Joy Parker of Madison said the nursing home where her mother lives has been slowly restricting visitor access over the past two weeks, but on Thursday announced that it would be closing its doors to all visitors at 5 p.m.

“I think it’s good to have precautions,” said Parker, whose mother, Wanda Tarwater, lives at the South Hampton Nursing and Rehabilitation Center in Owens Cross Roads. “It does hit the elderly the most, and when it gets into a facility like that, there’s really no end. If anything needs to close, those types of facilities should be the first ones to close.”

Nursing homes across Alabama are already restricting visitors in an effort to protect residents from COVID-19, a coronavirus that has proven lethal at much higher rates among the elderly, making nursing homes particularly vulnerable.

Nearly all of the 31 COVID-19 deaths in Washington are associated with a handful of nursing homes in the Seattle area.

Most nursing homes have also begun prohibiting volunteers and church and school groups from visiting, at least for the near future, said John Matson, a spokesman for the Alabama Nursing Home Association, which represents 216 of Alabama’s 231 nursing homes.

“That’s just too great a risk to put on our residents and staff,” he said. He said many nursing homes are connecting residents with their family via phone calls and video chat services like Skype and FaceTime.

About 25,000 nursing home residents live in Alabama, and nursing homes employ about 31,000 staff statewide.

“The key word for us is prevention,” said Matson. “We want to prevent COVID-19 from ever getting inside a nursing home, and we’re doing everything we can to prevent it from entering.”

As of Thursday evening, Alabama has not yet reported a confirmed case of COVID-19 but public health officials have said they expect to see confirmed cases as the state begins testing more people.

Dr. Shane Lee is the medical director of a nursing home in Perry County and one in Hale County. He said his nursing homes are not allowing visitors for the next two weeks.

“We’ll reassess toward the end of the 14-day period,” he said. “The risk for the nursing home is going to be exposure from staff and visitors, and to a lesser extent, new patients.”

He said his have their temperatures checked at the beginning of each shift and sign off that they haven’t had any symptoms of illness or exposure.

Centers that haven’t closed their doors completely have begun screening visitors more closely, said Matson.

“All of our nursing homes have procedures to limit visitation,” said Matson. “If you visit a nursing home, you’ll most likely be met at the door by someone who will as a series of questions and maybe take your temperature. If you meet certain criteria, you’ll be asked politely to leave.”

Lauren Goodman is the executive director of McCoy Adult Day Care in Birmingham. She said the facility doesn’t plan to close but is monitoring the situation. She said staff have also implemented several new policies, including limiting visitation of volunteers and of anyone who has traveled recently.

“We have enhanced our cleaning procedures to include hourly disinfection of all client areas,” she said.

Her staff are getting training on CDC cleanliness guidelines, and any staff with symptoms of illness will be asked to leave.

The Alabama Department of Veterans Affairs operates four veterans homes statewide – in Huntsville, Pell City, Alexander City and Bay Minette. The Alabama VA hasn’t prohibited visitation for families, but it has been screening all employees and visitors. Anyone with symptoms of illness, or who has traveled internationally in the past 14 days won’t be allowed entrance.

If a nursing home resident exhibited signs of COVID-19, Matson said, the nursing home physician could take a specimen and send it to a certified lab to be tested.

Lee said he has not had a problem getting access to tests for nursing home patients.

If nursing home resident were to test positive for COVID-19, said Matson, as long as the person’s symptoms were mild, the person would remain at the nursing home under quarantine. That’s the guidelines the association has been given by the CDC and the Alabama Department of Public Health, he said. If the patient’s condition worsens, the patient would be transferred to a local hospital.

Matson has not heard of family members pulling their loved ones out of nursing home care because of COVID-19 fears, but he warns against it.

“We are encouraging family members to leave their loved one at the nursing home because it’s a protected space,” he said. “Because we care for people who are so medically fragile, we practice infection prevention year-round. And we’re in the middle of flu season, so we were already on heightened awareness.”

Matson recommends family members stay in touch on a regular basis with the nursing staff caring for the loved one, to get updates when visiting is not possible.

Parker said she plans to do that. She and her family used to schedule lunches with her mother at her nursing home, but that’s not an option now. Her mom is not verbal and would not be able to communicate by phone. Parker said the family will take their new normal one day at a time: “There’s no perfect situation here.”