Dementia and failure to thrive pose significant health risks to nursing home residents. It's estimated that these two conditions ordinarilly take 370 lives in New York State nursing homes every single week. During the forced isolation of COVID, deaths from dementia are rising by +18% nationally. In NYS nursing homes, that increase would translate to about 60 resident deaths every single week due to isolation.
By contrast, COVID itself accounted for 10 deaths in New York State nursing homes (week ending 31 August). That means there are more than 6X as many nursing home deaths from COVID isolation than from COVID itself.
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Dementia and Alzheimer's disease effect about 50% of nursing home residents, and isolation has been shown to increase the risk of dementia by up to +20%. It's believed that extended isolation triggers the biological stress response, increasing accumulation of beta-amyloid peptide and tau protein in the brain.
Isolation also increases the risk of failure to thrive - a condition characterized by extreme weight loss, depression and decreased activity. It affects up to 40% of nursing home residents in ordinary times. Nursing homes have been observing increases in both extreme weight loss and hospice during COVID isolation - an indicator that failure-to-thrive is on the rise.
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Nursing home staff have the skills, compassion, and desire needed to care for residents at a very high level. Still, many residents do not thrive when family are not part of their care.
Sometimes residents have cognitive issues, and family members are able to connect with them in a way that staff cannot. But even if there are no cognitive issues, family visits trigger the memories and emotions that stimulate contentment and belonging. And there's no question that contentment and belonging support good health, stave off dementia and failure-to-thrive - and make life worth living.
Nursing homes understand the essential role that family members play in caring for residents. That's why so many NYS nursing homes have come out publicly - with family members - to advocate for visitation now.
The fact that nursing home administrators and physicians support visitation during COVID makes a powerfiul statement. They understand more than anyone the risks that COVID presents. But they also understand the risks of isolation. And they believe that visits can be managed safely - with the improvements in testing and infection control that have been implemented over the past several months.
COVID is a serious risk in nursing homes, but not the only risk. In an ordinary year, risk of death from dementia or failure to thrive is 19%, 22% if residents are isolated. For the average 90 year old, the risk of dying from any cause is 15% annually. By contrast, risk of COVID death could be modeled as 11% annually, possibly less if infection control improves.
There's no question that COVID is a risk for nursing home residents. The only thing worse is isolation. It increases the risk dementia and failure to thrive, and reduces their quality of life. Especially at low COVID positivity rates, isolation is the #1 risk to residents.
New York State enjoys some of the lowest COVID positivity numbers in the nation. Their visitation policy is among the most restrictive. They make no exceptions for family caregivers, except at end of life.
Texas, Florida, Michigan and Pennsylvania all have accomodative visitation policies. They allow compassionate and caregiver exceptions. Pennsylvania only requires a negative COVID test. These states understand the essential role that loved ones play in the health of the resident. We ask Governor Cuomo and Commissioner Zucker to show that they understand our essential role. It's time to let us visit again.