As restrictions lift, what about nursing homes?
Facilities search for ways to keep residents engaged as they remain isolated
Bonnie Smith ate shrimp and pasta — a favorite meal — and talked on the phone with one of her kids the night before she died. These were some of the last few pleasures her long-term care facility allowed.
For weeks, Smith — like thousands across the country — was largely stuck in her room at a facility in Florida, unable to go to Bible study groups or eat lunch with friends.
And though her daughter in Houston fully expected Smith to reach her 100th birthday in July, she had begun to worry. The isolation wore on her mom. Her voice weakened. Her breathing worsened. Her body grew more frail.
“She became increasingly depressed because she wasn’t in contact with other people,” said her daughter Marsha Hunt
er Smith, who visited every other month before the pandemic. “She just kind of lost her spark.”
More than two months have passed since federal and state officials ordered nursing homes to stop allowing visitors, group activities and communal dining. The decision seemed necessary to protect a vulnerable population.
Indeed, even with the restrictions, COVID-19 killed nursing home residents at an outsize rate. Around 700 people in nursing homes have died in Texas related to the novel coronavirus. More than 25,000 have died nationwide.
And while the federal government last month issued recommendations for how nursing homes could begin relaxing their rules, facilities in Texas remain under lockdown — which relatives and advocates say can be hard to bear. It’s left facilities searching for ways to keep residents engaged.
Anxiety and depression increase with loneliness, said Carmel Dyer, a geriatrician with UT Physicians Center for Healthy Aging. A lack of mental stimulation can impact memory and thinking.
But loneliness and isolation are different: For 86-year-old Lillian McNeill, the isolation hasn’t been too hard. She enjoys watching the news while she eats in her nursing home in La Marque.
On Wednesday, she won several rounds of socially distanced bingo in the hallway. She knows how to entertain herself, she said.
For Smith, it was different. Before the coronavirus began to spread, she got her hair done weekly and put on full makeup every morning.
Under the restrictions, this woman who enjoyed company couldn’t have visitors. This woman who appreciated an elegant table ate meals delivered on disposable plates. This woman who once had so much to look forward to was dying.
On the day she passed, her daughter told her by phone that she loved her.
“She did not have anything to live for,” Hunter Smith said. “Her kids couldn’t come see her. She couldn’t go do the activities she loved. She couldn’t be out with the people she enjoyed being with. There was nothing to keep her going.”
Jimmy Jones worried, too, about his mother, Leona, whom he used to visit regularly at the same nursing home where McNeill lives, Bayou Pines Care Center. Jones struggled to help his mom stay positive, especially after she contracted COVID-19.
She grew anxious, convinced the virus would kill her. “You need to get me out of here,” she told her son when she managed to answer her phone and get it to her ear. “I’m going crazy.”
It was hard to think of what to do. When she turned 98 in May, Jones tried to make a big deal of it. He hung a bird feeder outside her window. People sent 100 birthday cards.
Erika Parrish, the nursing home administrator, promised Jones a parade down the hall when she got better.
Parrish is seeing more depression among residents, and she is doing what she can to address it. They serve more ice cream to provide more calories. A person on contract helps them with mental health issues.
Most of all, they try to focus on the positive.
“We try to encourage the residents: Listen. You’re going to get past this,” Parrish said.
Still, there were limits to interactions nursing homes could facilitate. Margaret Chapman had a difficult time discerning how her 92-year-old mom was really doing in the Louisiana facility where she used to visit every other week.
She felt her mom couldn’t relax talking on an iPad in front of her roommate. She wondered: Was her mom as happy as she sounded?
Gov. Greg Abbott so far has issued no guidance. Instead, he announced $3.6 million in federal funding to help nursing homes buy tablets, webcams and headphones.
Abbott also mandated all nursing home residents and staff be tested for the coronavirus. That process as of mid-day Thursday was nearly complete, with testing finished in 1,146 of 1,223 facilities.
Working now to figure out what life will be like in nursing homes feels critical to Claudia Aguirre, president of BakerRipley and part of a Harris County Precinct 2 task force for nursing home issues.
She aims to be proactive, rather than reactive, and they have been brainstorming how to help going forward. “The aftermath is just as critical as what is happening right now,” Aguirre said.
Others meanwhile could help mitigate the sense of loneliness, suggested Anita Woods, a retired Baylor College of Medicine professor in geriatrics and palliative care. Could the neighborhood host a parade? Could kids out of school write cards?
Whatever it was, Woods felt society needed to rally around these residents who had long been under the radar — if not neglected.
Dyer suggested the opinion of those enduring this shouldn’t be discounted. With added testing, was there a way to protect everyone while also respecting their autonomy?
“The truth of the matter is we should ask people,” Dyer said. “Say: ‘Would you rather stay here and be isolated? Are you OK with that? Or would you rather take the risk and get out and see your children and see your grandchildren?’ ”