We all need to feel connected to the outside world. For people living in nursing homes, staying in touch has always been more of a challenge, particularly with family members at a distance. And for many months now, the fluctuating COVID-19 pandemic has made essential connections that much more difficult, even when loved ones live nearby.
The good news is that with vaccination and better control over COVID-19, visiting restrictions in long-term care facilities are easing. And a pandemic silver lining is the workarounds it inspired to link residents to family members, friends and fellow residents, even during the worst isolation periods.
From virtual technology to in-person visits, from creative activities to traditional letters, cards and phone calls, it’s almost always possible to somehow connect. Here’s what you can do:
Creative Connections
Technology, delivery and comfort options that helped make the pandemic more endurable and activities more doable in the outside world, can do the same for nursing home residents:
— Tablets. These devices offer countless ways to keep residents entertained, engaged and connected. Family Zoom meetings, favorite YouTube videos, subscriptions for music and movie streaming are among possibilities.
— Email. Residents who don’t care for texting may still enjoy connecting online through email. That allows them to read and respond to messages at their leisure.
— Delivered edibles. With DoorDash or other meal delivery services, residents can enjoy local takeout food. Or you can give the gift of sending favorite gourmet treats from across the country, providing “edible moments of joy,” says Dr. Scott Schabel, senior medical director for long-term care at Rochester Regional Health in New York.
— Virtual field trips. Poring over museum exhibits or experiencing breathtaking views at national parks nourishes the intellect and spirit while linking people to the larger world. “We have done a lot of what we call virtual field trips,” says Kari Staron, director of social services and activities with Altercare Integrated Health Services in North Canton, Ohio. “We’re always trying to look at different layers of engagement and making sure people stay connected to things they previously liked in the community.”
— Animal friends. Pets like gentle dogs and cats can bring cheer to nursing homes and make a resident’s day. Other animals have made pandemic appearances too, when isolated residents couldn’t come out to see them.
[SEE: 24 Gift Ideas for Nursing Home Residents.]
Windows of Opportunity
In nursing homes, first-floor windows aren’t just for looking outdoors anymore. During the pandemic, particularly before vaccines became available, window visits have been a way for family members to interact in-person while safely social distancing and preventing COVID-19 and other germs from entering the facility.
“We still use them in the event that there’s a resident who’s in an isolation situation,” Staron says, “or when we’ve temporarily had to suspend in-person visitation.”
Window visits also offered access to community members who wanted to donate time to see shut-in residents. “We’ve had police department (members) stop by and visit room to room with the windows,” Staron says. “There were times when people would bring their pets by to see all the residents and we would do visits with them.”
Transformative Technology
COVID-19 spurred seismic shifts in virtual technology use in settings from workplaces to nursing homes. In some ways, the pandemic awoke people to possibilities that had previously been overlooked or underused — including videoconferencing platforms like Zoom.
“Our society has gotten very mobile,” Schabel says. “The chances that kids and the grandkids are living in the same city, town or village that grandma or grandpa live in is increasingly small. But, when we were forced to shut down all the visitation because of the pandemic, and we created things like opportunities for videoconferencing, all of a sudden, relatives — from literally all over the world — were now able to have these videoconference visits and connect in ways that they’d never done before.”
Here are a few activities that have become more accessible:
— Spiritual services. During the worst of the pandemic, it became more difficult for nursing home residents to take part in spiritual activities. Visitor restrictions often prevented clergymen or clergywomen from entering hospitals or long-term care facilities. During that time, virtual church and other religious services helped meet residents’ spiritual needs.
— Celebratory events. Family celebrations needn’t exclude frailer nursing home residents. “I’ve had patients attend weddings, graduations and even a couple funerals using the livestreaming, videoconferencing things that are out there,” Schabel says. “Just to be part of a meaningful family event like that without all the potential trouble (in-person attendance) can cause was really touching.” Nursing home residents with higher risks of falls can participate from the safety of their own room.
— Family milestones. You can also share day-to-day family milestones with eager grandparents. “If the person in the facility is capable of using a cellphone or tablet, these are incredibly multifunctional devices,” Schabel says. For instance, “We share our videos on Facebook and Instagram of little Johnny’s piano recital,” he says. “Have mom enjoy — or endure — that piano recital just the same way we did.”
— Interactive gaming. Interactive gaming can combine classic games with newer technology. Chess, checkers, card games, board games like Scrabble, Monopoly and many others connect nursing home residents and loved ones as they compete online. “You can play the game, talk with each other and sometimes see each other — and do that without needing to be physically present,” Schnabel points out.
— Video streaming. Streaming services enable multigenerational connections on a different level. For instance, Netflix has a watch-together mode where you and your loved one at a distance can enjoy a movie or favorite show together, simultaneously.
[READ: Antipsychotic Use in Nursing Homes.]
Isolation Harm
COVID-19 breakouts hit nursing home residents and staff members hard, with widespread contagion, severe illness and deaths. In keeping with Centers for Disease Control and Prevention guidelines, facilities imposed strict visiting restrictions and social distancing measures that largely kept residents isolated in their rooms to reduce virus exposure. But these necessary precautions created emotional stress for residents, leaving them lonely and making their worlds even smaller.
A national survey of nursing home residents speaks for itself. Conducted during the summer of 2020, the online survey yielded responses from 365 nursing home residents in 36 states. Released by Altarum, a nonprofit health care research and consulting organization headquartered in Ann Arbor, Michigan, the survey included multiple-choice questions and an open comment section. Among the findings:
— 76% of residents felt lonelier than usual.
— Nearly 65% did not leave their rooms to socialize.
— In a given week, 93% of residents did not leave the nursing home to visit family or for other activities.
— Only 28% went outdoors to enjoy fresh air at least once a week.
— A majority, 54% of respondents, said they weren’t participating in any in-home, organized activities.
In a resident’s words from the survey:
“I want visitors to be able to come inside and see me. I don’t want to be restricted to my room all day and night….I want to be able to walk outside of my room and see my friends and family that I would usually see daily. I want to regain my strength, better quality of life and independence … I want to have my rights restored. I want to have the freedom to come and go like everyone else.”
Through the survey, “We (found that) residents spending a massive amount of time in their rooms, often with the door closed, to try to keep them safe really produced a different kind of harm,” says Anne Montgomery, director of the Center for Eldercare Improvement at Altarum. “A silent epidemic of despondency (was) leading to a collapse of mental well-being, and also in many cases, collapse of physical well-being.”
With careful planning, Montgomery says, this kind of harm can in many ways be avoided. For instance, she says, “Some homes have put money into renovating their outdoor space to be indoor-outdoor, where that is safer for people to interact with loved ones.”
For instance, a Michigan nursing home surveyed its residents about activities they’d like to do during COVID-19 as part of an Altarum-led project involving several facilities. Animal activities were frequently mentioned by residents, whose facility happened to have a courtyard with windows looking onto it.
“At the residents’ suggestion, they brought in a pony from a local farm,” Montgomery says. “The pony knows how to do tricks, and caper around and have a good time, and the residents just thought that was absolutely splendid.”
Those residents continue to have a stronger voice in planning. “Now, the residents are part of the activity-setting agenda, and the budget has gone up in that home,” Montgomery notes. “That is the kind of thing that makes a big difference in people’s lives.”
Traditional, Tried and True
In-person visits, handwritten notes and thoughtful care packages will always be appreciated:
— In-person visits. If currently allowed, in-person visits allow the warmest connections, complete with hugging, that virtual technologies can’t provide (yet).
— Phone calls. It doesn’t always need to be FaceTime. Just picking up the phone for a conversation with a resident can cheer them up with the sound of your voice.
— Snail mail. “Many of our residents really enjoy letters, cards and gifts,” Staron says. “A lot of families have provided care packages throughout the pandemic. They’re always well-received.”
— Flowers. If the resident you’re visiting is a flower or plant person, bringing a bit of nature to them is a great way to lift their spirits.
With any mutual activities you have in mind, reaching out and being proactive will make them more likely to happen. Oftentimes, residents may not know what’s available or be hesitant to ask, not wanting to impose on their loved ones’ time.
“No matter what you do, whether it’s any modern technology or the 100-year-old telephone system, it really is important for the family, the folks who are living their lives in the community, to make a real effort to initiate, initiate, initiate,” Schabel says.
Inside long-term care facilities, staff members have been stepping up to forge and maintain within-home friendships. That could mean residents sharing recipes and cooking together, or putting a different spin on bingo. “We might have been doing a hallway bingo instead of having it in the dining room,” Staron says. “That way, we could maintain social distancing. Keeping those social relationships going is paramount.”
[READ: Understanding the Different Senior Care Options.]
Changing for the Better
There’s no doubt that the pandemic has wrought havoc on long-term care facilities and made many residents feel isolated. But it could represent a turning point.
“This is a very pivotal moment for the nursing home sector,” Montgomery says. “It has the opportunity coming out of COVID-19 — which is happening gradually — to kind of reinvent itself and potentially become better, higher quality. I hope that happens.”
Nursing home connectedness can continue to improve, including using technology workarounds. “Like everything else with COVID, we actually learned some things during the pandemic when visitation wasn’t really possible,” Schabel says. “Just because things are opening up and vaccinations have paved the way to resuming some of our previous (routines), doesn’t mean we should forget some of the really good things we did learn through the COVID pandemic.”
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How to Stay Connected to Your Loved One in a Nursing Home originally appeared on usnews.com
Update 05/03/23: This piece was previously published at an earlier date and has been updated with new information.
