Caring for patients with dementia amid COVID-19 is a challenge for elder care facilities

By TEDDY ROSENBLUTH Concord Monitor

Ray Blanchard lived at the Edgewood Centre for almost 11 years before the COVID-19 pandemic hit.

He enjoyed summer afternoons sitting on the facility’s large sun porch that overlooked a pond. His wife of 52 years, Maryann often read to him when she visited — over the span of several weeks they worked through a biography of Ulysses S. Grant.

He suffered some cognitive impairments from dementia but his memory was mostly intact.

The Edgewood Centre, situated north of the major COVID-19 hotspots in Portsmouth, had been spared the clusters of coronavirus cases that had ravaged nursing homes across New Hampshire. Many aspects of life for residents stayed the same; they could still sit on the porch if they socially distanced and visit loved ones outside.

Once a staff member’s COVID-19 test came back positive, Edgewood faced the same difficult challenge as other facilities: quickly turning life upside down for its residents, many of whom couldn’t understand the complexities of the pandemic or even why the staff needed to wear masks.

As recommended by the state, Edgewood went into lockdown. Residents were sent to their rooms, where they would spend all of their time, including mealtime, for two weeks.

Ray’s world was suddenly limited to a couple of hundred square feet.

Maryann and their four children did their best to maintain some sense of normalcy during the isolation. They sent him letters and postcards, which staff read to him when they had a free moment.

Maryann mailed him magazines with lots of pictures like the New Hampshire Wildlife Journal and the Dartmouth Alumni Magazine. Ray’s poor eyesight made it difficult to read the small print but he could still make out bold headlines and photos with the large magnifying glass his children bought him.

Despite their efforts, the pandemic was hard on Ray.

Unlike other residents with dementia at his facility, Ray had a grasp of the pandemic’s effect on the world. He understood why he needed to wear a mask and socially distance. That didn’t make the isolation easier, though.

“I’m going to tell them we’re done with this stuff,” Ray told Maryann on the phone a couple of times during the two weeks in isolation.

Before the lockdown, when outside visits with Maryann were allowed, he often tried reaching across the table to hold her hand. When a caregiver gently reminded him touching wasn’t allowed, he became frustrated.

They also tried window visits, during which they stood on either side of a large glass door and spoke over the phone, but the barrier between them proved too frustrating as well.

“It isn’t easy for them to be docile kittens sitting in their rooms,” she said.

Craig Labore, an administrator at Grafton County Nursing Home, said isolating residents with dementia has been hard on home caregivers, too.

Staff, who were already stretched thin before the pandemic, have taken on a new host of responsibilities. When a resident wanders out of his or her room, staff members have to quickly suit up in full PPE gear to shepherd them back into the room.

Where other nursing homes have given up explaining a reality the residents will quickly forget, Grafton County Nursing Home has adopted a policy of relentless explaining. Staff will describe the pandemic as many times as residents ask about it, which is often multiple times a day.

“We’re trying to get the resident to understand why the door is closed and why need to take these precautions,” he said.

Labore said, for the time being, the home cannot accept as many new residents as before the pandemic. Isolating those with cognitive impairments, which is about 80% of their residents, is just too resource-intensive.

As cold and flu season approaches, a runny nose could put a nurse out of work for days while awaiting the results from a COVID-19 test, quickly throwing the isolation unit into a state of disarray.

“It only takes two or three call-outs to throw staffing into a bad spot,” he said.

He has heard of other nursing homes that have stopped accepting new admissions altogether.

Labore feels for the residents in isolation. Transitioning to life at a nursing home is hard without masks and days spent alone in a room.

“If you put yourself in the shoes of someone with cognitive impairment, seeing someone come in dressed in full (personal protective equipment) is a totally different experience,” he said.

For the most part, Patricia Cummings, an administrator at the Edgewood Centre, has been surprised by how well residents with dementia have adjusted to the new realities of COVID-19.

When walking through the dementia unit a couple of days ago, she worried what the residents would make of someone walking through in a blue plastic isolation gown.

“I love what you’re wearing!” one of the residents said.

When Cummings asks residents to wear a mask because of “the virus,” most of the residents happily comply. She suspects these precautions aren’t wholly unfamiliar to her residents who likely lived through infectious disease outbreaks like Polio.

Maryann Blanchard said she is making the most of the situation, but there are some things she misses about visiting her husband.

She misses walking him down to his room after lunch, tucking him into bed, and turning on classical music for his afternoon nap. She misses bringing him homemade food they could eat together in the facility’s dining room.

“We want to hold each others’ hands, give each other hugs,” she said. “We are the ones that keep our people stimulated to who they are. We help them with their memories.”

•••

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.

Add the C&V webinar to your Dementia Training:

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: