What To Know About California's 'Lockdown' Of Seniors And The Chronically Ill

By Nigel Duara, Ana B. Ibarra and Jackie Botts

California Gov. Gavin Newsom called for seniors and people with chronic conditions to isolate themselves during the coronavirus pandemic, raising questions about the state's capacity to ensure delivery of food, medicine and services to some of its most vulnerable residents.

On Monday, the White House called on all Americans, even the young and healthy, to cancel all gatherings of more than 10 people.

Newsom pledged that his office would address specific issues in a plan to be released on Tuesday, after state officials and private industry collaborate and work out the details. He did not say how long he expected that people would have to isolate themselves since no one knows how long the pandemic will last or how bad it will get.

The governor's advisory does not carry the force of law, but Newsom said he would not hesitate to sign an executive order making it mandatory if the directive is not followed.

"If you want to establish a framework of martial law which is ultimate authority and enforcement, we have the capacity to do that, but we are not at this moment thinking that is a necessity," Newsom said.

It's unclear how the government will coordinate the delivery of meals to an estimated 5.7 million California seniors and millions of other Californians who suffer from heart, respiratory, kidney and immune system disorders.

"We are doing so with our eyes wide open at the magnitude of what that means and the need to provide wraparound services to support our seniors in need of medical supplies, in need of meals and the like," Newsom said at a press conference.

The traditional method of delivering food to seniors is through "access points" like a senior center, said Los Angeles Regional Food Bank Chief Executive Officer Michael Flood. But dozens of seniors congregating in a small space is no longer feasible, so other options will have to be considered.

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Newsom emphasized multiple times that the state will partner with private industry to respond to the pandemic, whether that means feeding children with free or reduced-price lunches from shuttered school districts or seniors who are isolating themselves. Flood said the LA Regional Food Bank envisions something similar to feed the 28,000 seniors it serves each month.

"We've never had this type of discussion, how we can possibly leverage [private industry] logistics to deliver for a nonprofit," Flood said. "We're going to have to figure this out."

Here are a half-dozen questions raised by the governor's announcement:

How many people are we talking about here?

California is getting grayer. Newsom said his self-isolation guidance would apply to the approximate 5.3 million seniors age 65 or older who live in the state. However, according to 2019 Census numbers, that number may be closer to 5.7 million.

And it's not just the elderly who are being advised to stay home. So are people with underlying chronic health conditions. That means people with heart, kidney and respiratory diseases, as well as diabetes. This includes asthmatics. That's a lot of people.

In California, about one in three adults-- more than 8 million people -- live with cardiovascular disease, including high blood pressure, artery and valve diseases, strokes and heart failure, according to 2016 state data.

Also, about 2.5 million adults in the state have been diagnosed with diabetes, while 2.3 million adults have asthma and another estimated 1.5 million have chronic obstructive pulmonary disease.

Why the elderly?

"We are prioritizing their safety because of their unique vulnerabilities to this virus," Newsom said.

Health officials say that older adults, as well as people with compromised immune systems and those with underlying chronic medical conditions, seem to be at higher risk of developing serious, life-threatening complications from the coronavirus.

Out of California's 335 positive cases as of Sunday, 116 were among people 65 and older.

In China, where the virus was first detected, the majority of deaths have been among older adults, who tend to have weaker immune systems and have a higher rate of chronic disease. While the mortality rate for COVID-19 remains low -- about 2.3 percent -- it increases with age or when combined with a chronic illness.

For example, the COVID-19 mortality rate in China for people with heart disease jumped to 10.7 percent, and to 7.3 percent for patients with diabetes. The mortality rate for those with respiratory illnesses was 6.3 percent.

Similarly in Italy, a national analysis earlier this month found that the average age of 105 people who died in relation to COVID-19 was 81. Most of those patients were men and two-thirds of them had three or more existing conditions.

So, what does self-isolation mean anyway? Can they go to the grocery store or pharmacy?

The idea of Newsom's guidance is to keep people who may be sick away from seniors and people with compromised immune systems or weakened hearts, kidneys and lungs.

Newsom did not give any specific advice, but his plan likely would mean people staying home from work and other public places as much as possible, and not meeting with friends, even at home.

Guidelines from the Centers for Disease Control and Prevention say people should restrict activities outside their homes except for seeking medical care.

In New Zealand, self-isolation protocol allows for others to drop off food and supplies to those in isolation.

Until recently, only people who were infected or believed to be infected by the coronavirus but didn't require hospitalization had been asked to home isolate for 14 days.

Newsom recognized that asking millions of seniors to stay home was bound to create anxiety.

"We are doing so with our eyes wide open at the magnitude of what that means," he said. He added that his team is working on services to help these seniors with food and medication.

If these people can't go to the grocery store, how are they going to eat?

Good question. Newsom said that the state has "been working for days" to answer this question, but he did not provide specifics.

Newsom did allude to "strike teams that will support the social safety net and those services for our seniors" run by Mark S. Ghilarducci, director of the California Governor's Office of Emergency Services.

"What is really important is to understand what a massive logistics operation it would be to take a formerly pretty self-sustaining group of people and expand an already stretched safety net to cover that group of people too," said Ashley McCumber, executive director of Meals on Wheels San Francisco, which serves hot meals to 3,600 people who are over 60 or disabled each week.

McCumber said that the need for home-delivered boxes of groceries will grow dramatically, as will the need for hot meals for those who rely on senior day centers and other facilities because they can't prepare their own meals at home.

Food banks across California are already facing shortages of volunteers and closures of their distributions sites due to coronavirus concerns.

Partnering with private home delivery companies could bridge the gap. McCumber said the food delivery company DoorDash called last week to explore how it could support Meals on Wheels San Francisco.

Newsom said that he is not ordering restaurants to close, in part, because they could be part of the state's plan to deliver food to people in self-isolation. Instead, restaurants were asked to cut their number of customers in half, keep them separated and stress take-out meals.

"We want to expand the points of access to get those deliveries. Restaurants by definition provide those points of access," Newsom said. "So having an organized construct that allows delivery of hot, prepared and nutritious food within an existing infrastructure we think is appropriate to this moment."

What if you're homeless and you're also a senior or have a health condition?

Newsom included the homeless, along with seniors and those suffering from chronic conditions, among the three most vulnerable groups in the state. But the governor's directive was short on details for those who are seeking to self-isolate while they are unhoused.

Newsom said the state would prioritize getting homeless people indoors as soon as possible, either in hotel and motel rooms or in one of the state's 450 newly-purchased trailers. In an executive order issued Thursday, Newsom directed the state health agency and its office of emergency services to be prepared to make available accommodations "suitable for use as a temporary residence" and to commandeer those sites, if necessary.

The U.S. Office of Housing and Urban Development says there were more than 108,000unsheltered homeless people in California on any given day in January 2019. Those numbers are concentrated in the Bay Area and Los Angeles, and the counts have been found to dramatically underestimate the real numbers.

HUD issued guidance last week to homeless service providers regarding the coronavirus.

"Individuals experiencing homelessness have an increased likelihood of chronic medical conditions (such as diabetes, asthma, and hypertension) as well as coinciding mental health diagnoses or histories of substance use," according to the HUD document. "During crisis situations, health conditions can be exacerbated if health care regimens are not

maintained, or if histories of trauma trigger high-risk behaviors."

What about seniors who work but can't work from home? Is the state going to help?

More than one million seniors, or about 19 percent of Californians ages 65 and older, are in the labor force, according to 2018 Census data. Many continue to work because they don't have enough retirement savings or social security to cover expenses.

For seniors who can't take their work home -- for example, those who work in retail, the service industry, manufacturing or as drivers -- self-isolation could mean losing wages or even jobs.

Newsom made it clear that seniors working on the medical frontlines of the coronavirus response -- such as nurses, doctors and pharmacists -- are not exempt from the directive to self-isolate. A 70-year-old emergency room doctor in New Jersey contracted the virus and is in intensive care. He led his hospital's emergency preparedness.

The Governor's office did not immediately respond to questions about whether the state would provide financial aid to low-income seniors who are forced to miss work due to the coronavirus.

On Thursday, Newsom signed an executive order waiving the one-week wait time for those seeking unemployment insurance or disability benefits due to COVID-19.

On Saturday, the U.S. House of Representatives passed a legislative package that would provide emergency leave, including two weeks of paid sick leave and up to three months of paid family and medical leave. The Senate will consider the package early this week.

The state's public health department recommends that all people keep their distance from each other, disinfect their homes, wash their handsfrequently and avoid touching their faces.

CalMatters opened the floor to your questions and boy howdy, do you have questions. Let's get to them with what we know now and what we hope to learn soon.

First let's take a look at two questions from senior CalMatters readers who want to keep the blood pumping while in self-isolation:

First of all, this is where we're not: Italy, Spain or China.Italy and Spain have gone into full lockdown, with the Spanish military on the streets to enforce the mandatory stay-home order. That's what a true lockdown looks like.

In the U.S., Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he would like to see a 14-day lockdown, but nothing has yet been proposed.

Six Bay Area counties are expected to announce a "shelter in place" order forall residents on Monday, the San Francisco Chronicle reported. The order will apply to San Francisco, Santa Clara, San Mateo, Marin, Contra Costa and Alameda counties, beginning Tuesday and ending, at the earliest, on April 7.

It's not clear how the directive would be enforced. According to the Chronicle, the order calls for the local sheriff or chief of police to "ensure compliance."

There are still a lot of questions about the state plan, and not many answers. We don't yet know how the state plans to get food and medicine to seniors.

The national plan right now, according to Fauci, is twofold: Stop new infections from getting into the country and contain the spread of the virus domestically. International flights have already been severely curtailed. Containment,according to guidelines from the U.S. Centers for Disease Control and Prevention, happens when you stay more than six feet from an infected person. Basically, don't get coughed on.

But the guidance also says this, emphasis ours: "Considerable, thoughtful planning by public health authorities is needed to implement public health orders properly. Specifically, measures must be in place to provide shelter, food, water, and other necessities for people whose movement is restricted under public health orders, and to protect their dignity and privacy."

So, does allowing seniors and those with chronic conditions go for a walk while staying six feet away from other people and avoiding direct contact with body fluids, constitute a protection of your dignity? Does it fall under "other necessities?" There is no requirement to stay indoors.

So far, the state is saying it's your call. For now.

Here's a question from a reader about what to do about groceries and seeing friends:

The concern is warranted, and we don't quite know how far the state will go in curtailing personal movement in Newsom's plan, which he promised by Tuesday. We don't have many specifics yet, but we know the general outline:

•If you're over 65, do everything possible to stay inside, and if you have to leave the house, maintain six feet of distance and don't get coughed on.

•If you have a chronic respiratory, cardiovascular, kidney or immune system condition, the same guidance applies.

Other countries further along on the infection curve have already severely curtailed personal movement.

Can you go to the grocery store? You'll find yourself surrounded by people, and the lines are tight. Are there any alternatives, like a friendly neighbor? Can you have a friend over for dinner? Can you wave to someone across the street? Yes. You can. But do not attend events with more than 50 people, and avoid even smaller groups. Remember this is likely to be a short-term directive if the epidemic slows, so better safe than sorry. If your health is already compromised by a disorder, it's advisable to tightly limit your exposure.

Here's a question about tenants:

If your 67-year-old housemate is also your tenant, you may soon not be able to evict him. On Monday, Newsom is expected to issue guidance on foreclosures and evictions after eight lawmakers requested a 45-day moratorium last week. Some cities, like Los Angeles and San Francisco, have already enacted foreclosure and eviction moratoria.

But your question is also a broader one -- what do you do about people who just won't comply with the directive to self-isolate, especially if you're in an at-risk group?

Newsom briefly addressed that. Remember, the directive for seniors to self-isolate isn't a mandatory order with the force of law -- but it could be, if Newsom decides that voluntary compliance isn't working, and that the state needs to enforce self-isolation as an executive order.

So you could tell your housemate that, at the very least, he's tempting the fates by ignoring the directive, and perhaps inviting stricter actions from the state in the near future.

One reader has a question about jobs:

This is an excellent question, and one many working seniors are facing now. What happens if you can't go to work without risking your life? And when we return to whatever form of normalcy we can achieve, can you get your job back?

The state hasn't addressed the latter issue yet as it manages this crisis, but for the interim, Newsom ordered state agencies to waive the one-week waiting period for unemployment and disability benefits -- and extended disability benefits to those infected with the coronavirus.

For a senior with two part-time jobs, one which can be done from home and one out of the house, the loss of the out-of-home job would constitute a loss of hours. Unemployment benefits could help with that.

You can begin the unemployment filing process here.

Here's a question about events:

Ah, love. Nothing can stop it. Except perhaps a global pandemic that threatens the very fabric of society. But don't tell that to the bride.

Good for you for starting with your local authorities -- what Newsom has tried to emphasize is the state will set the basic framework of self-isolation and social distancing, and local areas can take it from there. For instance, after Newsom ordered the closure of all bars, wineries and brewpubs in the state, Los Angeles went further and ordered every restaurant to go takeout-only.

But back to the nuptials. You're looking for something official to show the betrothed that the postponement of their wedding is coming from someone in a position of authority. Here is Newsom's March 12 executive order that advises against "mass events" and uses the word "whereas" a total of ten times.

Eventually, it's going to come back to money. Newsom's order addresses that, too. Cancellations as a result of the pandemic "constitute a force majeure." What does that mean?

We aren't lawyers and this isn't legal advice, but guidance from this law firm explains force majeure clauses, see if you think these circumstances apply: "The purpose is to allow the parties to exit a contract without penalty where the purpose of the contract has been thwarted by circumstances that were not foreseeable by either of the parties at the time the contract was made."

Anyway, what percentage of those 95 invited guests is going to show up? Are those the wedding photos you really want, bride and groom standing six feet apart, sealing their vows not with a kiss but a thumbs-up?

Before presenting them with Newsom's order, it sure seems like a few very direct conversations with our lovebirds could do the trick. And when the big day finally does arrive, they are forbidden from tagging anything #LoveInTheTimeOfCoronavirus. Sorry, those are our rules.

This reader says she lives alone and needs help:

First, sorry you find yourself in this situation. It cannot be easy. You're asking a question that is top-of-mind for California seniors, low-income advocates and state and local governments.

The short answer is, we don't know yet. The slightly longer answer is, the governor assures us he and his team are working on it. Their top priority in this venue is making sure low-income seniors who rely on meal deliveries can still get food without having to congregate. The plan is also expected to involve private companies, though who is doing what, and for which populations, are still questions we're trying to get answered.

Perhaps contact your local county or city Area Agency on Aging. You can find a list of those agencies here.

But what about you, in your house, today. We are connected to our communities in lots of ways. Do you know any of your neighbors? If not, have you checked out neighborhood social apps? On Nextdoor.com in a few neighborhoods in Los Angeles, we've seen dozens of posts from young people offering to make grocery runs or a trip to the pharmacy.

Exercise caution. We've heard from utility companies that phone scammers are using the pandemic to try and fool people into thinking their water or power is about to be turned off unless they read out their credit card number. Humans are a flawed species. But if you can find someone in-person, or whom you trust from a social connection, give it a try.

Be persistent and be your own best advocate. People want to help right now.

This is an amalgamation of questions we've heard on social media and in personal conversations:

This is an extraordinarily difficult question even during times when it doesn't feel like the world is ending as we know it. Areas where seniors congregate have been the epicenter of some of the worst outbreaks of the coronavirus and the resulting disease, COVID-19. Outside Seattle, more than half of the original 120 residents of the Life Care Center have been transferred to hospitals. Twenty-six have died since Feb. 19.

So what are your options? Merrill Gardens Senior Living, which operates 33 sites in eight states, including 14 in California, is implementing heightened cleaning procedures, banning visitors except for medical care providers, cancelling all outings and taking the temperatures of residents. If a resident leaves -- and they're free to -- they may not be allowed back in without extensive screening and evaluation. Meals still are being served in common areas, but people are being separated. They also have the option of being served in their rooms. Families can drop off supplies without going inside.

At other senior facilities, such as Sunrise Senior Living in Seal Beach, similar protocols are in place. These are among the most vulnerable people, and their very way of life in a senior community is in direct contradiction to the governor's directive to avoid congregating.

This story from StatNews includes an interview with the AARP's chief medical officer, in which she advises the following:

So what are your options?

The risk of infection comes from the outside world. Senior-care workers go home and to the grocery store, then come back to work, but they're also trained to respond to health emergencies. At home, you have far more control over who comes in contact with your older relative, but you lose the advantage of having an expert on-hand.

Perhaps it's just adding up the pros and cons. If you feel the absolute greatest threat to your relative's health is the novel coronavirus, and they're otherwise relatively healthy, consider whether your home environment would be easier to control.

If they have serious health needs requiring continuous care you can't provide, and finding and paying for round-the-clock in-home caregivers isn't a possibility, it's perhaps a harder choice.

You also may consider that your parent or relative is all alone, with little emotional support, so bringing them to your house would be welcomed. Or they may prefer to stay in their own home. Just make sure that their facility is following the procedures outlined above. If they are not, point it out to them.

And remember that these seniors with options are the lucky ones. We've fielded dozens of questions from seniors with no family, few contacts and a baffling stream of information without much context.

The next question is from someone who's gotten a babysitting request:

This is a pretty straightforward one: Almost definitely, positively not. The person who made that request has perhaps not seen the directive from the state advising seniors to self-isolate. Seniors, even healthy ones, are too vulnerable to this virus.

Kids are ... not great at sanitizing, even in the best of times. Even with 20-second lyric memes and extensive parental supervision, it seems like an absolutely unnecessary risk to put yourself, an at-risk senior, in harm's way.

The other group of at-risk people in California is people with chronic health conditions. What do they do if they can't work?

This fits the definition provided by the state of someone with a chronic condition that is at-risk for the coronavirus, and consulting with your physician is likely the first thing on the checklist. As soon as possible.

The state isn't ensuring that people keep their jobs during the pandemic. Instead, they're trying to ease the burden by removing waiting periods for unemployment and disability benefits. That includes lost hours due to the pandemic and the government response.

Filing for unemployment can feel like a lot. If you feel comfortable navigating the state website, it's here: https://www.edd.ca.gov/unemployment/UI_Online_File_a_Claim.htm

Here's the official state guidance on filing for unemployment or disability/paid family leave: https://www.edd.ca.gov/about_edd/coronavirus-2019/faqs.htm

Since we've seen some iteration of this question a dozen times, let's go a little deeper into what you'll need to file for unemployment. (You're asking reporters, so most of us have filed for unemployment at least once.)

Here are some of the highlights of their advice. You know those tax documents you were just about to get to? Grab 'em.

First, do you qualify? Let's check the state list:

• If you're infected with the coronavirus, you're eligible for disability benefits. You'll need a doctor's note with the diagnosis, or if you don't have one, "a statement of symptoms; the start date of the condition; its probable duration; and the treating physician's or practitioner's license number or facility information."

• If you're healthy but you're caring for a sick family member, you may be entitled to Paid Family Leave. You'll just have to prove that they're sick using the same metrics above.

• You may be eligible for unemployment insurance if you
  • -Choose to stay home due to fears about the virus
  • -Your child's school district shuts down and you can't work
  • -Your child's school district shuts down and you were already unemployed
  • -Your employer reduces hours or shuts down operations.

Second, what are you eligible to receive? Disability and Paid Family Leave benefits pay about 60 percent to 70 percent of wages with a cap of $1,300 per week.
Unemployment pays $40 to $450 per week, depending on what you earned before you lost your job or hours. This is a state calculator to help you figure that out: https://www.edd.ca.gov/Unemployment/UI-Calculator.htm

So you're eligible. Now what? You'll need to create an account with the state system. This is the link: https://portal.edd.ca.gov/WebApp/Login?resource_url=https%3A%2F%2Fportal.edd.ca.gov%2FWebApp%2FHome

Register, then pick a benefit program that applies: UI for unemployment or SDI for disability or paid family leave benefits. As with anything related to the government and your money, file as soon as possible if you think you qualify.

This article is part of The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California.

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