Apr 3, 2020
Photograph: Dominic Lipinski/PA
‘We need to make sure that residents know that this is temporary.’
While isolation may protect older people in the coronavirus pandemic, it is exposing them to another, less understood challenge: loneliness
Loneliness is not only a grave threat to individual welfare and public health but one of the most underappreciated risk factors for premature mortality,” says bioethicist and physician Jacob Appel. Along with smoking and obesity, loneliness ranks among what Appel calls the “triad of potentially preventable causes of early death”.
Around the world, the coronavirus has predominantly claimed the lives of those over 60, which is why strict isolation of elders has become a feature of American efforts to contain the pandemic. Although those younger than 55 represent 38% of ICU cases in the US, the elderly make up a vast majority of coronavirus deaths, particularly those over 85 or those with underlying conditions (which applies to about four out of five elders). While physical isolation may protect our seniors from the highly contagious virus ravaging the world, it is exposing them to another, less understood challenge. “Forced isolation in challenging times can be expected to increase distress,” Appel says. “Loneliness also causes depression, anxiety, demoralization and despair. Increasingly we understand that loneliness endangers the body as well.”
The death of more than 30 residents at the Life Care Center of Kirkland nursing home outside Seattle placed coronavirus – for months a news item from other shores – on the US map. Since then, nursing homes and assisted living facilities across the country have ended visitation. Senior centers – where a hot lunch and gossip are a daily routine for as many as 30,000 New Yorkers – have also closed. Therapists who provided rehabilitation exercises and volunteers who brought entertaining classes to nursing homes, are now also forced to stay away.
Chris Collins, whose mother, Joyce, is a resident of Willow Valley Communities near my home town of Lancaster, Pennsylvania, says that she is grateful that the facility has closed off outside visitors but she’s worried about her mother. Chris, a health and science teacher in Lancaster, can only hope that her mother is getting enough socialization. To help, she walks her dog outside her mother’s room a few days a week and waves from the grass below, but she hasn’t been in the same room with her mother for two weeks. They speak often by phone, although Joyce’s hearing makes it difficult. Chris says staff members are good about returning her calls and emails, but she worries about Joyce becoming lonely or depressed. “Skin contact is so important,” Chris tells me. “No one is hugging her.”
Skin contact is so important. No one is hugging her
No one can physically connect with Virginia Cramer, who is 79 and lives in Mt Vernon, New York, either. Cramer, a widow, is alone at home and has experienced extreme lethargy and other suspicious symptoms for the past 10 days, so her doctor recommended she come in for a coronavirus test. Unable to move around easily because of a broken leg last October, Virginia is reliant on friends and family for assistance. Neighbors are leaving soup on her back porch; her daughter Liz is calling regularly. “I don’t know where we’d be without the phone,” she says. She hears from her sister in Connecticut, her brother in North Carolina and friends all over the world each week. When I ask her if she’s lonely, Cramer immediately responds: “Yes!” though she quickly amends that she’s almost too tired to be lonely.
Until Cramer receives the results of her test in three days, she’s on strict quarantine. “I haven’t showered in a week and a half,” she tells me, “I’m too tired and it’s upstairs.” She tells me the president is not thinking about the people who are suffering and thinks ageism has something to do with it. “We’re going to be ignored,” she says. “He doesn’t care much for older people because they don’t do much for him.”
The Centers for Medicare and Medicaid Services suspended visits to nursing homes on 13 March. That order also suspended routine visits by long-term care ombudsmen, the thousands of federally mandated advocates for residents’ rights and quality of care. When residents and their families have disagreements with facility operators – they receive substandard care, are told they will be evicted from a facility, or are struggling with paperwork, for instance – ombudsmen are able to resolve these care issues. They help to prevent staff retaliation against residents for speaking out and ensure that facilities are operating according to state and federal regulations.
Lori Walsh, a Philadelphia-based ombudsman who works for Carie (the Center for Advocacy for the Rights and Interests of the Elderly), tells me: “Nursing facilities should be working transparently and closely with family members to connect residents with their loved ones.” Walsh recommends that family members contact nursing home staff to facilitate phone, video calls or texting with residents. If you cannot reach nursing home staff, for whatever reason, she suggests contacting your local 0mbudsman. (A directory for long-term care ombudsmen can be found here. If that fails, you can reach Carie for directory assistance at 1-800-356-3606.)
Walsh recommends setting up frequent communication with your elders, whether they are in a nursing home, assisted living or living independently in your neighborhood. “Even talking to them through the window, six feet apart will help,” she tells me.
If services for elders, like a home healthcare worker or Meals on Wheels, have been interrupted, Walsh recommends contacting your local agency on ageing. (You can find a list of state agencies here.)
I asked Walsh how we can help nursing home residents feel safe, with their family members and ombudsmen barred from entry. “We need to make sure that residents know that this is temporary,” she says, “and that they are not alone.” Family members – and advocates – are only a phone call away.
Reaching out can be helpful and comforting to the people on both ends of the line. About every four to five days I talk to my friend Philip on the phone – long, rambling conversations that make us laugh like jackals and sometimes weep like babies. He listens to me do the dishes, I listen to him let Asa, his toy fox terrier, out the back door, as we talk about everybody else’s business.
Philip is 63 and a lifelong smoker; over the years he has had a heart attack and various other medical issues but today he is healthy enough to live at home alone. He’s an avid news consumer so he knows that any social interaction he has could jeopardize his health. These calls, long a feature of our friendship, are now helping to distract both of us from feelings of isolation as we stay in our homes.
“I know I’m going to get it,” Philip told me on the phone last week, referring to the coronavirus. “I just want to wait a while until they figure out what they’re doing.” When I next text Philip to ask if I can call, he replies: “Sure! I’m not going anywhere! Haha.”
- The SAMHSA Disaster Distress Helpline provides 24/7 crisis counseling and support for those experiencing emotional distress related to natural or human-caused disasters in the US at 1-800-985-5990.