Health Department maintains restrictions on nursing homes despite immunity

MartorellPandemic visits. The Ascaso Amills siblings shout: "Sign us up, we will come on Wednesdays and Fridays" to the assistant who takes their mother to the interior of the care home. Maria Amills will be 101 years old and was the first to be vaccinated at the Sant Joan de Déu residence in Martorell, where 99% of the users and 87% of the workers are already immunized but, nevertheless, they have not relaxed any of the anti-covid measures: sectored spaces, stable coexistence bubbles, and family visits through the perimeter fence of the huge enclosure. Although the effect of the vaccines has already been felt with the reduction in the number of outbreaks and that next week all homes will receive the second dose, the Department of Health does not contemplate more lax guidelines, as requested by some of the families. It is getting antigen test kits for visits -restricted, and weekly- but this is "insufficient," says Vicente Botella, president of Upimir, the employers' association of small and medium nursing homes. Insufficient in quantity and also to "ensure that a person is protected", warns Salvador Macip, a researcher at the University of Leicester and the UOC. The scientist maintains that the measures can be "relaxed a little", with distance, hygiene and face masks, but it must be borne in mind that the virus circulates "in both directions and a vaccinated person can infect" a visitor and cause an outbreak. Total immunity is not 100% guaranteed.

A tense calm

In the residence of Martorell they have preferred, with family consensus, that visitors do not enter. "We come from a war without weapons or shields and now we are in a tense calm", the director, Jonatan Triviño, reflects, and admits that the inevitable "hope" for vaccines coexists with "respect" to the scientific unknowns of effectiveness.

Around forty users of this home died, most during the first wave and, during the next two, they have remained many months free of coronavirus. The last positive case, explains the director, was in November. Miguel Angel Arteaga explains that surely during the "hard days" he did not hesitate to vaccinate his nonagenarian father, but acknowledges that it is hard for him to wonder "if he will live until everyone is immunized". Like him, Teresa Lozano is more than resigned to not hugging her 99-year-old mother Teodora. "Let the protocol come out now!" she says excitedly. It is also the "hope" of the Ascaso brothers, who suffer because their mother loves "hugs and kisses", but they know that it is best that visits are made on the street.

The hard regime of visits is the great battle between family members organized in entities born out of pandemic pain, the centres, and the Health Department. María José Carcelén, president of the Coordinadora 5 + 1, verbalizes the discomfort because, she says, the oldest have "assumed the risk" of being the first to be vaccinated - but have received no benefits for this. Joan Antoni Jerónimo accepts the restrictions but questions, "what good is the vaccine if they don't let them go out?"

Anton López Bastida, director of the public care home La Mercè in Tarragona, where 90% of the residents have already been immunised and where only one positive result has been recorded - that of a resident who was in isolation when he had just been admitted - is also awaiting orders. "The vaccine is reassuring from a health point of view", says the manager, who values "the collaboration of the families". Both he and his colleague Triviño agree that in order to minimise the "family unrest", "transparency and information" is vital so that they can accept the restrictions on physical contact.

"Relatives have suffered a lot and I understand their haste, but there is a need for precaution", López says. Aware of the criticism, Triviño admits that the homes play the role of "bad cop" but assures that, in his centre, the majority of families have understood that "rigour gives positive results" and this has earned their "trust".

For Màrius Garcia (89 years old), the pandemic has put him back in front of the microphones, after years doing it in Radio Martorell. Every Friday he hosts La veu de la residència, where he interviews the staff of the centre, reviews the current affairs, and gives "news of the nursing home". He explains that what he misses the most are the outings with his daughter or going for a walk. He shows the "resilience" and "capacity to adapt" of his generation, as María José Moreno, the person in charge of hygiene and health, points out. "I live through it with resignation, faith, will and the desire to get rid of this", he says, pointing to his mask. Together with Monica Salgado, a social educator, they discuss Carnival, which they will celebrate in the privacy of each support bubble. "The most important thing is that we will do it".

The great concern of families is the psychological toll of lockdown. Luis Fernández Bengoa, of the Working Group of psychology of aging of the College of Psychology (COPC), and psychologist in a nursing home in Badalona, notes the great deterioration of mood and cognitive ability due to isolation but says that the effects are also felt in the families' "feeling of guilt". However, he says that the pandemic will make us move towards a "more humane model".