How social distancing affects vulnerable nursing home residents

On a cold evening in early March, my grandpa and I queued outside a nursing home in rural California. He pulled an insulated lunchbox, filled with hot chai and pureed rotis, to his chest and sighed. There are at least eight families in front of us, and if we don’t move fast, my grandma will fall asleep before she’s had dinner.

Twenty minutes later, we’ve reached the threshold: a nurse takes our temperature, pours hand sanitizer into our outstretched palms, and fixes nitrile masks over our faces. There are no exceptions for my grandpa, despite the fact that he’s been visiting two times a day, six days a week, for the past year. The pandemic roars dimly over the Atlantic … we’d prefer to be safe than sorry.

My grandma is in Room 301B, reserved for patients nearing the end-of-life. Still, she recognizes us — her brown eyes, with the lashes still shockingly thick, fixating on our masked faces. Regular visits, we’ve been told, improve wellbeing even in largely nonresponsive patients: lowering blood pressure, regulating sleep cycles, and reducing anxiety. For my grandpa, this advice is gospel.

He pets my grandma’s head with one gloved hand and hands me an empty thermos with the other. “Can you fill this with hot water?” he asks. I nod and make my way to the nursing home’s lobby. Usually, the room feels like a bustling Main Street café — knots of women play bridge on checker-topped tables, men fix themselves mugs of sugared coffee and pass newspapers back and forth, the radio hums Aretha Franklin. Today, the scene is entirely different. The television mumbles softly to itself, and the bridge chairs have been folded-up and stacked against the far wall. The community calendar is stripped of events; the activities replaced with a directive to “Stay Safe, Stay Healthy.”

The main residential hallways are even gloomier. Mrs. Bennet, who knit my grandma a magenta scarf for Christmas, is in total isolation; her emphysema, acquired from a lifetime of smoking Camel Blues, puts her at high-risk. My grandpa says Mr. Lin, the guardian angel of the nursing home’s herb garden, hasn’t watered the plants in six days. We can hear Miss Sanders crying softly through the thin walls.

My grandma passed peacefully, within the week. Three days after her funeral, COVID-19 killed a dozen seniors in Seattle — prompting nursing homes across the country to enter total-lockdown; all communal dining and group activities are canceled, and residents are to practice strict social distancing. With the exception of compassionate care visits, patients are no longer permitted to see family or friends.

Given the staggering effects of COVID-19 on nursing home populations, these quarantine measures are an essential protective step. Seven thousand three hundred nursing home residents have lost their lives to the virus, accounting for 17% of the nation’s total fatalities. Lockdown slashes exposure to the COVID-19 pathogen, protecting vulnerable seniors from its deadly effects: severe respiratory distress, acute onset heart failure, permanent damage to the nervous system.

But if nursing home seniors are at high-risk for COVID-19, they’re also especially vulnerable to the side-effects of prolonged social isolation. With the exception of dementia, depression is the most common mental illness amongst nursing home residents, with rates three to five times greater than that of older individuals living in the community. With more than 20% of non-comatose nursing home residents suffering from depression, we must consider how prolonged social isolation will affect their mental health.

While all patients value in-person interactions, these face-to-face meetings are especially important for those with mental illness. Suddenly ceasing social activities can compound existing feelings of paranoia, restlessness, and fatigue. To help residents maintain a positive outlook, nursing home staff could implement a virtual community calendar. Staff could lead activities by phone or video: walking residents through simple exercise routines, hosting craft hours, and organizing support groups. Further, many nursing homes partner with community volunteers — who visit with the residents and host activities. While these volunteers can no longer visit in-person, some nursing homes have helped them remain connected with residents by assigning pen-pals or organizing book clubs.

Additionally, residents could benefit from transparent communication from the nursing home staff. Residents without cognitive impairments should be regularly updated on lockdown protocols and expected durations, rather than being left to guess. Conversely, those suffering from cognitive impairment might not understand why their loved ones have stopped visiting, or why they’re not allowed to go for a walk in the gardens. These patients’ families should be encouraged to keep up regular communication, even if just for a few minutes a day, to keep their loved ones from feeling abandoned.

Finally, in addition to being on alert for symptoms of COVID-19, nursing home staff should step-up screening for depressive symptoms. Residents should know that their mental health is a priority; support and guidance could be offered through virtual calls with faith leaders, online or television-based mindfulness workshops, or introductions to simple meditative practices. While COVID-19 is a public health priority, nursing homes should not let the mental health of their residents spiral.

I’m incredibly thankful that my grandma had her family and friends nearby throughout her nursing home stay. Today, the nursing home looks very different than when my grandma was there: nurses in full protective gear file in and out, the visitor parking lot is empty, and the residential hallways are still. While these strict quarantine measures are essential, we must prioritize the emotional hygiene of nursing home residents. Although they cannot physically celebrate the first harvest of Mr. Lin’s herb garden, or feel the soft wool gloves Mrs. Bennet has knit, it is certainly possible to video conference for a game of bridge.

Palak Patel is a medical student.

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