I have witnessed first hand the devastating effects of the lockdown and isolation of our long term care residents. Some facilities have required them to eat all meals alone in their rooms for the past six months. Weight loss and depression have been unprecedented. Eating is a social activity, after all. Services they previously had access to like podiatry, physical therapy, occupational therapy, speech therapy, and others were stopped. We have seen an increase in falls, weakness, bedsores, aspiration pneumonia, and many other complications including death. I was asked to do telehealth (which was basically face time) each month. This means the residents did not have a physical examination for up to 6 months in some instances.
The impact on the LTC staff has been extreme. Overnight they lost access to support from families, volunteers, entertainment for the residents (musicians, children, dog therapy…), the professionals listed above, and many others. The nursing staff was asked to provide all of these needs for the residents while their paperwork requirements increased. Compassion fatigue and burnout are at an all-time high. The best way for residents to receive socialization in some cases is to make a medical complaint like pain. Otherwise, they may be confined to their room. As you can imagine, resident concerns have increased due to this as well as the stress they are under. In addition, the risk of dementia is 50% higher for those in isolation. This further increases the workload of the staff.
The mortality risk of social isolation has been compared to smoking 15 cigarettes a day. Please refer to this article regarding the evidence around this issue: https://www.cdc.gov/aging/publications/features/lonely-older-adults.html. All-cause mortality is absolutely increased when we isolate residents. The complaint I hear from residents the most, besides the inability to see their family, is the lack of hair and foot care. This is a dignity issue. It is hard on our residents’ self-esteem to be denied access to these services. I literally have clients who I am allowed to see in person ask me to cut their hair.
CMS has come to recognize the unintended harm our lockdowns have caused. Last week they made the following recommendations:
- Outdoor visits
- Indoor visits if no new cases in the past 14 days with certain guidelines
- clarify compassionate care situations – visits typically only allowed if someone is hours from death. CMS states there are many other reasons to allow visits like when a resident is experiencing emotional distress, needs help with eating, is grieving, recent admit with adjustment problems…
I hope the facilities choose to implement these suggestions. Yesterday someone informed me he was going to stop going to dialysis because he was so tired of being isolated and alone. He is choosing death over loneliness. This is only one case. I could give you countless more. We need to protect our older adults from COVID 19 and the unintended consequences of isolation. There must be a balance.
