Eldon Webb, age 95, enjoys barbecue ribs, Mexican food, and going to the movies with his daughter, Sandy Cilone. But those outings and her daily visits to Webb’s apartment in the assisted living center at Morningside Ministries abruptly came to a stop a year ago.

“We missed birthdays, we missed Easter, we missed Thanksgiving [and] Christmas like we normally would have had at home or together,” Cilone said, looking back on a year of lockdowns and quarantines forced by the coronavirus pandemic. “So I’m just hoping and praying that on Easter, we can get him out and get him to our house.”

When the pandemic first started, coronavirus surged through nursing homes where congregate living and an elderly population with underlying health conditions created a perfect storm for transmission. In response, federal health officials mandated facilities to restrict all visitors and nonessential health care providers, except in the case of end-of-life situations.

Despite those efforts, nearly 70,000 residents in licensed Texas nursing home facilities have been infected with the virus, and 8,820 have died statewide, according to the latest data from the Texas Health and Human Services Commission (HHSC), which regulates long-term care facilities.

In Bexar County, nursing homes have reported 3,617 cases and 451 deaths, and assisted living centers have reported 605 cases and 124 deaths.

But the advent of a vaccine is leading many nursing homes to welcome family and friends into facilities once again. More than 44,000 nursing home residents in Texas have been fully vaccinated, including Webb and most residents at his care facility. Cilone’s visits with her father have resumed, though she is tested for COVID-19 weekly before entering the facility.

On March 10, the Centers for Medicare and Medicaid Services (CMS) released its first set of new guidelines since September, saying that vaccinations and a decrease in coronavirus infections within nursing homes warrant restoring indoor visits.

The state may soon follow with similar advice. Since October, HHSC has had in place a policy that allows nursing facilities to permit “essential caregiver” visits as long as the caregiver follows protective protocols such as wearing a mask and has tested negative for the virus within 14 days of the visit.

A Health and Human Services spokeswoman said last week the agency is reviewing the new guidance from CMS along with the state’s established policies and will post up-to-date guidance for providers on its website.

‘A lot of hope’

After a year of halting and then allowing visitors, Morningside Ministries today allows residents to enjoy a visit from family members or friends – but no more than two at a time. Visitors are required to show they have recently tested negative for the virus and are screened for symptoms of COVID-19 before they can enter.

The policy has been in place for several months, said Patrick Crump, president and CEO of Morningside Ministries, a nonprofit long-term care provider with about 600 residents in two facilities, one in San Antonio and another in Boerne.

During that time the policy was tightened intermittently due to positive cases of the virus among residents and staff.

“I think the vaccine is really giving everyone a lot of hope,” Crump said. “I think everybody’s beginning to relax and be a lot more optimistic about where things are headed.”

Crump anticipates the rules loosening to allow a greater number of visitors now that most nursing home residents have been vaccinated. Like other facilities, Morningside is waiting for guidance from federal health officials and Texas Health and Human Services.

The CMS guidance relaxing visitation rules also states that “outdoor visitation” is still preferred even when visitors are fully vaccinated and all visits must be suspended if there’s an outbreak in the facility.

Welcome signs

Outside the Lakeside Nursing and Rehabilitation Center on San Antonio’s far West Side, a large welcome sign greets family and friends to the facility. HHSC data shows the facility has had 63 cases of COVID-19 and 8 deaths but as of March 1 has no active cases among residents or staff.

A sign welcoming guests to Lakeside Nursing Aid near Loop 410 and Ingram Road is posted outside its entrance. Credit: Scott Ball / San Antonio Report

An administrator would not answer questions about the visitor policy, deferring to its parent company, Regency Integrated Health Services, which operates four facilities in San Antonio. Regency did not respond.

At Heartis San Antonio, an assisted living and memory care center in far North San Antonio, in-person visits are permitted as long as the visitor can provide a negative COVID-19 test result or has been fully vaccinated.

When the pandemic began, Heartis began coordinating “window visits,” for its 80 residents, said Casey Brill, executive director of Heartis.

“We’ve been one of those blessed communities that didn’t get any confirmed cases until November of 2020, so we did very well throughout the pandemic,” Brill said.

State data shows Heartis experienced a total of 11 cases. Since January, 99% of residents have been vaccinated, Brill said.

Vaccinations encouraged

Last fall, the Sarah Roberts French Home near Woodlawn Lake began allowing “window visits” and in-person visits with residents in the facility’s library.

Visitors must be COVID-tested first, said a receptionist at the facility, where there have been 14 cases among residents and two deaths.

At the Village at Incarnate Word, which offers assisted living, memory care, and skilled nursing on the University of the Incarnate Word campus, residents received their second round of the vaccine in February. The facility has had four positive cases.

Family members can visit one person at a time, several times a week, for up to four hours at a time, said Paul Harrison, president and CEO of the Village. But further expanding the policy to allow more and longer visits will happen only in a very controlled way.

“We had really, really high rates of vaccination here at the Village so we’re excited to be able to invite families back to see their loved ones,” Harrison said, noting that the limited visitation policies took a toll on residents.

However, some residents’ family members have told the facility they won’t visit until they’re vaccinated, “which we certainly appreciate and that’s what we’re going to encourage,” he said.

‘We miss families’

San Jose Nursing Center on the South Side is allowing visitors, as long as they’ve been tested or vaccinated, said one worker who spoke briefly with the San Antonio Report.

The facility has reported seven cases among its staff, but none so far among its 37 residents.

She said that though limiting in-person visits has been hard on the residents, they are so conditioned to wearing a mask now, she suspects they won’t want to take them off even if the mask mandate goes away.

A social worker at St. Francis Nursing Home north of downtown San Antonio said the facility hasn’t completely “thrown open” the doors just yet.

Visitors can enter St. Francis but must be masked and remain 6 feet apart from residents unless they have had a negative COVID-19 test within the last 14 days, said social worker Cordi Britten.

The skilled nursing facility has had 53 cases of the virus, with the most recent case in January, and six deaths among its 100 residents. Almost all have since been vaccinated.

“We are all looking forward to letting everyone in because … it’s hard on the residents, it’s hard on the families, and it’s hard on us,” Britten said. “… I know the residents will be really happy and we miss the families, too.”

Shari Biediger

Shari Biediger is the development beat reporter for the San Antonio Report.