Most indoor visits cease at San Diego County nursing homes as region drops to most restrictive tier

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By Lauren J. Mapp, The San Diego Union-Tribune, November 14 2020

Norma Cazares poses in her Chula Vista home with a photograph of her aunt and mother on Friday, November 13. Her aunt lives in a skilled nursing home in El Cajon, which will stop indoor visitations due to the county reaching the most restrictive tier. (Kristian Carreon / For The San Diego Union-Tribune)

New restrictions come as coronavirus cases spike in skilled nursing facilities across the country

With San Diego County dropping into the state’s most restrictive reopening tier for COVID-19 on Saturday, indoor visitations at the county’s skilled nursing facilities are once again off the table.

At the outset of the coronavirus pandemic, skilled nursing facilities became hot spots for the spread of the novel coronavirus due to their generally older populations, many with pre-existing conditions. In March, the California Department of Public Health and Centers for Medicare & Medicaid Services halted visits at nursing homes in an attempt to keep the virus from spreading within them.

Since late August, facilities without active coronavirus cases and with state-approved mitigation plans, adequate amounts of personal protective equipment and staff have been allowed to resume indoor visits. Although many facilities in San Diego County continued to restrict indoor visits to further protect residents, some had resumed them in recent weeks.

Now that the county is in the most restrictive purple tier because of rising case rates, all skilled nursing facilities that were previously allowed to resume indoor visitations have been removed from the California Department of Public Health list.

The only 32 skilled nursing facilities throughout California that remain on the state’s indoor visitation list are in Alameda, Butte, Kern, Modoc, Nevada, Plumas, Shasta Siskiyou, Sutter, Tehama and Tulare counties.

Until the county returns to a less restrictive tier, indoor visitations will only be allowed for patients who are pediatric; in labor/delivery; living with physical, intellectual or developmental disabilities; those with cognitive impairments; and those nearing end-of-life.

The restrictions, which will be in place for at least two weeks, can put a damper on family plans for the Thanksgiving holiday, or in one local caregiver’s case, plans to celebrate a loved one’s birthday.

Norma Cazares poses in her Chula Vista home with a photograph of her aunt and mother on Friday, November 13. Her aunt lives in a skilled nursing home in El Cajon, which will stop indoor visitations due to the county reaching the most restrictive tier. (Kristian Carreon / For The San Diego Union-Tribune)

Chula Vista resident Norma Cazares was planning to visit her aunt Alicia in an El Cajon skilled nursing facility for her birthday at the end of the month when she found out the news about the county’s new coronavirus status. (She asked that her aunt’s last name and nursing home not be published for her privacy).

Her aunt — who was the caregiver for Cazares grandparents before they passed — never married or had children of her own, so Cazares said she has become her primary caregiver.
Alicia was living in her own apartment until a few years ago, when she suffered an accidentally injured at home. She transitioned into an independent living facility, then to an assisted living home, where she was accidentally given someone else’s medicine and experience an overdose incident.

Earlier this year, while living in a residential boarding care facility, Alicia tested positive for COVID-19. She was treated in a hospital, then transferred to the El Cajon nursing home in May, where she has lived ever since without any indoor visits. Cazares has made weekly visits to her aunt, bringing her taquitos in an attempt to bring her back to a healthy weight, but they have always been either window visits or held outdoors.

“I’ve never been inside the facility,” Cazares said. “The fact that I have been able to see her outside was wonderful because this way I could read her better, instead of through the glare and shadows of a window.”

Cazares has been trying to keep her aunt’s spirits up with the promise of a visit, complete with taquitos, for her birthday on Nov. 24, but now she’s not sure if even a patio visit will be possible.

“She’s fully aware it’s her birthday coming up, plus we’ve been talking about it trying to keep her spirits up,” Cazares said. “She was excited about it, we were all excited about it, and now this.”

Photographs of Norma’s aunt, who is currently living at a skilled nursing home in El Cajon. Indoor visitations will stop now that San Diego County has reached the most restrictive tier. 
(Kristian Carreon / For The San Diego Union-Tribune)

Another caregiver missing a loved one after months of separation is Carmel Valley resident Phil Turner, whose 45-year-old daughter with epilepsy lives in a La Jolla nursing home. (Turner also asked that his daughter’s name and residence be omitted for privacy).

Turner’s daughter was transferred to her current facility in April, after flooding caused damage at her previous nursing home. He speaks with her briefly at the door when he picks up and drops off the clothes he washes for her three times a week, but hasn’t been able to have a sit down visit with her since before the pandemic began.

“I see her three times a week and text her several times every day, and that’s sort of good enough, but it would be nice to [have a formal visit],” Turner said. “I feel more sorrow for her because she’s missing going out to restaurants, as we all are, but she’s not, she’s not getting out about at all, where as I am.”

The local restrictions come at a time when reports of new coronavirus cases are once again increasing in nursing homes throughout the country, according to a report from the American Health Care Association and the National Center for Assisted Living.

Dr. David Gifford, chief medical officer for the AHCA and NCAL, wrote a statement this week reminding caregivers and the community at-large to take extra precautions as the holiday season approaches.

“We understand everyone wants to see their family and friends during the holidays, but we really need to consider our parents and grandparents who are living in our nation’s long term care facilities,” Gifford wrote. “Even though you may feel fine, more than half of people who have COVID-19 are asymptomatic, and the people you encounter at the Thanksgiving table or out at the grocery store may work in a nursing home or assisted living community.”

He added that “Wearing a mask and practicing physical distancing not only protects you, but it is a sign of respect for our elders and our health care heroes who care for them.”

The Centers of Medicare & Medicaid Services reports there have been 294,438 confirmed and 156,929 suspected cases of the novel coronavirus among nursing home residents as of Nov. 1, an increasing from the previous week by nearly 5 percent and 2 percent, respectfully. CMS also reported an additional 1,829 deaths among nursing home residents, bringing the national total to 65,446 nationwide.

According to CMS, California and Texas, which are the largest states by population, have reported the greatest number of coronavirus cases among nursing home residents in the country with 24,408 and 24,663 confirmed cases, respectively.

This week, San Diego County officials reported 18 active outbreaks at skilled nursing facilities out of the 95 outbreaks that have occurred since the beginning of the pandemic, which includes two newly announced outbreaks.

Outbreaks in skilled nursing facilities are considered active when at least one resident or health care worker tests positive for the virus, and deemed inactive once no one has tested active at the facility for at least two weeks.

For the first time in months, Reo Vista Healthcare Center reported one new case of the virus among skilled nursing residents at the facility, according to data from the California Department of Public Health. The Paradise Hills facility made headlines in early July for having the most cases among residents at any facility in the state at the time, but no new cases had been reported there among residents since mid-July.

So far, 1,279 skilled nursing residents and 810 healthcare workers have tested positive for the novel coronavirus, up from 1,220 and 771 the week before. The county announced one new death connected to skilled nursing outbreaks, bringing the total up to 189.

Arroyo Vista Nursing Center in San Diego, Monte Vista Lodge in Lemon Grove, and Somerset Subacute and Care in El Cajon continue to be the only three skilled nursing facilities in the county that have not yet reported a case of COVID-19 among either residents or health care workers, according to CDPH data.

For the online version of this story with novel coronavirus details for all 86 skilled nursing facilities, visit

The San Diego Union-Tribune is looking to speak with family caregivers with loved ones living in skilled nursing facilities for the ongoing COVID-19 coverage. If interested, email