In March 2020, Birchwood Terrace resident David Rines caught Covid-19. Rines, who is now 80, had no symptoms.
Her roommate at the Burlington Nursing and Rehabilitation Center was another matter. The man screamed and screamed, Rines recalled. The silence only came after the man died.
The coronavirus has forced nursing homes to take unprecedented steps in those early days of the pandemic. The facilities were virtually closed – except for staff members and palliative care visits – for weeks.
Residents lucky enough to live in a first-floor room with a window might get a glimpse of the outside world and their loved ones. Others tried to stay in touch with phone calls and virtual tours.
Life inside had stopped. Knitting circles, Scrabble groups and other gatherings – all potential Covid spreaders – have had to come to a halt. Virus precautions have even discouraged touch, the most basic form of human connection.
Rines is still scarred from that era, according to his daughter, Andrea Thorpe.
“He just felt like the world had let him down,” she said. “He went through seven days of quarantine and I almost lost him, not because he was sick with the virus but because he was isolated.”
According to Rines, the battle against Covid-19 has sidelined many things that make life worth living – family, friends, talking with people, having meals together.
Care homes reopened to visitors in November, but Rines and those close to her are worried about future lockdowns. Another viral spike could once again close the door to hooking up, weekend visits and the outside world.
Birchwood officials did not respond to interview requests last week. But a lobbyist for state long-term care facilities acknowledged that staff and administrators face tough choices.
Since the doors reopened, “retirement homes have been doing everything they can to balance the needs of residents to ensure they can maintain those connections with family and friends,” said Laura Pelosi of the Vermont Health Care Association.
The Covid-19 is still circulating in nursing homes. In the first three weeks of January, 21 residents and 17 staff at Birchwood came down with Covid, according to Medicare data.
The Burlington nursing home remains open for the time being, but with a sign warning visitors that active cases of Covid-19 are inside. Masked visitors are allowed inside after a temperature check. Some activities have resumed. A few weeks ago, for example, a musician visited Birchwood, Thorpe said. A hairdresser was due to give residents haircuts but canceled due to Covid.
On a recent Sunday morning, Rines sat in the sunny room he shares with his wife, Joyce, surrounded by photos of loved ones. Her daughter, who lives in Underhill, also joined them there.
When he recalled the week spent in solitary confinement, a shadow crossed his face.
“I can understand the prison sentence now,” he said. “I didn’t quite understand it before it happened.”
In the world of nursing homes, family members are the eyes and ears of residents. They schedule medical appointments for loved ones and watch for worsening symptoms, unusual behaviors and other telltale signs of poor health. They can also file complaints with the state government or the Long Term Care Ombudsman for negligence.
That all stopped with the lockdown, said Sean Londergan, the state’s long-term care ombudsman.
Londergan has compiled some of its findings in a report covering the financial year that ended September 30 – weeks before long-term care facilities, including nursing homes, reopened.
Family members filed fewer complaints during the lockdown, in part because they weren’t there to witness residents’ daily conditions, Londergan said. Lawyers from the ombudsman’s office were excluded, so some quality of care violations likely went unreported.
It all happened during what was arguably one of the biggest public health emergencies in state history. Birchwood alone has seen 21 residents die of Covid-19 in those early days. In June 2020, outbreaks at two nursing homes – Birchwood and Burlington Health and Rehab – were responsible for more than half of Covid deaths in Vermont. By mid-January, more than 130 nursing home residents had died of Covid-19 in Vermont, according to Medicare data.
Thorpe detected small signs of neglect in his parents’ care when the lockdown ended. Her father contracted a fungal infection in his arm from a wristwatch that should have been removed before showering. His dentures had tartar which made it difficult to eat.
Thorpe said his mother gained 65 pounds during the lockdown and developed type 2 diabetes. Her upper teeth rotted from lack of dental care.
“All I wanted was to be there to take care of my parents,” Thorpe said.
“Cruel and inhumane”
Londergan’s report highlighted another key concern: Social isolation and loneliness have become commonplace in nursing homes.
Social isolation increases the risk that older people die prematurely. The distress it causes can increase stress hormones and blood pressure, accelerating mental and physical decline.
Geriatrics specialist Richard Dupee said it was unclear exactly how many people died prematurely during the Covid lockdown.
Dupee, a physician at Tufts Medical Center in Boston, said beyond the impact of Covid, the decline of people in nursing homes often follows a predictable path.
Dementia patients become restless and confused without family members, he said, eventually ending up in hospital with delirium, an infection or a broken hip. Many die there. Other residents gradually decline as depression sets in.
“When you get depressed and you have a lot of other illnesses, then those illnesses start showing up and those people get hospitalized,” he said.
Amy Saunders, an elders’ rights advocate from Westford, believes her mother, Gloria Kravetz, died of malnutrition during the lockdown.
Saunders describes her experience in “Protecting Them Till Death: The Impact of Isolation in Long-Term Care,” a collection of testimonials from family members whose loved ones have lived or died in isolation. The book was created by the Movement of Essential Caregiversa grassroots organization whose members want to change confinement procedures in long-term care facilities.
“What we did was cruel and inhumane to the people who survived and the people who died alone,” Saunders said. “Asking healthcare workers to be their surrogate family members is a lot.”
Saunders and others in the organization urged Congress to pass the Essential Caregivers Act of 2021, a federal bill this would allow up to two caregivers per resident to enter nursing homes and other long-term care facilities during public health emergencies.
The bill was introduced in the US House of Representatives last summer and is now making its way through committees.
Saunders has also worked with state Rep. Alyssa Black, D-Essex, to introduce a similar bill to this effect in Vermont. The law project, H.595, was referred to the House Committee on Human Services in January.
Saunders knows the legislation won’t bring his mother back.
Kravetz died in Birchwood last summer from geriatric stunting, a catch-all term to describe the weight loss and decline that often precedes death in older people.
Saunders believes Kravetz, who suffered from dementia, wasn’t eating enough because her daughter wasn’t around to sit with her.
Staff members eventually allowed Kravetz to sit outside with Saunders during lunch weather permitting, but that wasn’t enough to halt the decline.
Kravetz died about two weeks after turning 87.
“My mom went through one of Vermont’s worst health emergencies and didn’t contract Covid,” Saunders wrote in the book. “…She died because of the toll isolation took on her.”
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