Citing the latest surge in Covid cases, California health officials on Jan. 7 implemented some of the most stringent rules yet for people visiting nursing homes and senior care facilities.

The guidelines, which are stricter than those for hospital visits, require all visitors who want to see their loved ones indoors to show proof not only of vaccination (including a third shot or booster), but also of a recent negative Covid test: either a negative PCR test taken within the previous two days, or a rapid antigen test taken within 24 hours. Proof of a negative Covid test is also required for outdoor visits.

Across the Bay Area, Jewish nursing homes and retirement centers have had to adapt quickly to the new requirements, balancing the need for emotional support and personal connection for seniors with the obvious risks of an outbreak. Communal dining and other social activities are limited once again, making visits from loved ones all the more important.

Some senior centers have arranged to provide on-site testing for visitors, while others have not, raising complaints that the stringent new rules are, once again, keeping family members “locked out” and their loved ones locked in.

The guidelines will remain in effect for one month, until Feb. 7 — while the Department of Public Health “continue[s] to assess ongoing conditions” to “determine any further updates.” Citing the omicron variant’s heightened transmissibility, the order outlining the new rules states: “Based on the experience from prior Covid-19 surge periods … the impact of such facility outbreaks may be devastating.”

Indeed, since the start of the pandemic, nursing homes and residential senior centers have become a hunting ground for the novel coronavirus and have seen its deadliest impacts. In California, residents at skilled nursing facilities have made up 13 percent of the state’s total deaths, according to the Los Angeles Times.

State data show that Covid deaths have remained flat during the omicron wave — though deaths usually are considered a lagging indicator.

But with nearly all senior center residents fully vaccinated against the virus, and with the variant shown to cause less serious illness than previous strains, there has been some pushback against the state’s new rules. Opponents say they have made it “functionally impossible” to visit their loved ones as the pandemic is about to enter its third year.

We could continue to isolate in place, forever, and nobody would get sick. But a meaningful, purposeful existence is crucial for everybody. Probably more so in the elderly population.

Andrea DuBrow, a social worker who chairs a patient advocacy group at the Reutlinger Community, a Jewish senior facility in Danville, is exasperated by the new rules. Her mother, 75-year-old Gale DuBrow, has dementia and Alzheimer’s and lives in Reutlinger’s memory care unit.

“I love the idea of being tested to show negative status and I went to get tested again yesterday,” DuBrow wrote in a recent email. “But the idea is conflicting with the reality of test availability which is incredibly limited and slow right now.”

Rapid tests have been hard to find nationwide due to massive demand, despite more than 70 million being produced each month. DuBrow has not been able to find one despite her efforts.

She was able to get a sophisticated PCR test at a nearby lab. But due to a backlog, her result didn’t come back for four days. That failed to meet the 48-hour window required by the state.

“Right now I’m just kind of screwed,” she said.

Meanwhile, DuBrow’s mother is suffering. “She can’t understand a video call. She can’t understand speaking on the phone. I need to be able to see her and have my eyes on her.”

Outdoor visits are not a solution either, DuBrow said, and in the past left her mom disoriented.

Throughout the pandemic, public health officials have had to make difficult decisions based on shifting science, weighing complex questions of medical ethics and the public good.

“I pity whoever is trying to work in some authoritative capacity in any public health agency,” said Paul Silka, an emergency medicine physician at Regional Medical Center in East San Jose.

Silka reflected on the benefits, and drawbacks, of restrictive public health measures like the ones California has implemented. It “really raises huge ethical questions” that require us to carefully weigh benefits and risks, he said.

“We could continue to isolate in place, forever, and nobody would get sick. But what we know is meaningful, purposeful existence is crucial for everybody. Probably more so in the elderly population.”

Some local Jewish senior facilities are trying to lessen the impact of the new rules on families by providing on-site testing for visitors.

The city and county of San Francisco, in fact, requires all skilled nursing facilities to provide on-site, supervised rapid antigen testing. The Department of Public Health “will use its best efforts to supply tests for this purpose,” a Dec. 30 public health order announcing the rule states.

At the San Francisco Campus for Jewish Living, which has a skilled nursing unit as well as a rehab center and residential living center, president Daniel Ruth said on-site rapid antigen tests are being provided to all visitors, exceeding the requirements of the city health department.

At the Moldaw Residences, a retirement community in Palo Alto, a handful of family members who visit on a daily basis and are deemed essential for providing face-to-face emotional support for their loved ones have been added to the weekly “surveillance testing” regimen performed for everyone on campus — including residents and staff — executive director Elyse Gerson said.

About five frequent visitors were added to the testing roster, which uses PCR testing, Gerson said.

“We’re figuring out how to accommodate [daily visitors] so that their loved ones do not feel isolated,” she said.

Moldaw gets only one box of about 40 rapid antigen tests per week via a state program, and they are used to supplement PCR testing for staff. Gerson called the rapid tests “very precious.”

Reutlinger executive director Clara Allen told J. that it has been “challenging” implementing the new public health guidelines and accommodating family members who feel shut out. She also said the Danville facility was looking at the possibility of providing tests for visitors.

Silka, the ER doctor, warned against the harmful effects of isolation, or marooning seniors in what he called a “cognitive desert.”

Sometimes “we think we’re protecting them in a paternalistic way,” he said, “but really we’re cutting them off. Is that really for the greater good?”