Keeping ailing people safe, healthy and happy during their final years can be a daunting task in the best of times. And recent weeks have not been the best of times. Care facilities for our frailest are facing shortages of supplies and staff, and residents have been cut off from direct family support under strict isolation measures.
“It’s a crazy time of life,” Michelle Fowler summed up.
She is a registered nurse at Golden Girls and Living Spring residential care facilities in Lewiston.
In a recent phone call, she credited the homes’ “incredible staff” of about 30 with finding creative ways to cope as they strive to shield their 19 residents from COVID-19 exposure and mitigate social isolation. She owns the homes with her husband, Lucas, and runs them with her mother-in-law, administrator Pat Fowler. All three live in Lewiston. Pat, Lucas and Marcus Fowler (deceased) founded the homes.
Stocking the shelves
“Finding supplies has been our biggest challenge right now,” Michelle Fowler said. The homes must be prepared to provide isolation areas with personal protective equipment for staff and patients — including masks, face shields, gowns and booties — and “it’s incredibly difficult to get gowns and masks right now.”
Sterile gloves, incontinence supplies, hand sanitizer and disinfectant wipes are scarce too.
“We’ve been able to find bleach, so we’ve just been using our own (disinfectant) solution,” Fowler said.
Other supplies aren’t so easily replaced.
“If this becomes an 1800s-type (situation), we could use cloth masks and gowns,” she said, “but they wouldn’t be sterile” and they would greatly increase the laundry burden.
For one critical tool, there is no reasonable substitute: “We use thousands of gloves just in normal use,” Fowler said, and the need is likely to increase substantially in the event of a COVID-19 case.
Suppliers are having trouble keeping up with demand, even though certain supplies, such as masks, are being reserved solely for medical care providers, Fowler said, and aren’t being sold online for personal use. A two-day turnaround is the norm for supply delivery to Golden Girls and Living Spring, but deliveries are about six days out during the current crisis, “and our stocks are dwindling.”
Meal-planning has grown difficult as grocery stores struggle to stock shelves. All menus need dietitian-approved, and food shortages have required last-minute substitutions that then must be resubmitted and checked for nutritional value.
Shopping trips themselves are no picnic in the current atmosphere. Fowler urges community support for caregivers instead of the judgment she has sometimes gotten while pushing a mounded cart through the aisles. “We’re shopping for 19 people. We’re not hoarding, we’re just trying to take care of (our) people, I promise.”
Staffing the homes
Maintaining adequate staff has been difficult.
“The CDC (Centers for Disease Control) and the Department of Health and Welfare gave us guidelines last week that we are to limit all visitors to essential staff,” such as caregivers, nurses and doctors, Fowler said in the March 20 interview. “Any of our visitors or staff now have to be screened before they can even enter the facility.”
The screening includes a questionnaire asking about a visitor’s current health and whether they’ve been around anyone exhibiting symptoms of illness. Temperatures are taken, and anyone with a temperature of more than 100.4 is denied entry. Caregivers who might develop a sudden sore throat or other symptoms of illness while at work must immediately put on a mask and a new worker must be called in.
Those rules, coupled with extra caution taken at the start of allergy season, when many of us are coughing and sneezing, have left the homes stretched thin.
So far, the caregiving team has really pulled together Fowler said, with people willing to take extra shifts and “everybody playing different roles” than normal to cover all their bases.
“But I can see (staff exhaustion) on the horizon,” she said, “and we’re actively trying to hire, as well as spreading out shifts so no one gets overwhelmed.”
A sense of isolation
Residents’ mental health also weighs heavily on caregivers’ minds.
“Almost all family members or friends of our residential homes have not been allowed to come into the facility since (March 15),” Fowler said. Loved ones are allowed in only in cases where “end of life is imminent,” and only if they are able to pass the health screening.
“Most of our residents have a cognitive impairment, either dementia or Alzheimer’s, and have limited mobility,” she said. “So, yes, we do have to tell the story each day, several times a day about why their family members aren’t here.”
Even within the homes, human contact is minimal. There is no more communal dining as residents are required to stay 6 feet apart.
The sudden loss of social connection remains disorienting for some. But most take it in stride once the situation is explained, Fowler said.
“Most of our residents have a World War II mentality: You don’t complain. They’re more worried about us, don’t want to be a bother — they’re very community-minded.”
Battling the loneliness
To minimize the sense of isolation, the staff is helping residents write letters and send cards. They’ve stepped up efforts to engage residents with extra activities and created a cheerful atmosphere, with bird feeders and flower baskets outside resident windows, colorful balloons and music from the Big Band era. Some staff members and residents have begun sharing hidden musical talents to keep things fresh as well.
“Music is a wonderful tool for cognitive impairment,” Fowler said. “We ask them, ‘When have you heard this?’ or ‘Who sings this?’ or ‘Did you know Bing Crosby?’ or ‘Did you ever dance to this?’ ” The music and questions tend to bring residents back to the 1940s and ’50s often trigger stories of their lives from that time.
Staff also encourage and foster distance communication with loved ones. For residents without access to a smart phone or computer, the staff sets up times for residents to video chat with loved ones using a sterilized facility tablet.
“We have a couple of tech-savvy residents,” she said, “and most all of our staff is very tech-savvy.”
For those families that are less comfortable with video conferencing, staff encourage phone calls, letters and even brief visits through an open window — from 6 feet away.
“I feel like we’re supporting the entire family,” Fowler said. “Many of our residents’ children are elderly, so we’re trying to encourage social distancing for them as well.”
She recently heard from a nurse at a larger longterm care facility of a family who gathered outside a resident’s window and held up signs to cheer her.
“I’m a Christian woman, so I’m just encouraging our families of faith to keep praying for peace through this time,” Fowler said. “It’s been a peaceful transition for the most part.”
And keep reaching out. “Continue to make the phone calls,”and send lots of mail,” she said. “This is a generation who really values a well-written letter or a beautiful greeting card.
“Throw a CD in the mail ... a favorite novel, fuzzy socks, comfort items, herbal tea — just anything to let them know they’re not forgotten and (family members would) love to be here if they could.”