Ideas to help people in nursing homes dealing with isolation on top of the pandemic

Eufemia Didonato

Older Americans were already in an epidemic before the pandemic began. In 2018, the AARP released a report about the mental and physical effects of social isolation on older Americans, particularly those living in skilled nursing facilities. “A lot of people, as they get older, their social circles decrease quite […]

Older Americans were already in an epidemic before the pandemic began.

In 2018, the AARP released a report about the mental and physical effects of social isolation on older Americans, particularly those living in skilled nursing facilities.

“A lot of people, as they get older, their social circles decrease quite a bit. Family moves away from many of them, and family and friends begin to die,” said Lori Smetanka, the executive director of the nonprofit advocacy organization National Consumer Voice for Quality Long-Term Care.

Some residents may have moved to skilled nursing facilities, assisted living residences or senior living communities in part to make new friends and spend more time around other people, sharing meals and organized activities. Now they find themselves more isolated than ever. As the coronavirus pandemic rages on, they’re dealing with chronic loneliness on top of the fear of a deadly disease that primarily kills people like them.

“There’s the isolation and then also the dual terror of how this disease has just torn through nursing homes,” Manuel Eskildsen, a clinical associate professor at the David Geffen UCLA School of Medicine who treats older patients. “I think everybody’s scared right now. But it’s even scarier to know you’re in the absolute most vulnerable group and you can’t get away from it.”

The effects of loneliness are mental and physical. And they can spiral: Feeling lonely and isolated might make you move around less and not eat as frequently or as much as you should, Eskildsen said, which leads to decreased quality of life and physical health, which can make you depressed, which leads to moving around and eating less.

Part of the problem is the ways many of us have adjusted to the new normal might not be available to older people. Figuring out video calls can be tricky, and they’re difficult to participate in if eyesight or hearing isn’t great. Many facilities have enacted strict rules about visitors, so even if someone’s offering a masked outdoor visit, they might not be allowed to do it. Even the brief socialization of a grocery store trip or walk in the park is not possible for people with limited mobility or who don’t drive anymore, or whose facilities won’t allow them to leave and come back. Inside the facilities, group meals and activities are canceled, and staff interaction is limited to food and medication delivered in full PPE.

Effectively, older adults in skilled nursing and assisted living facilities have been trapped in solitary confinement in their rooms as coronavirus has swept through the places they live. Smetanka called it a “triple whammy” of trauma: the fear of getting sick and dying, the isolation from protecting yourself from getting sick and dying and the high likelihood that your friends, relatives and the people who live and work in your facility are getting sick and dying around you.

“When you think of the number of people who have died in long-term care facilities, residents are losing whole support systems in there; the residents, the one they would sit in the dining hall with or see in activities, a lot of those people have died. And so it really has been very traumatic, the sense of loss, the sense of grief that they’re experiencing along with the loneliness and isolation,” Smetanka said. And the impact is grim: “There are, even beyond COVID, a lot of excess deaths [in nursing homes] that would not have occurred” if the pandemic hadn’t happened.

Even outside skilled nursing facilities, it’s a scary time for older people, said Kimberly Lewis. She’s the executive director of the I Did Something Good Today Foundation, a nonprofit that creates programs to help older people combat social isolation and other problems. The foundation runs the chat and crisis line GoldenTALK, where seniors anywhere in America can call and ask for help or just find a friendly person for a conversation. GoldenTALK is available from 11 a.m. to 11 p.m. Pacific time at (888) 604-6533.

She said something a lot of volunteers have been hearing from callers is that they’re afraid to go out and do the basic, normal things they didn’t think twice about doing a year ago.

“You’ve got people who are used to going out and getting things on their own, having their freedom and independence. Now they can’t,” Lewis said.

For older people and for everyone else, help is on the way. The vaccine rollout is now taking place, albeit haltingly: L.A. County has authorized vaccinations for people 65 and older. But it will likely be at least a couple of more months before that group is all vaccinated, and longer before their family members are able to get the vaccine and safely visit.

In the meantime, here’s what you can do to help ease the effects of loneliness and isolation if you’re an older person or someone who loves one.

Advice and ideas for older people dealing with loneliness

Don’t be afraid to ask for help. “Nobody wants to be a burden,” Eskildsen said. But you have to be willing to overcome that reluctance to reach out and ask for help if you need it, whether it’s telling family you’d like to hear from them more often or telling the staff at your facility that you need help or reaching out to your longterm ombudsman to get access to services like counseling.

Make a call. The Los Angeles County Department of Mental Health has a program for adults 60 and older called GENESIS (Geriatric Evaluation Networks Encompassing Services Intervention Support Programs). The program can connect you with individual and family counseling, medication services and education and support. Phone number: (213) 351-7284.

L.A. County also runs a warmline you can call to talk to someone about whatever’s on your mind. Phone numbers: (855) 952-9276 for English, (888) 448-4055 for Spanish. Available 5 p.m. to 10 p.m. Pacific time Monday through Friday and 11 a.m. to 4 p.m. Saturday and Sunday.

GoldenTALK, the program run by Lewis’ foundation, is available to help find resources and programs or just to talk with someone. Phone number: (888) 604-6533, available from 11 a.m. to 11 p.m. Pacific time.

If you’re experiencing a serious mental health crisis, the Suicide Prevention Lifeline is available 24 hours a day at (800) 273-8255.

Try to recreate your favorite pre-pandemic activities. Were you a regular churchgoer? Find out if your church is offering services online. If you enjoy listening to music, try an internet radio station or a service like Spotify.

How family and friends can help

Reach out. It really can be as simple as a phone call, Lewis said. “That voice means everything to them. … They want to know that they’re not forgotten and that they’re still loved.”

If they can’t speak on the phone, send emails or arrange video chats (keep reading for more on how to make that easier). Smetanka said she knew of one person whose father was in a longterm care facility who sent the staff a short 15- or 30-second greeting to play for him every day. Send cards, letters and drawings so they know you’re thinking of them.

Set them up with something fun to do. Puzzles, large-print books, music, knitting, crafts — “send them those things and then talk to them about those things,” Smetanka said. Whatever their favorite social activities were before the pandemic, help them find ways to do them virtually. That can mean sending a link to virtual religious services, setting them up with music streaming or introducing them to online bridge or other games and activities.

Lewis said she was working on a pilot program to get more Amazon Alexa-enabled devices to older people to make it easier to make phone calls, create grocery lists, play music and do other things for people who aren’t computer-savvy. Tools like an Amazon Echo Show or Facebook Portal will enable them to make a video call just using their voice.

Provide a tablet preloaded with video chatting apps. A lot of care facilities launched pilot programs last spring to get residents connected with Zoom and similar programs, Eskildsen said, but the problem is that staff is stretched so thin that it’s tough to carve out time to walk someone through a tutorial on video chatting. Make it as easy as possible for everyone by sending a tablet with the apps installed and an account logged in so all the recipient has to do is click a button to connect.

Talk to the staff. Yes, resources may be stretched thin in skilled nursing facilities right now. But if your loved one is having a hard time with their mental health, make sure the staff is aware, Eskildsen said.

“The squeaky wheel does get the grease,” he said. “If they have that person who’s constantly on their case to provide the opportunities for human interaction and decreasing loneliness … they’ll probably be more attentive to that person.”

Work on ways to visit. Stay in touch with the facility to learn about anychanges to visitation policy and to ask about ideas for connecting. Could you do an outdoor masked distanced visit? Can you arrange to have them by a big window where you can stand outside and wave? An abbreviated visit is better than no visit.

Volunteer. Get involved and help people in your community stay connected. GoldenTALK is looking for volunteers, Lewis said, and it can all be done virtually. You can learn more about that and more in our database of volunteer opportunities in and around Southern California. There is plenty that can be done without leaving the house.

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