A year of lockdown in nursing homes: ‘Staff and residents are now closer than ever’

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We speak to two staff members tasked with keeping care home residents engaged during the pandemic.

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SOME OF THE DARKEST moments of the past year involved news of nursing homes.

At times the headlines felt relentless.

St Mary’s Hospital in Dublin’s Phoenix Park recorded the deaths of 24 residents with Covid-19 during the first wave.

Dealgan House Nursing Home in Louth recorded 26.

There were significant issues with access to testing and personal protective equipment when the crisis first gripped the country in spring 2020. Once resolved, the public learned that these were not silver bullets and further tragic outbreaks are near impossible to avoid when there is widespread community transmission.

Issues persisted during the second wave. A manager at Nightingale Nursing Home in Galway made an emotional, desperate appeal for help from the HSE on RTÉ’s Liveline after all but two residents tested positive for the coronavirus, despite the best efforts of staff.

“I’m devastated,” she told the programme.

I can’t put it into words how helpless we all feel, and we felt that we were going to get help and it just hasn’t transpired. Our residents are down there and we’re trying to keep them alive […] and we really feel abandoned. That’s the truth.

This type of scenario didn’t play out in every home, but when staff were not busy shielding residents from the virus, they were busier trying to find a range of new ways to keep them engaged and occupied.

They worked to fill the gap left by the lack of frequent in-person visits from friends and family. This was a significant loss to many people, especially those eager to visit family members who may not have many years left.

Time passing

Combine this with what we know about how people have perceived the passage of time in the past year: Research suggests that if you’re older than 60, have fewer social interactions, and are not particularly busy, time during pandemic is more likely to crawl by.

There are few places where these factors are more pronounced than a nursing home in lockdown – but the sorry picture this paints isn’t necessarily a true representation of life in these facilities over the past year.

Mary Burke is director of care at Killure Bridge Nursing Home in Waterford, one home which didn’t experience an outbreak – she told The Journal the possibility that one might crop up loomed large over staff and residents.

This threat has eased since 8 February, the day when all staff and residents were fully vaccinated.

This opens up the prospect of resuming family visits or trips into the community in the future, as the situation allows. These have been absent for the past year, aside from visits on compassionate grounds.

New guidance came into effect this week allowing two visits per week to take place.

However, Burke’s description of life in the home isn’t one of solitude and long, empty hours. Staff worked to keep residents as engaged as possible:

Our activities have continued and probably ramped up, if anything, because we’re trying to fill that void. Families would have been in visiting between 2pm and 4pm, and so we have to create extra activities to keep people stimulated and occupied.

The opinion of those living in the home is often sought to determine if anything more can be done. Equally, they are not kept shied away from the reality of what’s going on (Burke said staff would often be asked in passing how the latest round of serial testing went).

One unexpected positive for both residents and staff was that close social bonds have formed within the home:

I’m after coming from the dining room, there’s three ladies in there having whiskey with ginger ale after their dinner, laughing away.
People living in the home have become friendlier with each other, and we might not have seen that in the past where residents might be rushing off because a son or daughter is visiting later, whereas now they have more time to sit down and chat.They’re relying on each other for friendship and companionship more.

“I think [the restrictions]impact more on family members outside of here than it impacts on the residents in here,” Burke added.

“Our elderly have overcome a lot in their life already.”

This doesn’t detract from the need for residents to see their loved ones and vice versa.

Burke pointed out that a year is a very long time in an older person’s life, and while there is a resilience to the hardships posed by isolation, the sooner that face-to-face family visits rather than through a window or over a video call can resume safely, the better.

The same sentiment on resilience was echoed by Teresa O’Donovan, the activities coordinator at Cramer’s Court Retirement and Nursing Home in Co Cork.

“We have a man who celebrated his 101st birthday recently, born in 1920, and he’s a tough cookie,” she said.

He has seen tough things happen in the world. Many residents have seen really harsh things, and their mental attitude is so positive. You might have a teenager who is thinking about all the opportunities they are missing, but our residents don’t think like that.
That doesn’t mean they’re expecting less for themselves, but they have a sense of realism. A positive inner strength, it’s quite amazing.

“I think people have an awful impression of what’s going on in nursing homes at the minute, ‘Oh, it’s very sad, they’re in an awful state, they must be mentally under such stress’. That’s actually so far from the truth.”

O’Donovan also noticed residents becoming closer to one another, openly showing affection and looking out for each other more in ways that might not have happened before the pandemic. One simple example was of a resident noticing that another was down and suggesting they would drop a newspaper over to them.

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A lot of O’Donovan’s work harks back to the core fundamentals that research on how we perceive time passing during the pandemic suggests, such as the importance of maintaining social bonds even if they’re not with the wider community.

 ”I suppose there’s a difference between isolation and social connections. You can be in isolation, to a degree, but have a very good social connection with those around you,” she said.

Activities are still all-important. O’Donovan said staff have been inventive in creating a whole new set of ways to keep residents engaged – be it a drama club or more outdoor activities – and that this is key to staving off the worst impacts of boredom in lockdown.

This is again in line with the research on how to make sure time doesn’t drag: stay active, keep occupied, in whatever way you can.

Dementia

This all changes dramatically for residents with dementia. Time is already passing at a very different rate for them.

In some cases, the past year may have seen their condition deteriorate irreversibly. For nursing homes spared by outbreaks, this lost time is certainly one of the pandemic’s greatest impacts.

There isn’t a one-size-fits-all approach to guiding a person with dementia through the pandemic.  Many might be aware of Covid, but not the finer details. In other cases, the best approach may be to shield them completely from it.

Staff worked constantly to make sure they do not regress and that their memories of their loved ones and life outside the care home are kept alive, O’Donovan explained:

Video footage has become a huge part of our daily life. We’re contacting families and asking them to send in footage of what’s going on at home. For example, say for people from the farming community, getting their families to send me videos that I can show them, like milking parlour or the cows calving, whatever it might be.
[This is so] we can keep them as connected as possible to the community.

This is equally why O’Donovan is thankful there hasn’t been an outbreak. “We’d be having a very different conversation,” she said.

The massive disruption could have a range of impacts: In a serious outbreak, residents would have to be moved rooms or to a completely different section of the facility. Staff would be overstretched, new and unfamiliar staff brought in, or even potentially the Defences Forces – all potentially distressing factors for someone with dementia.

“I was out for a couple of days recently, and staff working that day had to get in touch and ask me to call two particular residents who were wondering where I was and to reassure them I’d be back,” O’Donovan said, highlighting how much a simple change from the norm can prove distressing to people living with dementia.

Now the focus for all people living in care homes is beginning that slow transition back to normality.

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