Medical experts predicted it, anecdotal stories supported it, and now communities around the globe are experiencing the effects of long-term isolation of those at highest risk of COVID-19. While students are sent back to school, the more senior members of society remain separated from the people, places and supports that sustained them in pre-pandemic times.

Risks and needs vary widely across Bristol’s senior population, and the measures that people who work in senior services are attemptng vary widely as well. But by all accounts, even the best efforts are falling short of what seniors really need — and in the worst cases, both the elderly and the people who love them are suffering.

“My mother has had dementia for five years now, so I live it every day,” said Maria Ursini, senior center director. “The most important thing I find is keeping a routine. People are starting to understand, this didn’t just happen — isolation enhanced it when the routine disappeared.”

Ms. Ursini and Donna Wilson, assistant director of the Bristol Senior Center, are used to recognizing the signs of cognitive decline in their members, and with more people at home spending more time with their elderly family members, families are noticing cognitive decline more than before.

“Donna and I see it with members,” Ms. Ursini said. “We try to stay engaged with all of our members, but especially the ones we know are dealing with dementia or living alone.”

Said Ms. Wilson, “We are doing our best to reach out with activities like puzzles and cards and activity kits. If you don’t spend time with them, you don’t see these underlying issues. It makes it difficult. We are here to help as best we can, bring a smile. But they miss touch.”

“Senior Centers across the state are trying to be creative. Some have more open space to do things outside. We are short on volunteers because flu season is coming up, and we are hoping to pull through, but stay tuned about Thanksgiving. We want to do something special,” said Ms. Wilson.

“It takes a village, and we are part of their village.”

‘I want people to age in place’

“Cognitive decline is a big deal for us,” said Marie Knapman, director of Franklin Court Independent Living. “We want people to age in place, and residents can do that here because there’s a social element.” Like anyone living independently, Franklin Court residents are getting out and about a bit more these days — common rooms and the patio are open, COVID-safe bingo and coffee hours are on, and Stephany Silvia, the assistant property manager, has been doing Friday breakfast takeout and firing up the grill some nights. But just like everyone else, the lack of socialization plus extra time on people’s hands is a ripe recipe for cabin fever.

“Humans are social creatures. They’re not meant to be isolated.”

‘No end in sight’

“It’s an awful thing,” said Kim Ciociola, administrator and owner of Silver Creek Manor. “Unfortunately there doesn’t seem to be an end in sight.”

“We are doing our best with extra one-on-one visits, though it’s not the same as a family member. Believe me, if we could allow that, we would, but the Department of Health is driving what we can do.”

The home has incorporated Zoom, iPads, Skype, bingo in the halls, door to door ice cream socials, and other activities in an effort to keep residents engaged. “We encourage old fashioned letter writing, pictures, virtual visits. It’s not the same, but we are doing our best to maintain a normal routine.”

They have outdoor visitation stations, and they can allow 30-minute visits at discretion of the facility. “It’s very staff intense, including screening,” said Ms. Ciociola. “We are going on seven months, and people are missing their loved ones, the interaction and daily visits. You do see some decline.”

“The staff does a great job, but it’s hard to replace a daughter or son.”

‘My mother can’t Skype’

For many years, Dottie Silva was the very visible matriarch of Bristol’s first family of breakfast, running the Hope Diner with husband Mickey, daughter Lorene and son Bobby (she has two other sons who have not been part of the family business.) Whether seating guests or pouring coffee, Dottie was a familiar face to Hope regulars. Then, on July 4, 2014, Mickey passed away. Within the year, Dottie, who is suffering from advanced Alzheimer’s disease, moved to Silver Creek.

“It’s been very difficult, between my brother Bruce and myself we were there every day. Now it’s a 20-minute visit every couple of weeks, outside,” said Lorene Silva. “It takes more staff, so there’s a limit to how many visitors. Can’t they find a better way to get more people in?”

“I would feed my mother, my brother would exercise her legs, but now that she is in hospice, that’s not happening,” said Ms. Silva. “Her legs are completely contracted, and she’s losing weight.”

Ms. Silva is quick to credit the Silver Creek CNAs and staff for the care her mother is receiving, though she questions the wisdom of the restrictive rules.

She saw a glimmer of hope in a link her brother recently sent her, a press release by Centers for Medicare & Medicaid Services (CMS), which on Sept. 17 issued revised guidance providing detailed recommendations on ways nursing homes can safely facilitate visitation, specifically clarifying additional examples of compassionate care situations. They include weight loss, dehydration, and emotional distress.(cms.gov.newsroom).

“My mother is not responsive, not walking or talking, she’s experiencing weight loss, and not eating well,” said Ms. Silva. “I comforted her every day, for anxiety and nervousness. I feel she falls under those guidelines.”

“Why can’t I put on PPE and be with her? They are closing field hospitals … why are nursing homes still under such tight restrictions? My mother does not have COVID but she might die of loneliness. Where else is this headed?”

Ms. Silva also resents the lack of privacy granted families during their brief visits, which are all staff-supervised. “I understand the rules. I’m not a child. You gave me the rules. I’m not going to jeopardize my next visit.”

‘Staff is really trying’

“It’s having an effect, and I feel for families,” said Beth Russell, administrator at St. Elizabeth Manor. “Staff is great at identifying people who need extra attention, and we are bringing activities back like bingo, crafts, staying occupied and having window visits on birthdays.”

“Some families are affected more than others, but our staff is phenomenal, and our residents are their first priority.”

‘They are medically complex’

The nature of the Coronavirus is complicating efforts to keep dementia at bay for some elderly patients. Anytime someone new comes into the home, or returns from a hospital visit, they go into a full 14-day quarantine, and all interactions are done with staff in full PPE. “With masks, gowns, gloves, face shields, we must look like Martians,” said Cathleen Whelan, M.D., who serves as medical director for both Silver Creek Manor and St. Elizabeth Manor.

“We are working hard to make things as normal under the circumstances for patients and their families, but we are bound by state regulations. Each facility models a plan based on those regulations, coupled with staffing and residents’ needs.”

Dr. Whelan also noted that the workload under the Coronavirus has been further complicated by the medical complexity of the residents. “People are really trying to stay out of nursing homes these days,” she said. “We aren’t getting the otherwise-healthy 75-year-old in for rehab from knee surgery … People are here because they need to be here, and they are medically complex.”

‘Time’s ticking and people are dying’

Bristol resident Charlie Galligan cannot say enough about the “amazing” staff at St. Elizabeth Manor, where his mother has lived for more than seven years after suffering brain injury eight years ago. “I have so much love and respect for my mother’s CNAs,” he said. He knows a thing or two about their jobs, as he is the primary caregiver for his father, who is suffering from Alzheimer’s.

For years, Mr. Galligan would bring his father to St. Elizabeth to visit his mother. “With a brain injury and Alzheimer’s between them, they just held hands and volleyed I love yous back and forth,” Mr. Galligan said.

“It’s not the same, 8 feet away from each other, with plexiglass and masks.”

Mr. Galligan says his parents cannot hear each other over the PPE, and do not understand why they cannot simply hold hands and hug, like they could before March.

Mr. Galligan understands why such measures were necessary in the early days of the pandemic, but he has soured on the official guidance for nursing homes, and identifies his personal turning point as early June. “When the Governor reopened casinos and strip clubs I assumed the end was in sight.” He was wrong. Since then he has been campaigning for reasonable visitation.

“They’ve done a great job keeping the virus at bay, but visitation is not functional,” he said. “There is a safe way; we can take simple steps to show people mercy at the end of their lives. They handled close contact compassionate care visits, with no ill effects.”

“They allow carpet cleaners, physical therapists, and dental hygienists into the facility,” he said. “They take precautions, so can I. So can my father.”

Mr. Galligan says he has reached out to the Department of Health and the Governor’s office at least 20 times in the past three months, and only received two perfunctory responses from the DOH. Rep. June Speakman has been responsive, and he understands that there is an essential caregiver bill in the works that could bring some relief to families like his, but every day that passes is a day wasted.

“Time’s ticking away, and people are dying,” he said. “The elderly are lost in the shuffle with the focus on back to school, which impacts a lot more people. But nursing home residents are voiceless — they can’t speak up and their kids are busy, and kept away.”

On Sept. 10, Mr. Galligan filed a public records request, quoting the Gov. Gina Raimondo when she said at a press conference the previous day, “… last week the Department of Health sent updated guidance to all nursing homes … that nursing homes and assisted living facilities need to make every reasonable effort to ensure that residents and their families have access to regular in person visitation. Unless a facility has been expressly directed to stop in-person visitation by the Department of Health, they must work within the guidelines to make visitation possible on a regular, daily basis.” At the time, he asked for this specific guidance in writing, so he could share, and presumably enforce, with St. Elizabeth Manor. However his request has not yet received a response.

A recent incident has caused Mr. Galligan to become even more frustrated with the what he feels is stonewalling by the administration at St. Elizabeth Manor as well as state officials. As reported in the Providence Journal on Sept. 28 in “Epidemic of Heartbreak” by Tom Mooney, “Last week, two workers at Saint Elizabeth Manor, in Bristol, conspired to allow the mother of one, a resident of the home, to greet several relatives at the entrance, none of whom wore a mask or kept their distance. The incident forced the resident into quarantine and the cancellation of all visits for the Manor’s East Wing residents for 10 days.”

Last Monday, Mr. Galligan and other family member received an email that he characterized as cryptically worded and short of detail, saying that visitation was suspended because a resident had contact with several people. Mr. Galligan got the complete story — that the suspension of visitation was due to the actions of two staffers — from his network.

“This is a slap in the face to to all the other residents. I considered these two (staffers) friends and I’m crushed.” He sent an email to administration suggesting that they owed it to families to be upfront about why visitation had been suspended, but as of Tuesday, Sept. 29, the day after the ProJo reported the breach, that had not happened.

“It’s a miserable situation, and the powers that be are giving us no hope for any light at the end of the tunnel,” said Mr. Galligan. “While the elderly continue to die, alone.”