Only the lonely
Bill Herbert, who has dementia, loved to walk the halls at his Mississauga nursing home. But for him and others, months of isolation have taken a toll, and now his days are spent in a wheelchair
In his prime, Bill Herbert was a man of motion.
Walking was his thing. He’d walk to meet his brother for an early morning coffee and chocolate-dipped doughnut at Country Style, near Dixie Road and Lakeshore Road East.
On his days off, he’d walk to a local bar to meet friends. After two beers, never more, he’d amble home to his apartment, with a “Saloon” sign made of driftwood hanging in his living room, and fall asleep.
“He was an early-to-bed, early-to-rise kind of guy,” said his daughter, Terra Herbert.
In his elder years, living with dementia, Bill kept walking, even when he moved into the “behavioural” unit at Peel Region’s Sheridan Villa, with an emotion-focused care model that gave Bill, now 79, the freedom to do his thing. He’d patrol the perimeters of the hallway, checking on women in their offices. “Is everything OK?” he’d ask. When the nurses or social workers nodded yes, his eyes would shine.
Along came COVID-19 and, in early May, just as he moved onto a different floor, Bill tested positive. He was moved to the COVID unit with 12 other infected residents. Other than one day of drowsiness, Bill never really seemed sick.
He kept walking, an unwelcome pastime in a system now focused on rigorous infection control. Staff kept leading him back to his room, patiently donning and doffing fresh personal protective equipment, only to repeat a few minutes later when he emerged again.
Eventually, the message was received. In mid-June, two weeks after the outbreak ended, with no family caregivers allowed inside to help, Bill became depressed, staff said, and refused to leave his bed.
Mary Connell, the dementia adviser for the Region of Peel, said workers at the Mississauga home tried to get Bill on his feet again, but he would roll over in bed, his back turned and refuse to speak. She believes the loss of movement, the lack of circulation, at least in part, led to the blood clot in his left leg. Now Bill is in a wheelchair, his foot swollen.
When his daughter visited last Thursday, his eyes were flat, although he seemed interested in the chocolate-dip Tim Hortons doughnut she brought as a treat.
“How did this happen?” Herbert asked staff, 20 minutes into her visit, as her father grew restless. “He never sits still.”
Connell replied: “What ended up happening, I think, in isolation, is he just got tired of being told to go back into his room and then he just stayed in bed.”
Bill grimaced. Connell leaned down to check his foot, which was swollen. “His leg hurts,” she said. “It’s quite cold compared to the other one.”
“With immobility itself, you have significant health implications ... less oxygen to your lungs, for example.”
Dr. Samir Sinha, director of geriatrics with Sinai Health System
Bill’s face was hard to read, his head down. It was time to take him inside.
“Love you, Daddy,” Herbert said. She started crying.
“Can I give you a hug? I love yyou, Daddy. You be good, OK? I’ll see you soon.”
It’s not unexpected that an older person forced to stay immobile would develop a blood clot, said Dr. Samir Sinha, director of geriatrics with Sinai Health System.
“One of the common things wwe see is increased blood clots. People on long-haul flights who aare not getting up and walking aaround are much more likely to get a blood clot,” Sinha said.
“With immobility itself, you have significant health implications,” he said. “Decreased oxygen to the brain, which makes it harder to think clearly, it can increase your risk of delirium, makes your cognition worse, less oxygen to your lungs, for example. You get less oxygen to yyour lungs and poor circula- tion.”
Forced immobility and emotional isolation are documented in the long-term “indicators” that all nursing homes collect, as part of the Resident Assessment Instrument (RAI) data collection tool.
In a recent Star story, Sheridan Villa said its long-termcare indicators from February to May, “worsened depressive mood,” unexpected weight loss, antipsychotic medication, pres- sure ulcers and falls, showed that residents were declining.
Sheridan’s managers released tthe data to show the impact of isolation on residents. Sheridan, along with other Peel homes, has focused on the individual needs of residents using an emotion-focused care pro- g gram called Meaningful Care Matters (formerly Butterfly).
In June, its most recent month of data, Sheridan Villa’s indicators for weight loss and falls show additional struggles for residents, while the data for mood, medication and pressure ulcers showed some improvement. Connell said those improvements are likely due to cchanges that allowed people to start leaving their rooms, seeing each other again and, starting June 18, getting outdoor visits with families.
Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, said residents who love to walk, such as Bill and others with dementia, are increasingly at risk as the system embraces the rigour of infection control, shutting out family caregivers who once played a significant role in the home, helping with exercise, eating and bathing.
“Why aren’t the families allowed inside?” Grinspun asked. Some homes are allowing “essential family caregivers,” but many have strict limits.
Grinspun is worried hospital protocols are starting to dominate long-term care. Of the 11 nursing homes that now have outside management (three under government orders and eight voluntarily) all are now managed by hospitals, according to the Ministry of LongTerm Care.
“The philosophy of nursing homes is, they are the home of the residents,” she said. “The philosophy of hospitals is, ‘I need to fix your infection.’ We likely have a clash here of philosophies.”
She said she has heard of a few homes where nurses have been told to sedate residents who like to walk.
“(Long-term-care) nurses are refusing to give sedatives, psychotropic drugs, to people with Alzheimer’s who wander be-a cause that is what the residents do. That is what they do! And sedatives are not the solution.”