As of September 16, the novel coronavirus has infected more than 470 thousand people at 19 thousand long term care facilities across the United States. At least 77 thousand residents and workers have died from the virus, accounting for approximately forty percent of all COVID-19 deaths in the country .
Sadly, there is another side effect of the COVID-19 pandemic that is also killing residents: isolation.
There is not much data on the mental health effects of the lockdown for long term care residents in America. Experts, residents, and family members, however, are now saying the COVID-19 lockdown is creating a mental health crisis among residents. That crisis is costing even more people their lives.
Nursing Home Lockdowns
When the coronavirus hit in mid-March, the Centers for Medicare and Medicaid Services (CMS) issued guidance urging long term care facilities to ban all visitors and non-essential personnel. All communal activities, including eating in the dining room, were also cancelled.
This left residence alone in their rooms, with nothing to do, and no one to talk to. They could even visit with each other, let alone their families.
All of this was done to avoid spreading the virus among the nation’s most vulnerable population. Despite these efforts, dozens of outbreaks happened in facilities across the country .
Stories From the Inside
Sadly, the effort to protect the lives of older adults during the pandemic has potentially made the health of many residents even worse. Lorri Evans says that this is the case with her mother, 99-year-old Helen.
Helen used to go outside with her walker and the distance of about four blocks, twice per day. Just one year prior, the elderly woman was dancing at her granddaughter’s wedding. Being confined to her room during lockdown, she was unable to go for her daily walks. Her mobility began to deteriorate, as did her mind.
Today, Lorri has brought her mother home to live with her. She believes that these will be the final months of her mother’s life.
“I’m sure she would have declined somewhat, but I know in my heart the isolation accelerated it,” Evans says. “She would have made it to well over 100 but that’s not going to happen now. … She’s collateral damage of this COVID-19 seclusion, passing away because of a broken heart.” 
Robyn Grant is the director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care. She says that they’re hearing from a number of families and longer term care ombudsmen that many residents are losing the will to live.
It’s Showing Up On Death Certificates
In Minnesota, “social isolation” is now written as a cause or contributing factor on death certificates. Some states are using the term “failure to thrive”. It all means the same thing: residents in long term care are feeling lonely, and their health is deteriorating because of it.
Deirdre Anderson’s father, 85-year-old Richard, has Dementia. He lives in a long term care facility in Austin, Texas. Anderson says that before lockdown, her father was always very chipper. He was social and had a lot of friends in the home. Now, he feels like he lives in prison.
Tami Crady in Sonoma County, California, is having the same experience with her father. She has received several calls from him over the last six months, desperately asking her to “get him out of this prison”.
“As much as COVID could kill him, lockdown could, too. … I just hope he makes it through,” Crady said .
Judith Gimbel says that her 95-year-old mother Ida used to participate in every activity the facility offered. Now, she can’t even go down and eat meals in the dining hall. Without daily stimulation, Judith is watching her mother’s mental faculties disintegrate.
“She sometimes doesn’t recognize me, and that was never the case before,” she said. “Her brain has turned to mush.” 
How Isolation is Affecting Mental and Physical Health
According to the CDC, at least half of the residents in long term care centers suffer from some kind of dementia diagnosis . For this reason, Heather Smith, lead psychologist at the Milwaukee Veterans Affairs Medical Center, says that what they’re seeing is not a surprise.
Before the pandemic began , social isolation and loneliness were already significant health concerns among older adults. These two factors significantly raise a person’s risk for dying from all causes. They also are associated with a higher rate of depression, anxiety, and thoughts of suicide .
There are also physical symptoms resulting from isolation and loneliness. They include a 32 percent increase in the risk of stroke and a fourfold increase in the risk of death among heart failure patients .
Smith says they’re seeing withdrawal from care among many residents. Many are refusing to eat, take their medications, or engage in self-care practices like showers or exercise. Those behaviours can lead to weakness, weight loss, and an increased pain perception.
Those issues can each cause even further problems. For example, a weaker person is more likely to experience a fall, which can then cause other life-threatening problems .
Long Term Care Facilities are On Their Own
Carla Perissinotto, M.D., associate chief of geriatrics clinical programs at the University of California San Francisco, says she doesn’t envy these facilities right now. They’re trying to protect their residents from the virus, but in doing so they’re worsening mental health.
“It’s a double-edged sword where very, very angry families say, ‘How dare you risk bringing COVID-19 into the facility,’ while others say, ‘How dare you not let me see my parents for four months’ “ she explained .
Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, says that many of these homes are on their own. The guidelines they are given are often convoluted and difficult to follow, and limited resources and funding prevent facilities from meeting criteria.
In an effort to combat loneliness, some homes have hosted outdoor or window visits with residents and their family members. Others are taking advantage of technology, using FaceTime or Zoom for virtual visits.
These solutions have been very beneficial for some, but less-so for others. Judith Gimbel has found that outdoor, socially-distanced visits have actually contributed to the frustration felt by her mother, Ida.
“She’s 6 feet away from the table; she can’t hear me,” Gimbel says. “I can’t pass her my phone to show her pictures of her great-grandson. I can’t share the food I bring with her. I think it’s worse than no visits at all.” 
Gibson says that lack of touch is another factor that is making problems worse for residents.
“We know that tactile sensation is one of the senses that remains intact, even throughout more severe levels of dementia,” she says, “so taking that away can be harmful.” 
Talk About Mental Health
Gibson says that at the moment, the most important thing friends and family members can do for residents is to talk about mental health. We need to validate how difficult this is and normalize feelings of anxiety, loneliness, and hopelessness for the resident.
“Talking about this is incredibly healing because it acknowledges you are not alone in this experience.” 
So if you have a friend or family member in a long term care facility, make sure you reach out to them in whatever way you can. Talk to them, ask them how they’re doing, and tell them that you’re here for them. It could be the difference between life and death.
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