Days grow long at nursing homes as virus lockdowns drag on

In the activity room, where birthdays were celebrated and Sunday services were held, the aquarium and its brightly coloured tropical fish are the only signs of life.

Off quiet hallways, Southern Pines residents pass the time with word-search books or a nap. Meals once were a social time enjoyed at tables of neighbors; now most are delivered bedside. Visitors are resigned to muffled conversations through windowpanes, and the only tickets out maybe a trip to dialysis or an ambulance ride to the hospital — or something worse.

Life has frozen at this nursing home, walled off for four months by a virus that’s zeroed in on the old. And with the pandemic raging outside, there’s no telling when the thaw might come.

“It’s really not normal,” says Christen Washington, a nurse who handles social services and admissions at Southern Pines. “I don’t know what that is anymore.”

Like facilities nationwide, Southern Pines followed the federal government’s March 13 guidance to halt all visits, a move that spurred some backlash but seemed prescient as the news exploded of deadly outbreaks elsewhere. The home went six weeks with no infections at all.

When the lucky streak ended, the on-edge early days of the pandemic gave way to a weeks-long fight to contain it, with more than a quarter of residents infected. Today, Southern Pines is like many nursing homes, neither in the heat of panicked battle nor past it. Normalcy remains a distant hope, the threat is as persistent as at the onset, and no clear path forward has emerged.

And so everyone just waits.

Watching over this community is administrator Donna Stefano, who, on a whim, once answered an ad for a clerical job at a nursing home. Thirty-five years later, she finds herself minding Southern Pines’ twin populations: Those who call this home, but live walled off from those they love in sometimes oppressive isolation. And those who have taken on the back-breaking, near-poverty work of caring for them.

Both cling to hope that the end to all this is near — even as infections in the outside world surge, deaths creep up, and the lockdown continues.

“We’re going to have to run different for a long while,” says Stefano. “Otherwise it’s going to come back and next time we may not be so lucky.”

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The morning starts with a blare of sunshine but threatens to deliver a fourth straight day of showers. By the time Kendell Floyd sets up in Southern Pines’ in-house beauty salon, the dark clouds have already amassed and a resident has an early review of her shampooing technique.

“You’re too gentle!” the woman offers, asking for a more vigorous scrub.

Floyd is 25 and handles record-keeping and supplies at the home, but like everyone else here, has had her routine upended by the virus. The facility can’t let hairdressers inside, leaving the job to staff on site. Residents, however, blunt they may be with their advice, ooze with gratitude too.

In between wash-and-style sessions, Floyd is summoned to a resident’s room where she’s asked about the status of a run to Dollar Tree for popcorn and word-search books. She hasn’t made the trip yet but assures the woman she will, and the resident offers parting words of appreciation.

“I’ll sure be glad whenever we take these masks off,” she says, “so I can see you smile again.”

Southern Pines is in central Georgia, about 20 miles (32 kilometres) south of Macon. About 70% of its population is female. There are a handful of younger residents, including a man in his 30s, and a range of older ones, from those in a haze of dementia to those as lucid as they were a half-century earlier. Some never finished high school, some have college degrees. They were truck drivers and teachers, people who worked all their lives and people who never could.

Before the clock hits 11 a.m., activities director Tomica Mace has the bingo cards set on long tables outside, and some of the game’s regulars are arriving, all masked and spaced out from neighbours. Nine residents congregate, but Mace’s voice is the only one that rises as the players concentrate on their cards.

“Everybody ready?” Mace bellows before the first ball appear. “N-45!”

When Southern Pines shut outsiders out, life inside transformed too. The dining room closed, with meals delivered to rooms. Most group activities were nixed. One of the only mainstays to survive was bingo, and that morphed into a socially distanced game largely played with residents seated in their doorways, aides in the hallways parroting Mace to ensure the numbers are heard.

Today, the game came with a breath of fresh air, each suspected win followed by a check of a player’s card and crisp dollar in their palm when Mace confirms with glee, “That’s a good bingo!”

Before long, though, the sky rumbles and the drops begin to fall and the players are ushered away from the wafting aroma of towering pines, back into a spotless, sterile hallway, while “The Price Is Right” plays on TVs affixed beside nurses’ stations on each end of the home.

Bingo ends with no wins for Kay Gee, but when she gets back to her room, the midday news brings a happy update: A deal has been reached to bring a beloved sport back to her screen.

“Baseball’s coming back!” she says. In other news: “It’s gonna rain. That’s what they say every day.”

Gee is 80, a retired office worker who wound up in a home when back surgery brought problems with her right leg a year and a half ago. She hopes to live outside a facility again, but nothing seems so sure these days.

She misses visits from her four children and three grandchildren. She misses plunging her hand into the fur of Annie, her poodle, and Mugsy, her dachshund, when they would visit. Sometimes she feels little urge to do any more than sink into a book. Other days it all feels harsher.

“Some days you feel like you could scream,” she says.

Angie Shepard, the home’s 53-year-old nursing director, says she and her staff have done their best to hold residents’ hands, rub their backs and otherwise bring those touches that have been missing in the lockdown. They know these people are hurting. They’re hurting, too.

Americans were first shaken to the arrival of COVID-19 when an outbreak raged at a nursing home outside Seattle. The dozens of deaths were shocking and the images of families paying visits through windows at once both peculiar and heartbreaking.

They were just a tiny precursor of what was to come as the virus took hold in facilities around the country.

As the pandemic proliferated, Shepard sank to her knees in prayer, pleading to keep the virus out of this place that’s like a second home, away from these people she’s come to love.

At Southern Pines, it started on April 26, when a woman with a low-grade fever went to the hospital with what the home thought was a urinary tract infection. It was, but she tested positive for the coronavirus as well. That unleashed a search for who else was infected, and a frightening revelation: A dozen of Southern Pines residents were infected, though most showed few symptoms, if any.

In the end, all survived.

When Shepard returned home, she isolated herself, using a different door, staying in a different room and phoning her husband so they could chat without shouting. She went five weeks without a hug from her son. When his 23rd birthday came, she missed the party, and when it was time to mark 25 years since the death of her 10-week-old daughter to sudden infant death syndrome, she went to the cemetery alone.

Shepard is being treated for ovarian cancer and underwent surgery just before the pandemic started. Her husband asked if she might go on leave, but she couldn’t consider it.

“I’m here for a reason and it’s to take care of these people,” she says. “That’s all I ever wanted to do.”

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Lunchtime arrives and 26-year-old Unterria Redd, in fuchsia scrubs, delivers the trays. Most still eat in their rooms, but as Southern Pines saw some residents’ weight drop, they reopened the dining room, hoping a semblance of normalcy might nudge them to clear their plate. A few residents now sit, socially distant, at tables topped with flowers in glass milk jugs.

Redd is a certified nursing assistant, the bedrock of a home like this one. The field’s high turnover rate reflects the grueling shifts undertaken by a workforce that is overwhelmingly female, a majority of them members of minority groups.

Southern Pines, like homes around the U.S., has struggled to fill CNA openings and the pandemic has only made it harder. The work is steady and demand is growing, but injuries are rampant and the salary is low. Aides hired by the home earn $9.50 to $11.50 an hour; those like Redd working for an agency that contracts with the home are paid a few dollars more.

“You can go to McDonald’s and make more,” says Shepard.

But Redd never saw herself working at that kind of job. In those dark first days of the virus, she worried as she covered herself head to toe, donning an N95 mask and a face shield, and she found herself lying awake at night. But it grew as familiar as any other routine. She’s been doing this work for six years and can’t picture doing anything else.

“If we’re not here to do this who else is going to do it?” she asks after dropping lunch to Judy Morey in Room 107.

Morey has a stone cross in a window facing a Baptist church with a white steeple that blends with a cloudy sky. Solar-powered plastic sheep, snowmen and anthropomorphic flowers dance beside plaques with inspirational quotes. Next to a word hunt book in the basket on Morey’s walker are two dollar bills, reminding of her bingo prowess today.

She is 71 and wears neat black pants and a beige blouse embroidered with leaves. Morey was born with cerebral palsy and lived with her brother and sister-in-law until eight years ago when she began needing more help. She is president of the home’s resident council and, before the pandemic, she enjoyed playing cards and huddling close with friends to put together a puzzle. Those simple joys are gone, along with those frequent pop-ins from her brother.

She wonders if things will even change by the time her birthday arrives next month. For now, she says she’s coping as best she can even as the days feel far longer than any that came before.

“All I kind of want to do is taking naps all day long out of boredom,” she says.

And, with lunch over and little else to do, she returns to bed.

___

At 3 p.m., when the first shift is over, aides meet with their replacements on each of Southern Pines’ four hallways. They are short meetings today, with no recorded falls, no skin tears, no notable behavioural issues and, importantly, no new infections.

“We love uneventful days,” says Tammie Williams, a 40-year-old CNA with thick pink eyeshadow, huge fake eyelashes, blue hair and a top with a fittingly colourful array of superheroes.

In the lobby, a young woman in a “Golden Girls” T-shirt arrives with a complaint about her father’s care, asking why he fell from the bed and shuffling paperwork she needs to file to grant her power of attorney. And outside Room 303, 88-year-old Barbara Fowler taps on the window of her 90-year-old husband William, who has been recovering at Southern Pines after breaking a hip.

She’s brought him a favourite treat, vanilla Ensure, calls him as she stands outside the glass, tells him she loves him and earns a broad smile. This is the routine, three times a week: Fleeting glances, muted voices and a resounding hope that something will change soon.

“It’s very lonesome and stressful,” she says.

For many Americans, ending up in one of the country’s 15,000 nursing homes is seen as a worst-case scenario of lost freedom and faculties. Many will wind up in one anyway, at least for a time.

Homes were no stranger to bad press when the virus began sweeping through and the pandemic only exacerbated negativity, with rampant problems with infection control coming into plain view. At least 55,000 residents and staff of U.S. long-term care facilities have died of COVID-19, a disproportionately high figure. It represents about 40% of the total U.S. virus deaths.

To move past this, to guard safety while acknowledging the rights of residents and their families and the toll of isolation, testing is key. With staff constantly coming and going — a key source of the virus in nursing homes — the Centers for Medicare and Medicaid Services, which regulates the facilities, has called for weekly testing of employees. It is just a recommendation, though, and like most things in American health care, it’s viewed through a lens of money.

Southern Pines, like seven in 10 U.S. nursing homes, is a for-profit enterprise. About 90% of its residents have their care paid by Medicaid, for which the home receives about $186 a day. Shorter-term rehabilitation stays paid by Medicare can deliver a daily rate several times that.

Each staffer at Southern Pines underwent testing for COVID-19 in April, but barring a government mandate there is no plan to require tests at regular intervals. The cost is too high.

“You start doing the math,” says Stefano.

As a girl, Stefano visited nursing homes with her Girl Scout troop and Sunday school class and didn’t step foot in one again until answering that newspaper ad. Over the years, she’s run nursing homes’ housekeeping and laundry and kitchens, coordinated admissions and, in her most lasting role, led them as an administrator.

Her two children practically grew up in nursing homes and became used to middle-of-the-night calls that sent mom back to work. Her husband and son run a business that sells janitorial supplies to nursing homes and that, as the virus raged, made sure Stefano had hand sanitizer in stock. Her daughter is a pediatric nurse, but Stefano, 61, is convinced she’ll make a change.

“She’ll flip to geriatrics before it’s done, I guarantee you,” she says.

Southern Pines had a previous life as a nursing home under a different name, but it was closed a couple of years back, then gutted and rechristened when it reopened five months ago. On Stefano’s first day, March 26, the doors were already plastered with signs advising of the shutdown.

No one thought it would last quite this long.

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Dinner is chicken tenders with roasted potatoes, zucchini and a biscuit, and 72-year-old Butch McAllister is home in Room 306 when the tray arrives. His bulletin board is full of photos and two small American flags, and bottles of orange Fanta are neatly lined in front.

On the windowsill are remnants of his May 13 birthday — a balloon and a sign his family made — alongside a football, stuffed animals, a Bible and a sign that says, “I Love That You’re My Dad.”

McAllister is a retired glass salesman who wears a cap from the Army’s 82nd Airborne Division at Fort Bragg where, he notes, he “jumped out of perfectly good airplanes.”

When the virus tests came back, McAllister’s was positive, forcing a move from his room into isolation. He’d heard all the horror stories but says he turned it over to God and didn’t fret.

He felt fine the whole time, eventually tested negative, and returned to 306.

McAllister’s wife is at a different nursing home and they haven’t seen each other in months. His daughter and a grandson visit at the window, a nice sight, but he wishes he could touch them too.

He admits feeling lonely at times and can’t wait for in-person visits, just as he salivates thinking about going out for a meal at a Greek restaurant or a favourite steakhouse.

“Nobody can come in and nobody can go out,” he says. “I’m ready for it to happen.”

Though most American nursing homes remain locked down, restrictions are beginning to ease in some places. Some states have allowed a trickle of visitors back into homes, but most have tip-toed back with rules like Indiana’s, where relatives must have a negative virus test in order to sit, masked and distanced from their loved one, outside of the facility. In other places, like California, the rules have changed to allow visits, but facilities have been wary to reopen.

At Southern Pines, a state emergency order barring nursing home visits has been extended another month to Aug. 12. With Georgia recording a sharp spike in virus cases, residents and staff alike know another delay is possible. And they know they are not out of the woods.

A nurse at the home grew worried this month when she opened a bottle of nail polish and didn’t smell anything. She tested positive for the virus, prompting new tests for the 30 residents she’d come in contact with. To great relief, all were negative.

As night falls, the resident count grows to 47 as two people arrive from the hospital. Out front, a sign says “Heroes Work Here”; down the road, shiny black hearses are parked at the mortuary, and in simple ranches, people retire to bed. Here, the halls grow quiet and the staff thins.

Stefano gets home late, enjoying a glass of chardonnay while doing the laundry and playing slots on her iPad. She’ll go to sleep without a crisis erupting at work, no calls to stir her awake.

She knows everything remains imperfect, but on a day like today, when no one fell ill, when the fight to keep the virus away was victorious, it almost feels like the old days at Southern Pines.

“Anytime it feels like it used to feel,” she says, “that is a good thing.”