Maintaining Connections

Long-Term Care During COVID-19
By Diane Farsetta, Center for Aging Research and Education
This store appeared originally in Issue 22 of CARE’s Newsletter

From the beginning of the COVID-19 pandemic, long-term care staff knew they were facing multiple challenges. 

“When we closed the doors of nursing homes and visitors were no longer allowed, I went home, I packed my belongings, and I moved into the nursing home,” says Janelle Zacho, RN, DNS-CT, the Director of Nursing at Columbia Health Care Center in Wyocena, Wisconsin.

Janelle Zacho
Janelle Zacho

“I felt it would really help me to make sure we got our system changes in place,” she says. “Seeing me walking the halls at nine at night or two in the morning, and knowing I was here made a big difference to our residents. I would tell them, ‘If you can’t see your family, I can’t see mine—and together we’ll get through this.’” 

Many of the measures needed to reduce the spread of the virus also limited residents’ social interactions. 

“Social isolation and loneliness have been linked to a number of poor health outcomes,” says Tonya Roberts, PhD, RN, an assistant professor at the University of Wisconsin–Madison School of Nursing. 

Tonya Roberts
Tonya Roberts, PhD, RN

Having few social connections causes social isolation, while loneliness is a negative feeling about being isolated. Studies have associated both with cardiovascular disease, cognitive decline, depression, anxiety, and increased risk of death. 

“Older adults who live in nursing homes or other long-term care settings have lost connections with family members during COVID,” says Roberts. “My research suggests that residents can have challenges trying to develop close relationships with both peers and staff. One of the common places that they can make those friendships is at the dining table. But communal dining—as well as activities—had to be stopped or reimagined because of COVID.” 

While Zacho lived at her nursing home from mid-March to early June 2020, long-term care staff everywhere went above and beyond. At the Felician Village continuing care retirement community in Manitowoc, staff prioritized keeping residents connected with their families. 

“Email is how we started,” says Felician Village’s Director of Enrichment Services, Connie Thimmig, MS, CDP, CADDCT. 

Connie Thimmig
Connie Thimmig

“We worked with our marketing department to have a resident communication email put on our website,” she says. “We told families that this was the best way to communicate for right now. They sent their messages to their loved ones and our staff printed them and delivered them to the residents. We waited for their response and wrote it down. Then we emailed them back to the families. It was the first way that we connected and families were so appreciative.” 

Felician Village then began scheduling video visits with residents, settling on three different platforms. “Anything that families were comfortable with, we were willing to give it a try,” says Thimmig. 

“There will be lessons that we learned through COVID,” she adds. “One is that we’re always going to offer video visits. In the past, every Sunday we had a phone call from a son who lives in a Southern state to his mom who lives here. Since COVID, he’s been able to see his mom. So, we’re certainly going to continue that.” 

Columbia Health Care Center also found new ways to bring residents and families together. Inspired by the 1976 movie “The Boy in the Plastic Bubble,” Zacho raised funds to purchase dome tents. They offered outdoor visits, with residents inside the tents and their family members outside. 

older woman and man visiting using a dome tent
Dome tent visit between a Columbia Health Care Center resident and her husband; used with permission

Zacho worked with her residents to keep them informed and engaged. 

“I started a newspaper with my residents,” she says. “I had them writing stories, writing jokes, drawing pictures, cartoons—all the things you’d see in an old-fashioned newspaper. I would write something too, keeping them updated on what we’re doing to protect them. I had families send in something fun to add. I felt it was important to give residents that education piece, so they knew what COVID was and how things were changing. It also gave them a focus in the beginning, instead of sitting in their room wondering, ‘Is this my life and for how long?’ Because none of us could answer that.” 

Now, more than a year into the pandemic, many long-term care residents and staff have been vaccinated. Restrictions on activities and visitors are being lifted. 

“Unfortunately, there are a lot of anecdotes to suggest residents are experiencing cognitive decline, weight loss, depression, newer or increasing behaviors, and failure to thrive in general, due to COVID restrictions,” says Roberts. “That’s why these amazing strategies that long-term care staff used to combat social isolation during COVID are so important.”