COVID Monomania has Allowed Nursing Homes to Disappear from the Public’s Attention

They're sealed away, so they can be out of sight, out of mind. In the meantime, even my colleagues don't seem to want to collect stats on how isolated nursing home residents have become.

So I have been writing about the subject of what I have been calling “nursing home prison” for the past month or so on this Substack (feels like longer!), which is the term I’ve attached to what we’ve done, to various degrees, to nursing homes across the United States and around the world over the past 2+ years, ostensibly in the name of COVID avoidance.

Photo by Emin BAYCAN on Unsplash

In terms of the local region I work for, our facilities have (as I’ve documented previously ) done a whole bunch of “mitigation” measures, including the following over the last 2+ years:

• Severely restricted and/or outright banned visitations from family members / outside visitors

• If family members / friends are allowed to visit, requiring prescheduling as well as masks, face shields, surgical gowns, “social distancing” (no hugs, kisses, etc.) and time-limiting the visits

• Effectively banned paid companion services

• Completely banned any and all outings for residents outside of for specific, pre-approved medical visits

• Masks & face shields required for anyone who interacts with residents

• Masks required of residents (although residents who, due to dementia, are “unable to comply” do get a pass)

• Congregate dining banned

So – this is what I’m pretty certain of for my local region.

Once we start going outside my region into my state as a whole (a blue state), or throughout US - this is when I get less certain. The organization I work for is a large, national & public healthcare organization that has nursing homes in every state, and I’m at least fairly certain that there’s probably little variation between our various facilities (they may have found ways to bring in paid companion services, for example). Our version of “nursing home prison” may be in fact how my organization practices things across the United States.

When it comes to LTC facilities outside of my organization and across the United States – this is where I am even less certain - to the point of being basically in the dark.

WTF - Why Has Nobody Done Surveys on This?

I have done a bunch of Google searches and Google Scholar searches. I’ve poked around one of my professional listservs. I’ve polled some colleagues of mine (tentatively) on the subject. It appears that at least for now – no one has asked the question, essentially “what is the current status of lockdown policies at your nursing home?”

The few colleagues I’ve tentatively asked about this have responded mostly in silence, and that seems to jibe well with the absence of information I’ve found out about this subject.

I think they’re generally uncomfortable, even scared, to start asking about this.

I did recently learned from a new follower on Twitter (who happens to be an LTC nurse) and who works in Washington State that apparently much like my residents – they have been on house arrest for the last going-on-three-years now, in full-blown “nursing home prison.” Like our residents, they have not been allowed to leave for even an hour, just to go have a meal in a restaurant across town with family members. They are in prison.

But aside from that, I have no idea what’s going on out there.

Besides, Kids, Right Now, are Getting All the Attention

We’ve all seen the increasing media drumbeat on the “looming pediatric mental health crisis” - usually superficially explained as “due to the effects of the pandemic” – as if a virus with a 99.99%+ survival rate in children somehow magically caused all the school closures.

There’s even the recent article from The Economist:

Covid learning loss has been a global disaster | The Economist

So - it’s been all over the news lately – the effects of lockdowns on children has set them back years in terms of learning, has resulted in social regression, depression, behavioral issues spiking – you name it.

But when you think about it (and not to minimize any of this) – healthy, able-bodied children, to a certain degree, *are* by definition resilient. It’s amazing how much children can bounce back from even severe trauma and needless deprivation (which in many cases I think all this lockdown stuff would definitely qualify!).

Older Adults and in particular Geriatric Long-term Care patients – They are not resilient!

Long-term care patients are often cognitively impaired, and are functionally impaired by definition. They are unable to initiate pleasant activities, complain / communicate distress the way that younger people can. They are not mobile. They are dependent on their caregivers in ways that are unique and incomparably significant compared to all but on the youngest of children.

So when we take away their activities, their visitors, their families, their psychosocial lifelines – we are quibbling with taking away some extremely powerful stuff that has (as I’ve mentioned elsewhere) potentially very real negative consequences to the health (not just mental) and well-being of these people when they are removed.

After all – it was only just a few short years ago that the National Institutes on Aging was basically sounding the alarm on loneliness and isolation amongst older adults:

Social isolation, loneliness in older people pose health risks | National Institute on Aging (nih.gov)

… and so now, regardless as to how worth it you may think this extreme and ongoing lockdown approach may be for older adults – it seems like we have been creating a perfect breeding ground for an absolutely monstrous pandemic of loneliness and isolation in facility-dwelling older adults.

You think the current and epidemic of learning loss and mental health problems in children is bad? Try being an older adult in a nursing home in 2022 - at least, in mine (and apparently the ones in Washington State).

But again, where are the surveys?

“Information is Never Politically or Morally Neutral.”

I was talking with my wife about this the other day late at night before bed (yes, I have a bad habit of bringing up heavy subjects with my spouse before bedtime).

I was very frustrated – why the heck is it, I said, that I can’t seem to find information as to what other nursing homes are doing (or not doing) in terms of allowing residents outings privileges, for example? Why hasn’t someone done a survey? “It’s just information,” I said!!!

She kind of looked at me and said in that wise kind of way and said “sweetheart, you know there is no such thing as neutral information.” She then chided me a bit. She said “gerodoc, really,” (yes, she calls me that!) “did you want this information to get out there, ‘just for informations sake,’ or did you want it out there to make a point”?

I had to admit – I did. I suspect that nursing homes (and assisted living facilities, also known as ALFs, lets count them too) across the United States, are all, *still* to varying degrees severely restricting their residents – “nursing home prison” or “assisted living prison” across the United States. I think nursing homes are actually to varying degrees slowly killing our patients in the name of COVID monomania.

And yes - I admit it – I want the public to start grappling with this.

But - I think people are terrified of even talking about this.

And it’s not just because people are terrified of speaking out due to fear of speaking against the official line. This is in keeping with the United States’ general approach about aging. We deny aging is happening and we take the most difficult-to-manage examples of it and then tuck them away, hide them from view in places called “nursing homes.”

It’s ageism, yes. And COVID monomania has allowed society to stop thinking about older adults again, particularly those that live in facilities – as long as they are sealed in, supposedly “protected” from COVID – we don’t have to worry about them right? Out of sight, out of mind.

I feel like the small advances that have been made in terms of making nursing homes and ALFs more homelike and humane have taken a massive step backwards over the last 2+ years with COVID lockdowns.

So Talk to Me – What is Your Nursing Home Doing? What is Your Assisted Living Facility Doing?

• Do you or a loved one live at a nursing home or assisted living facility?

• At your facility are you ever allowed to leave for a social outing? If so, what are the limitations on this privilege?

• What are the current policies at the facility in terms of having visitors? Are visitors allowed to hug or kiss loved ones? PPE policies? Time limits? Other limitations?

• What activities have disappeared from your facility over the last two years and have not returned?

• Can you or your loved ones have paid companion services?

• Are all visitors required to be vaccinated? Boosted?

I’m also not going to drop this idea of somehow getting a survey going.

But – information, even superficially neutral information (like, what are current policies on COVID at US nursing homes?) – is very politically fraught right now to even simply just gather and report.

So maybe – just maybe – we can all have a conversation about it here.

So let’s talk!