There is no doubt that nursing home residents were the hardest hit in the early weeks of the Covid-19 outbreak in the United States. The first fatalities recognized as being caused by the coronavirus in the U.S. were, tragically, nursing home residents. In a response that came too late for many people, nursing homes across the country locked down, prohibiting visitors and not allowing residents to leave. In many facilities, residents were confined to their rooms in complete isolation for 24 hours a day.
In Texas, the total lockdown was lifted in September of 2020, but questions remain about the rights of nursing home residents and what is best for them in emergency situations such as the pandemic. We want to take this opportunity to share valuable information about the rights of nursing home residents and how to support them in difficult times.
Effects of Isolation on Nursing Home Residents
There is no doubt that something had to be done quickly to stop the spread of the mysterious virus in the early days and weeks of the pandemic. Closing the doors and isolating 
residents was the right move to get the situation under control. However, as weeks turned into months, many nursing home residents were suffering from loneliness and isolation even as they were protected from the virus. According to the American Association of Retired Persons (AARP), the pandemic lockdown fueled a mental health crisis in America’s nursing homes that might have proved fatal for many residents. AARP cites studies that show that loneliness and isolation among the elderly causes:
- Dementia. Lack of social interaction increases the likelihood of developing dementia by 50 percent and speeds up cognitive decline in patients with Alzheimer’s. Many family members of nursing home residents noticed sharp declines in their loved ones’ cognitive abilities during lockdown. This was most likely due to a lack of social, mental, and physical activity.
- Loss of mobility. Being confined to a small room means that residents can’t get the physical exercise they need to maintain some level of strength and fitness. Not using their muscles means losing the ability to do so for many residents.
- Depression. Anxiety and sadness are common outcomes of isolation. Along with depression often come increased frustration, confusion, and anger. All of these feelings can cause a resident to descend into a deep depression.
- Failure to thrive. Some nursing home residents count on visiting loved ones to encourage them to eat and care for their personal needs. Isolated residents can forget or refuse to eat, develop bedsores, and give up the will to live.
- Stroke and heart failure. Studies show that loneliness and isolation among the elderly increase the chance of a stroke by 32 percent and increase the fatality rate among heart patients by four times.
Unfortunately, many older people don’t benefit from virtual interactions like video calls and Zoom meetings in the same way many younger people do. Even outdoor, distanced interactions can cause confusion and frustration for residents of long-term care facilities who have poor hearing or vision. Efforts to allow visitation through Plexiglas or outside bedroom windows are not helpful to residents who don’t understand the restrictions.
Rights of Nursing Home Residents in Texas
When the Centers for Disease Control and Prevention (CDC) finally recognized the need to care for the mental well-being of nursing home residents and offered recommendations for safe visitation, Texas followed suit and began allowing family members to visit their loved ones under certain conditions in September. Before the 2020 holidays, the Texas Department of Health and Human Services (HHS) acknowledged that nursing home residents have the right to make informed decisions about leaving a facility to visit family members. Texas Administrative Code 19e protects the rights of nursing home residents. Provisions of the code that are relevant to isolation include guarantees that residents of long-term care facilities have the right to:
- Be free from any physical or chemical restraints used for discipline or convenience and not required to treat your medical symptoms.
- Receive visitors.
- Make your own choices regarding personal affairs, care, benefits, and services.
- Participate in activities inside and outside the facility.
- Discharge yourself from the facility unless you have been determined mentally incompetent.
- Complain about care or treatment and receive a prompt response to resolve the complaint without fear of reprisal or discrimination.
While the safety of the general population can override some of these rights, it’s important for family members to be aware that they can and should take action if their loved one’s life is at stake.
