Isolation is a feeling we've all experienced at one point or another during the COVID-19 pandemic. But one group in particular, elderly residents in assisted living or nursing home facilities, have felt it on a different level. Restrictions on in-person visitations have been hard on those living in facilities - especially people suffering from memory loss. It hasn't been easy on caregivers or families either.
It’s days before Thanksgiving and 57-year-old Tammy Commisso wants to check in on her dad, Wayne. She’s standing outside The Blake at Baxter Village in Fort Mill, South Carolina—the assisted living center where he lives. Because of COVID-19 restrictions, she stays outside, fortunately, it’s a warm albeit windy November day. The two are separated by a tall window cracked open slightly. Wayne is inside, sitting in his wheelchair ready to talk. First Tammy has to get her gear ready.
In one hand, she holds an important piece of this communication puzzle—a small black rectangular speaker that connects to her dad’s hearing aids. He can hear her very well because of the speaker. But, it’s a challenge to hear him because of the window—so she calls the smartphone sitting on his lap—a phone that was her mother's until she passed away from COVID-19 in a different facility a few months ago.
He ignores the buzzing phone on his lap. He can hear her just fine, why would he need to answer the phone?
She abandons that plan and leans in close to the window to ask how he’s doing and if there’s anything he needs.
He says he’s doing alright, but it’s been hard. Everyone is healthy he says, but "being locked in, ain't no fun."
He misses going out to eat. He misses the longer, more frequent visits. He misses giving Tammy a big hug. A few times during their visit, he says it would probably be ok if we came inside to talk to him, each time his daughter reminds him about the restrictions.
They used to run errands together. Now, Tammy gets a list from her 86-year-old father and brings back what he needs. He reminds her numerous times he’s out of milk.
When they could visit in closer quarters, navigating the challenges of her dad’s hearing loss was much easier.
"Because of his hearing loss I feel like he doesn’t get to have good conversations with the other residents as much," she said. "Not having me with my speaker two or three times a week and of course we would be together for hours, I can tell a decline."
Over the summer Wayne fell and broke his hip. He’s doing pretty well considering everything. He still reads a lot, she says, which she’s thankful for. He asked her to buy him a dictionary a few years ago saying he wanted to “study,” because words seemed to be escaping him more easily. Although he’s never been formally diagnosed with dementia by a neurologist, she says, doctors usually note it on his records.
Whether someone has dementia or is losing memories with the natural progression of aging—the pandemic has been tough on the elderly who rely on routines.
"It’s been really difficult," says Dr. Thad Clements. "The touchstone things that they have to keep them oriented on a daily basis just completely disappeared."
Clements is the medical director of three nursing facilities, one being Southminster in Charlotte. He also has a family practice with Novant Health and is the current president of the Carolinas Society for Post-Acute and Long-Term Care Medicine.
Take away something like a daily communal meal, he says, and there goes a helpful tool anchoring someone to time, place, and something they can count on.
"It’s so disorienting to their schedule," Clements said. "That balance is so fragile."
And it’s something families are constantly worried about he says.
After this interview, Southminster alerted families that a resident in the Embrace Health Center had tested positive for COVID-19. That means all visitations to residents of the Embrace Health Center, except for compassionate care situations, are discontinued for the time being.
Restrictions put on activities that would normally occur as well as limitations on consistent in-person visits have led to severe consequences during the pandemic. Some residents have stopped eating causing weakness and in turn, more falls. Others stopped doing the small things that used to bring them joy—hobbies like a daily crossword puzzle. The isolation brought on by the pandemic has sped up what would normally be a more natural slower decline in health.
"I do think we have to recognize that some of these folks are living in a skilled nursing setting because they have to, they are vulnerable," he said. "Some of these folks will not survive this."
Clements is counting down the days till there is a vaccine that will hopefully bring back more normalcy—less social distancing and more family time.
That’s what Dr. Mark Pippenger, a behavioral neurologist with Novant Health is hoping for as well. He says studies have shown since the pandemic began the rate of deaths from Alzheimer’s Disease has gone up.
"At least one study looking at the risk gene that is commonly associated with old onset Alzheimer’s disease, that gene also appears to dramatically increase the risk of having severe COVID-19 if you do get it."
He points out COVID-19 has even had an impact on medical research, slowing down the progress in drug trials.
"Now there are precautions and people who are in facilities who are a part of research studies are not allowed to attend visits that are needed for the research," Pippenger said.
Everyone is feeling the effects of this pandemic he says, from residents in facilities, to medical professionals, to the caregivers—the ones who work in the centers and the family members like Tammy Commisso trying to check in as much as possible.
Which is what she’s going to do this Thanksgiving. She’ll have a meal with her husband and son at home and then she’ll come visit her dad in the window.
Then she pauses. It’s not hard to see even with a mask on and sunglasses she’s getting choked up. She’s thinking about the staff at The Blake at Baxter Village who will be working Thanksgiving Day, in order to spend time with people like her dad.
"People take it for granted when they are at home on the holidays that there are people working," she said through tears. "It’s just humbling. I know they’re getting paid but you know, it’s still hard for them because they're not with their family."
It’s obviously hard for Tammy as well. But she’ll be back on Thursday to see her dad. She’ll get her speaker ready for his hearing aids and try to see if he’ll pick up the phone so she can hear him. She’ll step up the window to hear about his Thanksgiving Day. And she'll ask him those two questions she always does: How is he doing? And, what does he need?
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