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Foss: Life and death in a nursing home

Foss: Life and death in a nursing home

Foss: Life and death in a nursing home
Colonie resident, Kelly Kavanaugh holds apicture of her dad, Kenneth Lanza from her wedding day.
Photographer: Marc Schultz/Staff Photographer

Kelly Kavanaugh said good-bye to her father over the phone, in a call that lasted about 30 seconds. 

She could hear him breathing, and her stepmother, who was in the room, told her that “his eyes fluttered when he heard my voice, and that he heard me.” 
 
A few hours later, Kavanaugh’s father died, his loved ones barred from his bedside in an Albany County nursing home. With the exception of an hour-long visit with his wife shortly before he passed, he spent his final days separated from family who lived just a short distance away. 

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Unlike so many other nursing home residents, Kenneth Lanza didn’t die of COVID-19. 
 
But that doesn’t mean he and his loved ones were spared the pandemic’s irrevocable cruelties. 
 
“It kills me to this day that he died alone,” his wife, Christine Lanza of Colonie, told me.  
 
The Cuomo administration order restricting visitation at all New York nursing homes, issued in March, deprived Lanza and his family of each other’s company, but also of care. 
 
Christine Lanza told me that until the lockdown she visited her husband, who suffered from Parkinson’s disease, every day, feeding him, trimming his nails and taking him for walks when possible. 
 
“When I was there I more or less took care of him,” she said. "When the virus came, I couldn't even go in to see what was going on." 
 
The state guidance for nursing homes does permit visits for family members of residents in imminent end-of-life situations, while noting that “the duration and number of visits should be minimized.” 
 
Both Lanza and Kavanaugh said they were unaware of this guidance - and that they wish the nursing home had told them about it. “The way my stepmother was forced to leave (when my father was dying) - that never should have happened,” Kavanaugh said. 
 
Exacerbating their pain is the lack of Catholic mass or a wake for Lanza; the small service at the cemetery was limited to 10 people. 
 
“To lose your father is hard enough,” Kavanaugh, 41, told me, in an email. “To watch him lose a battle with an incurable disease, where every single time you see him you feel like you are trying so hard to hold onto him, and he is mentally and physically slipping through your grasp, is hard enough.
 
But to be deprived of saying goodbye and being unable to give him the respectful funeral he deserved? I do not even have the word to explain how much additional grief this adds.” 
 
Robert Puglisi, a spokesman for St. Peter’s Nursing & Rehabilitation Center, the longterm care facility where Lanza died, said that St. Peter’s does “allow a visit from a loved one if a resident is at the end of life, we sadly recognize that other family members who want to say goodbye in person, but can’t, are struggling with the limited access. It is tragic and heartbreaking, for us as well as for families, that we’ve been compelled to take these necessary precautions.” 
 
He added, “We look forward to the day when it’s safe for our policy to be far less restrictive or, preferably, be totally unnecessary.” 
 
Due to HIPAA, the law that protects patient privacy, Puglisi could not comment on Lanza’s specific situation, or confirm that he was even a resident there.  
 
The Cuomo administration’s decision to ban nursing home visits made a great deal of sense when it was issued, given the coronavirus’ rapid spread, the vulnerability of older adults, and how little was known about the virus at the time. 
 
In the months since, we’ve seen the COVID-19 death toll in nursing homes soar, which would seem to suggest that keeping these facilities off-limits to visitors was the right call. 

Look a little closer, though, and you'll see that there's a big cost to banning nursing home visits. 

Patients are deprived of affection, help with hygiene and extra attention to well-being and comfort. Those that die miss out on time-honored rituals that bring meaning and closure to the end-of-life. 
 
It wasn’t until I spoke with relatives of people living in nursing homes that I realized just how much visiting family members do for patients - how they serve as eyes and ears, making sure often-understaffed facilities are meeting basic needs. After months of window visits and video chats, they're pushing the state for information on when they’ll be allowed back into nursing homes. 
 
“It’s been a long time,” Schenectady resident Mark Buddle, whose 88-year-old father is in a Schenectady County nursing home, told me. “You hold your breath every day, hoping for some guidance as to when you can go back in.” 
 
Last month, the Centers for Medicare & Medicaid Services issued guidance for nursing home reopenings, and some states have started permitting visits with restrictions. In Massachusetts, which resumed in-person visitation last week, visits are permitted outdoors, so long as they are scheduled in advance, social distancing is observed and masks are worn. 
 
Unfortunately, New York has shown no sign of budging on the question of nursing home visits. 
 
In response to my inquiry, Jeffrey Hammond, a spokesman for the state Department of Health, sent me a statement reiterating the state’s guidance on restricting nursing home visitation. “As we review reopening nursing homes to visitation, this guidance, which was created to protect our vulnerable nursing home population, should continue to be followed until further notice,” Hammond said.  
 
The state has been accused of not doing enough to protect nursing home residents from COVID-19, so it’s easy to understand why officials might be reluctant to take on the risk of opening up homes to visitation. 
 
That doesn’t mean they're right.
 
It’s been far too long since residents and family members have been able to see each other, and as this gap increases, so does the potential for adverse health consequences. The state should consider the benefits of nursing home visits, and allow them on a limited, heavily restricted basis. 
 
“You worry when you’re not there, because there are a lot of things that happen when you’re not there,” said Buddle, who runs the watchdog Twitter feed Better Nursing Homes for New York State. “Are residents being watched to make sure there are no falls? Are they being toileted? My dad needs to be toileted six times a day. … There’s low staffing just about everywhere you go. It eases your mind to be there and have lots of eyes.” 
 
“I brush my father’s teeth,” Buddle continued . “I shave him. I give him haircuts.” 
 
Hammond said that the state requires nursing homes to meet the social and emotional needs of residents using other methods, such as video calls, and Buddle said his Facetime calls with his father have been useful, though far from ideal: His father has dementia and aphasia, a language disorder that makes it hard for him to communicate.  
 
“People with loved ones in nursing homes shoulder burdens the rest of society may not know about,” Buddle said. 
 
Kenneth Lanza was a former beer salesman and Sherlock Holmes enthusiast who enjoyed music, movies and live theater. 
 
“He loved a good cup of coffee and a good book,” Kavanaugh, who lives in Colonie, told me. “He was a hard worker who always took care of his family, and even all the way to the end he never complained about the hand he had been dealt.” 
   
In January, Lanza’s health worsened, and it became clear he didn’t have much longer to live. Relatives in other parts of the country began making plans to visit. Then the pandemic hit. When Lanza died, on April 13, it had been five weeks since he had received visitors, with the exception of that hour with his wife. 
 
“The end of February was the last time I saw him,” Kavanaugh said. “Had I known he was going to be locked down and I was never going to see him again, would I have done things differently? Absolutely.” 

"My father was going to die. But he didn't have to die alone." 

Reach Sara Foss at [email protected] Opinions expressed here are her own and not necessarily the newspaper's.

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