Brandy O’Keefe visits her mom three to five times each week at Parkview in Allen, an independent living and retirement complex in the Dallas suburb. O’Keefe brings groceries, helps with laundry and bathing, and keeps 76-year-old Vi Rentz company.

As of last week, however, she stopped hugging or kissing her mother goodbye before she heads home to Prosper.

“I’m just kind of waving at her and heading out the door,” said O’Keefe. She’s concerned she could expose her mother to COVID-19 as cases have steadily begun to emerge in North Texas.

Nursing homes and long-term care centers in Dallas-Fort Worth are beginning to limit visits to elderly residents after public health officials provided updated guidance this week.

In an address to the country Wednesday evening, President Trump said his administration was “strongly advising that nursing homes for the elderly suspend all medically unnecessary visits.”

Now they’re grappling with the how.

“It’s pretty much a nightmare,” said CC Young president and CEO Russell Crews.

The CC Young assisted living campus, in Dallas near White Rock Lake, is planning to restrict access for anyone who isn’t a family member of a resident and everyone under 18. It’s also suspending its volunteer staff for the time being.

“We’re moving toward restricting campus access, and that will probably go into effect by Monday,” Crews said.

“How do we decide who comes in and who doesn’t? Because that’s ... that’s not an easy mark,” said Crews. “The biggest challenge is families. How are we going to restrict that?”

Protocols for family member visitation of the community’s roughly 425 elderly residents are still evolving, he said.

‘Killing machine’

Before Trump’s address Wednesday, U.S. health care experts had been advising senior living and long-term care facilities across the U.S. to limit visitors “regardless of whether your surrounding community has confirmed cases.” Centers have been encouraged to have residents use alternate forms of communication with loved ones because the new coronavirus poses an increased risk to elderly populations.

The president and CEO of the American Health Care Association, Mark Parkinson, called coronavirus an “almost perfect killing machine” for the elderly during a recent interview with CNN.

There are 24 cases of coronavirus confirmed in Texas, with three in Collin County and three in Dallas County. Physicians have warned, however, that the lack of widespread testing means Texas may not have an adequate sense of how many people have the virus or how rapidly it’s spreading.

There are 249 nursing homes in the Dallas-Fort Worth metropolitan area, according to U.S. News & World Report. Vulnerable elderly populations, however, live in a wide range of varying long-term care centers that include more than just nursing homes.

Skyline Nursing Center in Oak Cliff said it’s following guidelines from national health officials and the federal government and distributing a Q&A explaining that it is limiting visitation to its roughly 100 residents.

Lennwood Nursing & Rehab in Dallas is only allowing visitors for reasons that are medically necessary or in a situation where someone is receiving end-of-life care, according to Lennwood VP of clinical services DJ Cook. When asked to elaborate how Lennwood was determining which visits were medically necessary, Cook said the nursing home is considering visitation on a case-by-case basis.

Sunrise Senior Living, which has four locations in North Texas, said it’s “taking extra precautions — beyond our existing infection control and emergency preparedness programs — to help prevent the spread of the virus.” The company is limiting entry to its communities to only “essential individuals.”

Sunrise’s team members and its crucial service providers are allowed to enter its communities, and the company is following “rigorous” screening policies to minimize infection risk.

Brandy O’Keefe delivered groceries to her elderly mother, Vi Rentz, at her independent living unit at the Parkview in Allen retirement community in Allen on Thursday, March 12, 2020. In light of the COVID-19 global pandemic, O’Keefe delivers groceries to her mother to limit her exposure to pathogens, since she has COPD. (Lynda M. Gonzalez / Staff Photographer)

Tough decisions

O’Keefe’s mother lives with chronic obstructive pulmonary disease, or COPD, a long-term condition that makes it difficult for her to breathe. Rentz’s condition means she has less than 50% of typical lung function and uses an oxygen tank. It also puts her in the most vulnerable category for potential coronavirus cases.

Rentz, who can only move around with the assistance of a motorized wheelchair, said her retirement community was still open to visitors Thursday.

Parkview in Allen did not respond to The Dallas Morning News’ request for comment, but O’Keefe says the facility has CDC-provided signs and is signing in and screening visitors at its front desk.

O’Keefe took the day off work Thursday to stock Rentz up with groceries and necessary medications and says she’s not sure whether she should continue visiting her mother.

“She usually can figure out problems and issues, puzzles and things like that,” O’Keefe said of her mother. “And this is a puzzle that can’t be understood or figured out right now for her.”

She doesn’t like thinking that they might not see one another in person for a while. “I know that she would feel more comfortable with that physical touch or being able to actually see someone,” O’Keefe said.

But a diagnosis of COVID-19 would be a “death sentence” for someone like her, Rentz said.

“As isolated as I’m going to start feeling — because I’m already feeling it — that’s one of the things that is really going to hurt,” Rentz said.