//// by: Kizzy Chambers ////

The pandemic of COVID-19 has increased concerns about older adults’ cognition among many family members. Most of us understand that older adults or individuals with significant cognitive impairment or dementia, need stability and routine. As a result of the COVID-19, visitors are prohibited in nursing homes and assisted living facilities. Many residents lost access to some essential basic needs and routines, such as car rides, walks in the park or around the mall, or daily lunch at their favorite restaurant.

Federal and state governments implemented guidelines to protect one of our most vulnerable populations, the older adults. However, we did not consider how the effect of these strict guidelines would have on older adults. Primarily, the impact on residents who suffer from depression, anxiety, and those with dementia. Before COVID-19, residents were able to interact with other residents. They felt some sense of empowerment and control. Now many of their usual activities have been limited or canceled until further notice. Residents are isolated to their rooms, having to eat meals in their rooms alone. Several residents do not have family members locally or have limited support in place. And the facilities are understaffed. Some nursing staff have quit or had to reduce their hours to accommodate personal life changes as a result of the COVID-19.

As an Aging Life Care Professional and Licensed Clinical Social Worker, I am concerned and afraid of the state I will find my clients in once I can resume visits with them. One family member described her mother with increased delusions since the implementation of social distancing in the facility. Another family member reported their mother sleeping more often, and her verbal ability has significantly declined. These family members feel helpless but hopeful. I provide emotional support, but it does not seem enough when you have a family member declining, and you cannot physically be there with him or her. I ask myself, “What other ways can I support my family members and clients throughout this pandemic?” How do we foster a system that forces senior living communities into an interdisciplinary collaboration with family members and community partners during a time of crisis? Or, how do we ensure residents, who are in senior living communities, needs such as their emotionally and physically, are being met?

Some senior living communities are doing as much as possible, given the limited resources that are reasonable and accessible. Some communities are encouraging some form of visual and audio contact, such as Facetime or Skype, between family members and residents. Many senior living communities arrange for window time between residents and family members. Some residents are still capable of making and receiving phone calls from family members. But other residents do not have access or are incapable of managing some of these options. For those residents who do not have family support or the ability to utilize wireless programs and social media, how are we supporting them? Nick McKeehab, a blogger, reminds us how social isolation is associated with adverse health conditions. Research supports that social isolation increases the risk of chronic medical conditions and mortality.

To reduce risks for chronic medical conditions and mortality, I suggest a senior living community model that increases one-to-one physical contact with residents, primarily for those who suffer from significant cognitive impairment or dementia. Spending 10 minutes daily with an isolated resident has the potential to maintain their quality of life, decrease the risk for depression and acute cognitive decline. This daily human connection could be with any person within the community. I am not talking about the brief minutes when the nursing staff is passing medications, or when the dietary team delivers meals. Staff can be assigned to two-three residents daily to spend at least 10 minutes of one-to-one contact while maintaining social distancing. Staff members can also be assigned to walk a few residents around the building a few times. Checking the residents’ refrigerator and helping them make a sandwich or a quick snack increases social empathy. These tasks may seem overwhelming to Executive Directors when they are burdened with staff shortages and added functions due to a crisis or pandemic. Still, ultimately, these tasks are invaluable when you are making a difference in the lives of residents with cognition impairment or dementia. These tasks can be maintained with appropriate social distancing and by wearing proper protective equipment.

How are we as Care Managers trying to mitigate the loneliness and isolation?

Just as senior living communities are working within their limited resources, Aging Life Care Managers must get creative as well. Families hire us to oversee the medical care and well-being of our clients. Many of our goals include ensuring our clients are safe, medically managed, and have a quality of life. These goals are challenged by restricted guidelines implemented to address the pandemic of the COVID-19. During these uncertain times, family members rely on our expertise and creativity. At FHL, we are mailing greeting cards, dropping off boredom boxes, making weekly phone calls to speak with nursing staff at senior living communities where we have clients. We are asking the nursing staff to take our clients’ weight and inquiring about mood changes. We are requesting medical records to be faxed for review, phone calls, Facetime, or Skype with clients, and arrange for window visits. We also make sure clients have personal hygiene items. During this time, we have increased our communication with family members, so they know they are supported and not alone. How are you mitigating the loneliness and isolation of your clients?

About the Author:  Kizzy Chambers MSW, LCSW, CMC is a Professional Care Manager and a Licensed Clinical Social Worker with FHL Care Management, LLC in Orlando, Florida. She has over 13 years of experience in health care, working in a hospital setting, and as a Care Manager. She is also a mental health therapist, focusing on depression, anxiety, stress management, and crisis stabilization.  Kizzy attended the University of Central Florida, where she obtained her bachelor’s degree in Psychology and her master’s degree in Social Work. She is active with the Aging Life Care Association (ALCA) and currently serves on the ALCA Florida Chapter’s board of directors. She also serves as the Orlando Unit Leader for the ALCA Florida Chapter. Kizzy served on the 2020 National ALCA Conference Committee. She is  a member of the National Association of Social Workers (NASW).