’s a numbers game. In a much larger facility they might have more cases, but they have a lot more individuals as well. So you have to put it into context.”
O’Donnell said that in general it can be difficult to track a COVID-19 outbreak because the state totals include reported PCR test results and not rapid test results. Congregate care facilities, he noted, are held to stricter requirements than the general public when it comes to testing and vaccinations. A state health directive requires that the facilities report daily all positive COVID-19 test results for residents and staff members and their vaccination status on a weekly basis.
“There is a continued concern, and a continued focus on those higher-risk populations in the congregate settings,” O’Donnell said.
During the first year of the pandemic, nursing homes in the county experienced a high number of cases, hospitalizations and deaths. At one point in December 2020, more than 3,200 cases of COVID-19 had been reported in nursing homes and other congregate facilities, which accounted for about 9% of the more than 36,000 total cases that had been reported in the county at the time. Additionally, nearly half of the county’s COVID-19-related deaths at that time were made up of residents in those facilities.
Despite the overall improved COVID-19 metrics in the county, and the fact that restrictions such as a mask mandate are no longer in effect, congregate care facilities have continued to maintain restrictions as COVID cases continue to occur among residents and staff.
At The Village of Rockville, a roughly 400-resident community offering assisted living, independent living, skilled nursing, memory and long-term care, visitors are allowed on a limited basis, ConnectedLiving Director Melissa Blackstone said recently.
“We do have to limit the number of visitors who can actually attend programming. But they come into the dining spaces, they visit common areas, they are very much involved with the residents,” she said.
At The Village at Rockville’s health center, family members could come into the facility and participate in programs such as social events and concerts before the pandemic, Blackstone said. As of this month, family members still cannot participate in programs at the center, she said.
Additionally, Blackstone noted that any time the facility holds an outing to a location in the area, that location must pass a screening process to ensure the residents’ safety. That includes taking steps such as making sure residents are seated in an area with proper social distancing and making sure everyone else at the event is vaccinated, she said.
“If we go to the Kennedy Center, or we go to a concert, we are asking questions to the vendor to make sure that our residents are safe,” she said.
Rebecca Lipscomb, a spokeswoman for National Lutheran Communities & Services, the umbrella organization for The Village at Rockville, said this month that residents have said they feel safer inside their community as opposed to the outside world, where many people are no longer taking precautions. It’s a comfort to residents to know that they can play cards with each other and attend movie nights with others that are fully vaccinated.
“Knowing that they can do those things safely with friends that are like-minded and equally protective of our safety, whereas in the outside public they don’t feel as safe,” she said. “Some people in the community assume ‘I don’t want to be in a community because they’ll lock me down and take away my freedoms.’ But the reverse has been true. Our residents have been freed to live more independently. They’ve been supported and engaged during the pandemic in a way that people living in isolation in the outside community have not been able to experience.”
Living with COVID-19 rules
Steve and Donna Edwards moved into the independent living portion of The Village at Rockville in April 2021. Steve said they weren’t too concerned about the safety protocols when they moved in.
“We had gotten to know the facility well enough, that we knew the people who were running it knew what they were doing. And we never really had any concerns,” he said.
Steve Edwards said when they moved in, some areas currently open were not open at the time, such as the aquatic center.
“Some activities were in delay mode because they didn’t have the people [to staff them], but also because of COVID,” he said.
Additionally, the dining room was not open to visitors when the couple moved in, but it is now, Donna Edwards said.
The Edwards said that when they participate in activities on campus, such as working out in the fitness center, many people wear masks. But that isn’t always the case at other social events, such as happy hour.
Steve Edwards said the residential community has an effective tracking system, in which residents self-report if they contract COVID-19. “Donna and I have had COVID. Many residents have had COVID. They have a tracking system here. The day I got it I made the call,” he said.
Steve Edwards added that the community’s executive director sends weekly updates that include the number of residents and staff who are vaccinated. More than 90% of both residents and staff are vaccinated, he said.
Following state guidance
Congregate care facilities in the county follow guidance provided by the Maryland Department of Health, which includes policies about topics such as vaccinations, testing, training for healthcare personnel and countermeasures to prevent the spread of COVID-19.
At The Hebrew Home, a nursing home that is part of Charles E. Smith Life Communities in Rockville, visitors were not allowed into residences earlier in the pandemic, but now they are coming in, according to Brenda Rice, vice president of operations.
Rice said the facility is following the guidance of the CDC and the state health department. Staff conduct temperature checks at the welcome desks and also have COVID-19 test kits available, she said.
“If you have a temperature, we’ll stop you from coming in,” she said.
Rice said of the largescale group activities at Charles E. Smith’s various facilities remain scaled back.
“If I have a musical band come in or something, there may have been 200 or 300 people in a room together, we no longer have those going on. We may have 50 people or so,” she said.
Independent and assisted living residents at Charles E. Smith also sometimes take bus trips to performances in the area, Rice said.
“They’re back out into the community, but are wearing masks on the bus. [We’re] making sure the bus is getting wiped down,” she said.
Rice said the mood is lighter in her community than it was at the beginning of the pandemic, but some staff members have a sense of burnout because the virus is still a threat and precautions are still necessary.
“There’s always been a higher expectation in healthcare. You’re taking care of your loved ones,” she said. “Every day you have to remember there’s still COVID here.”
O’Donnell, the county’s public health emergency preparedness manager, said that even during periods when transmissions have gone up in congregate facilities, county officials are seeing fewer patients transported to hospitals.
“That is leading us to have some faith that the vaccinations, the control measures, are helping to curb some of those sorts of more serious outcomes,” he said. “We’re still trying to protect that most vulnerable group of people.”
Dan Schere can be reached at firstname.lastname@example.org