Post-Vaccination CDC Guidelines and A Family Centric Reflection of a Year in the Life of COVID-19
Reasonable thoughts from a Geriatric Nurse Care Manager & Daughter
By: Hildy Sheinbaum, RN
I hope you are all beginning to see some light at the end of a long dark COVID and winter tunnel! The sun is rising earlier, the snow has melted, and spring is around the corner. As we emerge from this unprecedented time, undoubtedly many of us will feel renewed and liberated.
If you (as I am) are lucky enough to have had parents avoid COVID completely, or recover, it is my hope that most have been vaccinated by this time. If your parents have not yet been vaccinated and you are unsure of how to schedule one, I suggest doing a Google search “how to schedule a COVID-19 vaccine” for the state they reside in. The state government online sites have been refined in recent weeks and will allow you to navigate through the process with more ease than at the beginning of the vaccine roll out. While vaccine eligibility differs from state to state, all individuals over 65 are universally in the first phase. Additionally, various pharmacy chains are offering the vaccine across the country exclusively to people age 65 and older. Check out www.cvs.com or www.walgreens.com. The key is NOT to give up or get frustrated; be tenacious and attempt to navigate the site during different times throughout the day.
Last week, the CDC released its guidelines on how to conduct ourselves post-vaccination. Those recommendations are encouraging, but it is important to keep a perspective and not let our guards down. Can we really safely visit and dine with our parents during Easter and Passover? Can your mother go on the supermarket journey she has been craving for the past 8 months? Can your folks meet their friends at an indoor restaurant?
So, to be specific, (for brevity, I won’t re-hash them all) the new guidelines from the Centers for Disease Control and Prevention state that people fully vaccinated against COVID-19 “can safely visit with other vaccinated people and small groups of unvaccinated people in some circumstances.” Therefore, we can safely enjoy a small Easter or Passover celebration surrounded by vaccinated family or friends, and we can actually do away with masks in these situations. But please keep in mind that the CDC is concerned about protecting unvaccinated people who could possibly be at risk for COVID complications, and this should be considered when planning any gatherings. We do need to continue to mask and keep social distance guidelines if non-vaccinated, vulnerable individuals are in our company.
Many assisted living communities have begun to ease their visitation restrictions, allowing in-apartment visits. It is important to realize that while CDC provides us with guidelines, it is up to each individual community to make the final decision about how quickly they will re-open and relax the stringent guidelines they have been following. If your parent is living in an assisted living community, familiarize yourself with the community’s new and evolving policies, and be understanding about how they choose to relax their COVID precautions. The change in restrictions will likely depend upon how the community staff and residents are faring and will consider how much hardship they have been through during this pandemic.
On March 10, 2021, the Centers for Medicare & Medicaid Services, in conjunction with the CDC, updated its visitation guidance for nursing homes across the country. They stated that “visitation can be conducted through different means based on a facility’s structure and residents’ needs, such as in resident rooms, dedicated visitation spaces, outdoors, and for circumstances beyond compassionate care situations.” As with assisted living communities, it must be stressed that individual nursing homes have jurisdiction as to how to carry out these visits; however, the overriding premise is that infection prevention practices must be maintained based on core principles of COVID -19 infection prevention. There is a list of qualifiers that identify when limitations should be placed, for example for unvaccinated residents if the nursing home’s COVID positivity rate is greater than 10% AND less than 70% of the residents are fully vaccinated. If you have a parent in a nursing home, check often about the facility’s updated policies before visiting. Again, I stress the importance of having patience and understanding when faced with a decision being made by a particular nursing home.
And what about those of us who have parents living at home–either by themselves or with a caregiver? In the hope of providing some wisdom, a little humor, and a professional perspective, I thought I’d share with you my personal experience with my own parents during this past year, as well as my thought processes in navigating the CDC post-vaccine guidelines.
Just one year ago, as my stepfather turned 90 and my mother reminded us repeatedly that we needed to celebrate this milestone, I found myself in a complete quandary. The new virus was circulating; we knew little about it, other than that it was dangerous, extremely contagious, older adults were more at risk, and looming was the fact we were about to be faced with something that this generation had never before confronted. Nonetheless, my 91-year-old mother was insistent that we needed to celebrate this 90th birthday milestone: “He’s feeling like no one cares,” she kept repeating. There were no masks at the time, just complete uneasiness and uncertainty. But dare we not comply with my mother’s mandate? Could we live with the guilt of not doing something?? Debatable. So, we gathered the siblings and brought lunch and a birthday cake to my parents’ apartment to celebrate my stepdad’s 90th and keep everyone happy. As we were putting out the food on the dining room table, my brother-in-law paced nervously and continuously in the living room, reminding us that my sister had been at school and at various functions just the day before, and that we had no idea if we were transmitting something to our very vulnerable parents. The angst was unbearable, so we literally placed the food on the table, sang a quick happy birthday, and left without eating a morsel. My parents put a smile on their face, let us know that “it’s okay, go, go, go,” but it was quite clear that they were not pleased by the sudden departure. As the coronavirus journey was just beginning, I immediately knew that my parents were not going to make it any easier.
And the months that followed were…well, you know…. The frustration and angst surrounding trying to keep my parents and my clients safe was unlike anything I have ever experienced. I explained countless times how the mask must be worn OVER the nose, not under it. I explained that hands had to be washed the minute they arrived back into the house, and that they shouldn’t touch ANYTHING before washing. I explained why a grocery store was NO place for a 90-year-old lady in a wheelchair on a Saturday afternoon—or anytime, for that matter. I talked about why they couldn’t go into a restaurant; that despite their insistence that “there was no one there and it was just fine,” it was anything but “fine” in my mind. “Don’t pull your mask away from your face in front of people so that they can hear you because you are jeopardizing everyone’s health,” I repeated over and over again. “Do NOT invite the neighbor into the house for a cup of coffee!! Why can’t I get through?” Not to mention, the broken record of, “each and every time you do any one of the things I’m asking you not to do, you’re jeopardizing me and my family” …. And then the response, “just stay away then.” In an exhausting tone, I would repeat, “Well, since I am the one sorting your medicines, changing your dressings, and checking your blood pressure, I doubt ‘just stay away then’ is really an option. It was an exhausting year made more difficult by aging parents who felt they were doing what they were supposed to be doing, without any real self-awareness or awareness of this new world.
Sound familiar?????
So, here we are a year later, eternally grateful to the dedicated scientists and their quick development and approval of a highly effective COVID-19 vaccine. With my stepfather’s 91st birthday upon us, my dear mother, now in her 93rd year, once again reminded us “not to forget.” Being the overly cautious nurse and daughter that I am, I quickly decided we would put off eating at an indoor restaurant (my parents’ preference) and risk being exposed to any lurking variants that we don’t know enough about. I will, however, partake in outdoor eating at a restaurant when the weather gets warmer, and leave indoor restaurant dining for a safer time, hopefully when more people are vaccinated, and we reach herd immunity. Needless to say, we opted to do this year’s birthday celebration by once again bringing food into my parents’ apartment to keep everyone safer.
For the first time in a year, my sister and I arrived at my parents’ apartment mask-less. My mother immediately realized that she hadn’t seen our full faces in what seemed like an eternity. We hugged each other and shed a few tears— acknowledging that the end of isolation might actually be in sight, and grateful we had come through. I felt anxious, but free; and I had to continuously remind myself that this was okay—we were all going to be okay. Afterall, the CDC guidelines clearly stated that small groups of vaccinated persons could safely visit and eat without having to mask. We opted to allow the non-vaccinated sons-in-law to join us, in conjunction with the CDC guideline that vaccinated people could gather indoors with unvaccinated people unless any of those people or anyone they live with is at increased risk for severe illness from COVID-19 (thankfully we did not meet that criterion). We all sat together at the table for the first time in a year…. So many thoughts ran through my mind and it was like watching a movie of our life being fast forwarded. We were all able to relax for that moment.
And as we were sitting quietly, my mother suddenly announced that despite the fact she could go to the grocery store, her desire to do so was diminished. The irony!! She spontaneously promised that she wouldn’t be going during crowded times, she’d wear her mask properly, and would make sure to wash completely when arriving home. Lessons learned!
Stay well and safe!
