COVID-19 has forced major changes in life at nursing homes around the country. Infection precautions and visitor restrictions put in place to protect residents from infection may have an unfortunate side effect – loneliness and inactivity among residents who are essentially confined to their rooms.
Older adults need family and social interaction, and regular activity of body and mind to thrive. Activity directors like Tammy Macklin at Life Care Center of Boise, in Idaho, are easing pandemic-related isolation by keeping nursing home residents active, engaged and connected.
The pandemic has not slowed Macklin and her team down – they’re working harder than ever.
Put together personalized activity packets for every resident in the building – check. Set up craft tables with knitting, leather or woodworking supplies for roommates to share – check.
Give one-on-one painting classes – check. Bake goodies for special Mother’s Day and Father’s Day teas – check.
Fill a wagon with balloons and stuffed animals – check.
Drive the facility bus to get residents some fresh air – check.
Do video calls with families, make daily throw-away bingo cards, find a few extra minutes to simply sit with a resident who’s feeling depressed – check, check, check.
Macklin and her staff have ramped up their already impressive efforts to fill the void created by pandemic restrictions. Before COVID-19, some eight to 12 activities appeared on the daily calendar. “We believe that every person’s not going to come to every activity, but there’s an activity for every person,” she says. “Now we are averaging 44 activities a day through the building. Because we are seeing every resident at least once, doing personal one-on-one with each resident, every day.”
As COVID-19 began to hit nursing homes nationwide, Macklin says she and her team “automatically jumped into action” to prepare for the inevitability of pandemic restrictions. “We did surveys with our residents – ‘If we go into isolation, what do you want to do in your room? What can we do to keep you busy? What kind of one-on-one activities do you want?'”
By the time that Idaho Gov. Brad Little ordered visitor restrictions and cancellation of communal dining and group activities in long-term care facilities in mid-March, following recommendations from the Centers for Medicare & Medicaid Services, “we were ready,” Macklin says. She and her team had already secured an abundance of supplies and prepped individual activity packets for each resident.
Macklin thrives on helping others. That drive has been a common thread throughout her career and life. Originally from Georgia, she started out as an art teacher, working with students who had disabilities. “If they couldn’t hold a paintbrush, we figured out a way for them to paint with their mouth,” she says.
That creativity continues in Macklin’s current role. “A resident who might have Parkinson’s and shakes a lot is not going to be able to use a normal paintbrush,” she says. “So, I adapt the paintbrush to where they can do stippling. I work with each resident’s abilities on what they want to do.” For those who want to knit but only have use of one hand, she says, “We make clamps to hold the knitting looms so they can do that.”
Now, in the pandemic, giving residents an occasional change of scenery can make a big difference, says Macklin, who holds a commercial driver’s license. “They aren’t actually able to visit out in the community yet,” she says. “But we can take the residents on rides. We can have up to two in the bus at a time as long as they are roommates.” That provides a safe way to social distance while staving off cabin fever.
A recent request was: “We want to go to lunch,” Macklin says. “Well, we went through a drive-in, sat there in the parking lot and had lunch delivered to the bus. It was the best thing those ladies could have had. They loved it – just them getting out of the building was a major step.”
Macklin is married to a retired Navy officer who served on submarines. They and their three children have traveled extensively on the West Coast, in Hawaii and overseas in Japan. While living in the Monterey, California, area, she ran a teen center and led a program for seniors. She’s worked with both the Girl Scouts and Boy Scouts.
Macklin’s son and some of his fellow Boy Scouts have been carrying on a moving and respectful practice: When a resident who was a veteran passes away, they come out and play taps as the resident is leaving the building.
Macklin has been at Life Care Center of Boise for about a year. Obviously, the experience is much different than what she expected before the pandemic changed everything. Some staff members have contracted COVID-19. Macklin did not escape – she was diagnosed in early August.
“Everybody in my department has been out for it,” Macklin notes. “We kept trying to stay two weeks ahead so in case we did go down, everything was ready, so there wouldn’t be any hardships on the residents.”
Fortunately, Macklin did not have to be hospitalized and was able to recuperate at home. “I was out for 10 days,” she says. “My mom doesn’t know yet, so once this goes out I’m sure I’ll hear about it,” she adds with a rueful laugh.
Macklin took her personal isolation stint in stride: “I had my computer and my iPads, and I was doing video calls and conferencing, answering my phone and everything while I was out with COVID.”
Employees make up more than half of the nearly 2,300 confirmed or probable COVID-19 cases in Idaho’s nursing homes, assisted living facilities and group homes, based on Idaho long-term care data and CMS records, and reported Sept. 5 by the Idaho Statesman newspaper.
The Life Care Center of Boise is among the Life Care Centers of America group of facilities, which includes the nursing home in Kirkland, Washington, at the epicenter of the early COVID-19 outbreak in the Seattle area in March.
Vulnerability to COVID-19 among nursing home patients doesn’t necessarily reflect quality of care. Having higher ratings in the CMS five-star system for nursing homes was not associated with having reduced COVID-19 outbreaks, according to a report published June 2 in the Journal of the American Geriatrics Society. Instead, the number of cases within a facility was tied to infection rates in the surrounding community.
What should readers understand about the activity team’s work? “We’re busy,” chimes in Lindsay Anderson, Macklin’s assistant and all-around right hand.
“There are days where we feel like we’re run ragged,” Macklin admits. “We don’t stop.” Even so, the urge to normalize the situation as much as possible and get residents through these difficult times keeps the team going.
That’s why Macklin wheeled her wagon filled with 60 stuffed animals and 180 balloons (“like the movie ‘Up,'”) door to door, to provide a little pick-me-up for each resident to keep. “Residents just want touch,” she says. “They just want sympathy. They want a hug.”