Iowa nursing home residents suffering from loneliness may soon find relief

CEDAR RAPIDS — Like many other milestones over these past months, Linda and David Scott’s birthday celebrations looked very different during the pandemic.

Linda turned 70 in March and David turned 75 in April. However, the Cedar Rapids couple could not be together for their birthdays.

David, who has dementia and a variety of other medical issues that require additional care, has been a resident at Hallmar Nursing Home in Cedar Rapids for a little more than a year.

When the novel coronavirus first appeared in Iowa last March, every nursing home and long-term care facility across the state locked its doors and ended visits from family and friends. The precautions were meant to keep COVID-19 away from the population most vulnerable to severe complications. But now seven months into the pandemic, those restrictions have begun to take a toll on nursing home residents.

David’s family threw him a birthday party from the parking lot of the nursing home, within view of his window. But it was bittersweet.

Linda said her husband’s connection to his family is something “he always appreciated and needed,” and the separation has been a very rough ordeal.

“It really hit him hard,” she said. “He was pretty depressed for a while.”

Officials with long-term care facilities in Eastern Iowa say they are seeing more loneliness and social isolation among their residents, a serious concern among older populations that puts their health at risk for depression, anxiety and premature death.

Dr. Clete Younger, a UnityPoint Health-Cedar Rapids physician and medical director of seven nursing homes across the city, has seen more symptoms of depression and more instances of “giving up” among residents, such as those not eating or drinking as much as they should.

“They’re emotionally stuck, and there’s only so much we can do about it,” he said.

While it may range among the variety of residents, Younger said the average life expectancy for residents of nursing homes under two years.

“If your life expectancy is 14-24 months, what confidence is there that this COVID-19 situation will be better in your lifetime? It becomes a very emotional moment, because nothing we currently have tells us that everything will be back to normal in 14-24 months. If you think through that thought process, you see where people feel like they want to give up.”

Changes to pandemic-related guidelines to nursing homes and other long-term care facilities may help address this issue, according to some officials in these facilities. New federal guidelines have allowed states to loosen recommendations to nursing homes even further, allowing indoor visits if the county positivity rate is less than 10 percent.

Many nursing homes this summer had been offering outdoor visits, but as temperatures began to cool officials acknowledged this arrangement won’t work for long.

In a news release about the new guidance, officials also acknowledge the change was an effort to better address residents’ emotional and social needs.

In its announcement, the federal Centers for Medicare and Medicaid Services stated it understands “nursing home residents derive value from the physical, emotional and spiritual support they receive through visitation from family and friends.”

Under guidance from the Iowa Department of Public Health, residents can still qualify for compassionate care visits with members of their families if the county’s positivity rate is higher than 10 percent. But unlike early in the pandemic, these visits do not apply exclusively to end-of-life scenarios.

Residents who qualify for compassionate care visits include those needing encouragement with eating or drinking, grieving a recent death or currently experiencing emotional distress.

These visits can take place within a resident’s room or in a dedicated indoor visitation space after the visitors are screened for symptoms and potential exposure.

Hallmar Nursing Home, a 55-bed facility owned and operated by Mercy Medical Center in Cedar Rapids, has allowed compassionate care visits since August. Hope Covington, director of nursing, said all the residents qualify for such visits.

“I can only speak for Hallmar, but what we are doing is what we felt was needed for our residents,” said Coco Barlow, a social worker at the facility.

Linda Scott said she saw an improvement in her husband after she could begin visiting him in-person for an hour a day for five days a week.

“I try to stay positive and he seems to grab onto that,” she said.

The number of long-term care facilities experiencing an outbreak has been increasing in recent weeks. As of Thursday morning, 53 long-term care facilities in Iowa reported an outbreak among its staff and residents, including two facilities in Linn County.

If an individual within Hallmar would test positive, Covington said, officials would suspend visits until 14 days have passed since the last positive test.

While Linda s fearful her husband may become infected by the virus, she said she believes the nursing home is doing everything possible to keep COVID-19 out.

Linda acknowledges she does worry about David’s well-being as the pandemic wears on, but said she’s confident he will maintain good spirits as long as she can stay connected with him through the hourly visit.

“It’s just that connection, sitting there together and visiting. I think that’s what will hold him,” she said.

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