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Visits under cover Nursing homes balance COVID-19 prevention, social isolation

Cape Cod Times - 1/3/2021

Jan. 3—CHATHAM — On a breezy, chilly winter day 98-year-old Mary Eldredge tried out the new outdoor visitors' gazebo at Liberty Commons nursing home.

"It's fine," Eldredge said, before heading back indoors.

The Dec. 24 visit with her children was brief, but Kenny Eldredge and Christine Skidmore said

"Even if it's only a half-hour, it's great," Skidmore said.

As the spiraling cases of COVID-19 shut Cape nursing homes — including Liberty Commons — to indoor visitors, fears of a return to the social isolation

Social isolation can be a threat to physical and mental well-being,mj according to experts in elder health care.

"I call her every day," Skidmore said about her mother. But she said Eldredge, who turns 99 next month, misses the outside world. "She hates not being able to go out to the hairdresser. Just to ride around."

The community spread of COVID-19 is forcing public health officials and nursing home operators to strike an uneasy balance between protecting the state's most vulnerable

Long-term care residents have borne the brunt of the

Vaccinations started rolling out in Massachusetts nursing homes — including Liberty Commons — last week. But some nursing homes are not getting the vaccine until mid-month and in all cases, a second dose of the Pfizer or Moderna vaccine three weeks later is needed to complete the immunization process.

Coronavirus already had a foothold inside long-term care facilities when Gov. Charlie Baker announced on March 15 that visitors would no longer be allowed in nursing homes and assisted living centers.

Outdoor visits were allowed to resume in June, with indoor visits permitted as of Sept. 25 as long as residents and visitors wore masks and maintained a social distance of 6 feet.

The fall and winter surges, however,

Currently, long-term care facilities must suspend indoor visitation, group activities and communal dining if a resident or staff person contracts coronavirus.

The state Executive Office of Health and Human Services and the Department of Public Health said families must be notified of the conditions necessary for resuming visits.

In the meantime, residents and their families suffer the loss of connection, said Alena West, quality assurance director at Broad Reach Healthcare, which operates Liberty Commons as well as the Victorian assisted living center.

Nursing home employees have become adept at assisting residents in the use of Zoom and Facetime to communicate with loved ones.

But "it's so much harder for the family members not to be able to see how their loved ones are" in person, West said.

Sean Griffin, of Osterville, decided to pull his 93-year-old mother from the Mill Hill Residence in West Yarmouth after a recent outbreak of COVID-19 at the assisted living and memory care center

"She gets great care. But we're not going to lose the ability to have our arms around her," Griffin said.

He

Griffin said one of the main reasons he moved to the Cape full time was to be able to keep a close eye on his dad's care.

That wasn't possible once Cape Regency closed to visitors.

"That isolation and abandonment is too much to even contemplate," he said.

Nancy Bishop, of Falmouth, said she thinks social isolation contributed to the May 18 death of her 91-year-old father, Al Bishop.

Bishop's father resided at Royal Megansett Nursing and Retirement Home in North Falmouth, which has not lost a single resident to COVID-19, according to the state Department of Public Health.

But the mid-March visitor shutdown cut Al Bishop off from his wife, Mary

He had some form of dementia "but he knew us. He knew his whole family. He knew that we weren't there," Bishop said.

Family members waved at him through a window and tried to communicate on Facetime.

"He just didn't understand how it worked," she said. "He'd stare at the screen like it was a movie. We'd say, 'Dad, you can talk to us.'"

Nursing home visitor suspensions constitute a second epidemic — a silent epidemic of social isolation, said Dr. Joanne Lynn, health and aging policy fellow in the office of Congressman Thomas Suozzi.

"We did not ask, as a country," what elderly people thought of being isolated by virtue of their age and susceptibility to the disease of coronavirus, Lynn said.

Even if the outcome wouldn't be any different, it is important to include elderly people in the conversation, she said during a presentation for journalist fellows with the Gerontological Society of America.

Lynn wrote a report released in November titled "Elder Care and the End of Life in the U.S." that said COVID-19 has made end of life even grimmer for many.

The percentage of people in long-term care who ate meals in the dining room dropped from 69% to 13% during the pandemic, while the percentage of those who went outside for fresh air one or more times a week declined from 83% to 28%.

"Elders are dying from meaninglessness," Lynn wrote. She said 76% felt lonelier than before.

"Isolation is so big in this COVID pandemic," said Molly Perdue, co-founder of the Alzheimer's Family Support Center of Cape Cod in Brewster.

A small study from France found that the inability to go to the hairdresser or dine out because of the pandemic aggravated symptoms in people with Alzheimer's who lived with family members.

"Loneliness is not necessarily the product of physical distance but it can be the product of social isolation," said Perdue, who has given Zoom talks on the subject to councils on aging and the Massachusetts Assisted Living Association.

"You can be with people and still experience loneliness. You can be alone and not be lonely."

A Malaysian study indicates the quality, as well as the quantity of social interaction, makes a difference, she said.

Increasing social interaction with residents in facilities from four to 10 minutes and making sure they are positive interactions made a difference in residents' well being, Perdue said.

"Asking 'How was your day?' Saying, 'I really like that green sweater. It brings out the color of your eyes,'" are simple interactions that show promise in reducing isolation, Perdue said.

There are other things people can do, too, including exercising, having pets and even giving themselves hugs.

"Right now the emphasis is on trying to keep people COVID free," Perdue said. But "the confinement has to be balanced with this positive social interaction."

Broad Reach Healthcare is attempting to help residents maintain their mental well-being in a number of ways.

Residents have access to weekly, half-hour televisits with a psychologist, West said.

And to help expedite in-person visits, Broad Reach Healthcare President and CEO Bill Bogdanovich ordered the wood-framed gazebo, where Eldredge family members had their Christmas Eve visit, from Wayfair.

"We wanted to see what we could get quick," he said.

The gazebo has a metal roof to make it safe for a patio heater. Tarps take the place of clear plastic sheets that are on backorder and will provide some protection from the wind.

"You really don't want to close all four sides anyway," Bogdanovich said during a Dec. 24 interview.

In November, the state visitor restrictions to long-term care centers applied only to the wing, floor or unit where the COVID-19 case was located.

But last month, as coronavirus cases and hospitalizations continued to soar, even one case of COVID-19 among residents or staff was enough to make a whole facility off-limits to visitors.

Broad Reach is trying to make outdoor visitation as appealing as possible. Artificial poinsettias decorated the gazebo near the front entrance, where pots of roses already had been placed for outdoor visits in the summer.

Bogdanovich ordered five patio heaters for the facilities, to warm visitors and residents.

In the meantime, Skidmore is hoping for a mild winter for the sake of her mother.

"She loves to get outside," Skidmore said.

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and The Commonwealth Fund.

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